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IRAQI JOURNAL OF MEDICAL SCIENCES

المجلة العراقية للعلوم الطبية

ISSN: P16816579,E22244719
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 70044, Baghdad, Iraq.
E-mail: iraqijms@colmed-alnahrain.edu.iq , ijms@iraqijms.com , iraqijms2000@gmail.com,

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E-mail: iraqijms@colmed-alnahrain.edu.iq , ijms@iraqijms.com, iraqijms2000@gmail.com, ‏ http://www.colmed-alnahrain.edu.iq, http://www.iraqijms.net

Table of content: 2017 volume:15 issue:4

Article
1. Editorial :PREVALENCE OF CELIAC DISEASE IN DEVELOPING COUNTRIES

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Abstract

Celiac disease (CD) is an autoimmune disorder, which affects genetically predisposed individuals upon the ingestion of gluten. So, it is the result of both environmental (gluten) and genetic factors (carriers of HLA-DQ2 and DQ8 haplotypes). A duodenal biopsy with positive serology is the gold standard for the diagnosis of CD. Celiac disease world geographical distribution seems to have followed the spread of wheat consumption in addition to the migratory flows of mankind. Following the application of simple serological tests for the diagnosis of CD in the 1980s, it gradually became clear that the prevalence of CD in different countries in the Middle East, North Africa and India is almost the same as that in Western countries. A high index of suspicion for CD should be maintained in all developing countries for patients who present with chronic diarrhea or iron deficiency anemia. The prevalence of CD varies with sex, age, and geographic location. The global prevalence of CD has increased over time from 0.6% in 1991 to 2000 to 0.8% between 2001 and 2016. According to that, there is a need for population-based prevalence studies in many developing countries especially middle east to estimate the burden of CD properly. Keywords:Celiac disease, gluten, HLA, prevalence, meta-analysis, Middle East, developing countries. Citation: Al-Shami SA. Prevalence of celiac disease in developing countries. Iraqi JMS. 2017; Vol. 15(4): 324-326. doi: 10.22578/IJMS.15.4.1


Article
2.THE RELATION OF SERUM OMENTIN-1 LEVEL WITH INSULIN RESISTANCE IN PATIENTS WITH POLYCYSTIC OVARY SYNDROME AND ITS RELATION WITH METFORMIN TREATMENT

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Background: Polycystic ovary syndrome (PCOS) is still a matter of research looking for the true pathogenesis of this enigmatic syndrome. Although the majority of cases are familial, genetic studies have failed so far to identify the specific genes involved. The presentations of PCOS are heterogeneous and may change throughout the lifespan, starting from adolescence to post-menopausal age, and may have health impaction later in life. Omentin-1 is a fat depot-specific secretory protein produced by visceral stromal vascular cells. Recent studies showed that omentin-1 is correlated inversely with obesity and insulin resistance. Objective: To assess the serum omentin-1 concentration in PCOS women and the effect of metformin on omentin-1 level, to evaluate the role of omentin-1 on insulin resistance and hyperandrogenemia in PCOS women and to look for the correlation of omentin-1 with body mass index (BMI) in PCOS women. Methods: Eighty women involved in this study; 40 women with PCOS diagnosed according to Rotterdam ESHRE/ASRMS 2003 criteria and 40 apparently healthy women considered as the control group. The participants were allocated into six groups: “10 obese women with PCOS (BMI ≥30 kg/m2, without metformin treatment)”. “10 obese women with PCOS (BMI ≥30 kg/m2, taking metformin)”. “10 non-obese women with PCOS (BMI <30 kg/m2, without metformin treatment)”. “10 non-obese women with PCOS (BMI <30 kg/m2, taking metformin)”. “20 obese controls and 20 non-obese controls. Blood samples were taken from them for estimation of fasting blood glucose, insulin and omentin-1 levels. Hirsutism score was also evaluated according to Ferriman–Gallwey score. Results: There was a significant increase in omentin-1 in non-obese PCOS (taking metformin) (3.02±0.71) compared to obese PCOS (taking metformin) (1.59±1.48) (P value = 0.0132) and in PCO non-obese (taking metformin) (3.02±0.71) compared with control non-obese (1.96±1.65) (P value = 0.121). No significant correlation was found between serum omentin-1 level and insulin resistance as well as with hyperandrogenemia in any of the six study groups. Conclusion: Omentin-1 is found to be inversely related to body weight in PCOS women. Serum omentin-1 level has no effect on insulin resistance and hyperandrogenism states. Keywords: Polycystic ovaries PCOS, omentin, hyperandrogenemia, insulin resistance Citation: Kareem JM, Hashim ZH, Almoayed HA. The relation of serum omentin-1 level with insulin resistance in patients with polycystic ovary syndrome and its relation with metformin treatment. Iraqi JMS. 2017; Vol. 15(4): 327-338. doi: 10.22578/IJMS.15.4.2


Article
3.THE RISK FACTORS AND FREQUENCY OF CONGENITAL ANOMALIES IN NEONATES BORN AFTER ASSISTED REPRODUCTIVE TECHNIQUE IN BAGHDAD

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Background: Assisted reproductive technique (ART) has helped couples all over the world. There have already been over 3,500,000 births resulting from ART, and with falling fertility in some countries. Objective: To identify the frequency and types of congenital anomalies among neonates born after ART, and to identify the probable fetal and maternal predisposing factors that may associated with these congenital anormalities and neonatal complications. Methods: This prospective study was performed in the Neonatal Intensive Care Unit in 3 teaching hospitals in Baghdad, from 1st day of January to day 31 of December 2015, and 306 live birth neonates were delivered by ART, and evaluated by the researcher and his residence pediatricians' doctors, and other congenital anomalies were assessed by ultrasonography, x-ray and echocardiography. Information about each neonate were taken from the records and families which includes: gestational age (term ≥ 37 week and preterm < 37 week) no post-term case were reported, body-weight (≥ 2.5 kg and < 2.5 kg), sex, system affected, age of the parents, consanguinity, residence, job of the parents, level of education, health condition of the parents, causes of infertility, any family history of congenital anomalies, death in the family. Exclusion criteria included mothers’ age above 40, any maternal chronic diseases and chronic drugs taken. Congenital anomalies were classified into systems according to WHO recommendation. Results: Three hundred and six neonates were delivered, from which, 30 (10%) had congenital anomalies with male to female ratio (1.2:1), (20 (67%) twins and 10 (33%) were singletons), a significant association between congenital anomalies in ART products and male sex, consanguinity, and gestational age, as the p-value is significant (< 0.05), and the most common system affected was the gastro-intestinal tract (3%), but there was no significant association with body-weight. Conclusion: The ART born neonates are more prone for congenital anomalies. Gastrointestinal anomalies, especially esophageal atresia, are the commonest type of congenital anomalies followed by neurological anomalies. Male sex, consanguinity, and gestational age are significant risk factors for congenital anomalies. While body weight had no significant association with congenital anomalies. Keywords: Assisted reproductive technique (ART), intensive care unit, gastro-intestinal tract. Citation:Deia K. Khalaf. The risk factors and frequency of congenital anomalies in neonates born after assisted reproductive technique in Baghdad. Iraqi JMS. 2017; Vol. 15(4): 339-344. doi: 10.22578/IJMS.15.4.3


Article
4.SERUM LEVELS OF GLYCODELIN A AND SOLUBLE INTRACELLULAR ADHESION MOLECULE-1 AS BIOMARKERS FOR ENDOMETRIOSIS

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Background: Endometriosis is a benign chronic disease, characterized by the presence and proliferation of functional endometrial gland and stroma outside the uterine cavity. Objective: To evaluate the usefulness of intracellular adhesion molecule-1 (ICAM-1) and Glycodelin (Gd) as a biomarker for the diagnosis of endometriosis and to help in detection of various stages of endometriosis. Methods: Forty-four patients with endometriosis and 35 apparently healthy women as control were enrolled in this study from November 2015 to April 2016. All individuals were subjected to blood sampling for measuring their serum ICAM-1 and Gd A level by using enzyme linked immune sorbent assay technique. Results: The current study revealed significantly higher serum levels of ICAM-1 and Gd in patients group in comparison with healthy control. In addition, the sensitivity and specificity for ICAM-1 and Gd A in serum were 61%/ 66%, 76%/ 85% respectively. Conclusion: The ICAM-1 and Gd A level in serum may be useful as noninvasive test for diagnosis of endometriosis in all stages. Keywords: Endometriosis, ICAM-1, Glycodelin Citation: Draj HA, Abbas AA, Abdullah TH. Serum levels of Glycodelin A and Soluble Intracellular Adhesion Molecule-1 as biomarkers for endometriosis. Iraqi JMS. 2017; Vol. 15(4): 345-349. doi: 10.22578/IJMS.15.4.4

Keywords

Endometriosis --- ICAM-1 --- Glycodelin


Article
5.DETECTION OF PARVOVIRUS B19 IN BAD OBSTETRIC HISTORY BY USING REAL TIME PCR

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Background: Human parvovirus B19 (B19V) is a small single-stranded DNA virus. Infection during pregnancy can cause a variety of signs of fetal damage. The risk of adverse fetal outcome is increased if maternal infection occurs during the first two trimesters of pregnancy but may also happen during the third trimester. Objective: to determine the screen of parvovirus B19 in pregnant women with bad obstetric history by real time polymerase chain reaction (PCR). Methods: Two hundred Plasma and 200 placental tissue samples were collected from all pregnant women enrolled in this study. Three ml whole blood was collected in sterile EDTA-blood tube. Plasma was obtained by centrifugation of whole blood. Twenty-five grams of the placental tissue was homogenized with 10 ml of PBS by using tissue homogenizer for about 1 min at 4 °C. Results: 40 (20%) out of 200 plasma samples were real time PCR positive, the remainder 160 (80%) were real time PCR negative. Nineteen (9.5%) out of 200 placental tissue samples were positive for B19 real time PCR the remainder 181 (90.5 %) were real time PCR negative. All placental tissue positive (n=19) were positive by real- time PCR in plasma samples (n=40). Out of 40 pregnant women presented with positive parvoviruses results in current study demonstrated 21 (52.5%) gave abortion in first trimester and only 8 (20%) gave abortion in second trimester. Conclusion: Parvovirus B19 is common and highly distributed among pregnant ladies in this study and there is a significant association between B19 positivity and adverse pregnancy outcome. Keywords: Parvovirus B19, bad obstetric history, adverse pregnancy outcome, non-immune hydrops fetalis Citation: Abdulhassan LF, Hathal HD, Abdullah TH. Detection of Parvovirus B19 in bad obstetric history by using Real Time PCR. Iraqi JMS. 2017; Vol. 15(4): 350-357. doi: 10.22578/IJMS.15.4.5


Article
6.DETECTION OF ExoT GENE IN LOCAL ISOLATES OF PSEUDOMONAS AUROGINOSA IN A SAMPLE OF BURN INFECTION

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Background: Pseudomonas aeruginosa (P. aeruginosa) is an opportunistic microorganism that requires damaged mucus membranes and epithelial tissues to cause acute infections. It had been stated that P. aeruginosa alters mammalian cytokinesis in a type III secretion system and exotoxin T (ExoT)-related way. Objective: To identify exoT gene local isolates of P. aeruginosa isolated from burn infections. Methods: Forty bacterial isolates of P. aeruginosa (isolated from burn infection) were identified by standard laboratory methods and polymerase chain reaction (PCR) technique was applied for the detection of the gene encoding for ExoT. Results: The results showed that PCR amplification of exo T gene occurred in 24 (60 %) isolates out of the enrolled 40 isolates of P. aeruginosa while 16 (40 %) of the isolates showed negative amplification reactions. Conclusion: It appeared that exoT can be a significant virulence factor expressed by 60 % of P. aeruginosa isolates as indicated by positive PCR-amplification results. Keywords: Burn infections, Exotoxin T, type III secretion system, PCR, P. aeruginosa Citation: Hanoon RA, Auda IG, Aziz IH. Detection of ExoT gene in local isolates of Pseudomonas auroginosa in a sample of burn infection. Iraqi JMS. 2017; Vol. 15(4): 358-363. doi: 10.22578/IJMS.15.4.6


Article
7.PREVALENCE AND DIAGNOSIS OF SEXUALLY TRANSMITTED PATHOGENS IN A SAMPLE OF IRAQI WOMEN: A MOLECULAR STUDY

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Background: Sexually transmitted infections (STI), also referred to as sexually transmitted diseases (STD) and venereal diseases (VD), are infections that are commonly spread by sex, especially vaginal intercourse, anal sex and oral sex. Most STIs initially do not cause symptoms. This results in a greater risk of passing the disease on to others. Symptoms and signs of disease may include: vaginal discharge, penile discharge, ulcers on or around the genitals, and pelvic pain. Objective: To detect the two microorganisms (Gardnerella vaginitis (G. vaginalis) and Trichomonas vaginalis (T. vaginalis)) in the same sample taken from women with genital tract infection by microbiological and molecular methods and to investigate the contributions of some socioeconomic factors and clinical features. Methods: Two hundred samples were collected from females attending the Gynecology out-patient department in the Al-Imamein Al-Kadhimein Medical City and Baghdad Teaching Hospital during the period from May 2014 to April 2015. Based on availability of full clinical information about each patient, high vaginal swabs were taken from females at different ages (15-54 years) representing patients group complaining of abnormal vaginal discharge with or without other symptoms, questionnaire was applied. The two diseases associated with vaginal infection include G. vaginalis and T. vaginalis. Each of the vaginal swabs collected was examined microscopically, whilst the remaining was preserved at -20 °C for DNA extracts were analyzed with the real-time poly meres chain reaction (RT-PCR). Results: In RT-PCR, the rate of infection was 120 (60%) G. vaginalis, and 34 (17%) T. vaginalis. Highest rate of infection in women with G. vaginalis was among age group (15-24) years and (25-34) years 38.3%, 35.0% respectively, the lowest rate was among age group (45-54) years 8.3 %. In T. vaginalis, the highest rate of infection was among age group (15-24) years 61.7 %, the lowest was among age group (35-44) years 8.8 % and on infection in age 45-54years. Conclusion: The commonest genital tract infections among women were G. vaginalis and T. vaginalis. Molecular methods are considered the gold standard for diagnosis, given the excellent sensitivities and specificities in diagnosis. Presence of clinical symptoms helps and lab diagnosis of infection. Vaginal swab samples showed that most common co-infection is between G. vaginalis cases and T. vaginalis. Keywords: Sexually transmitted infections, Gardnerella vaginalis, Trichomonas vaginalis, molecular study Citation: Ali MK, Hathal HD, Almoayed HA. Prevalence and Diagnosis of sexually Transmitted Pathogens in A Sample of Iraqi Women: A Molecular Study. Iraqi JMS. 2017; Vol. 15(4): 364-376. doi: 10.22578/IJMS.15.4.7


Article
8.REMARKABLE ENHANCEMENT OF MEAN PLATELET VOLUME IN IRANIAN PATIENTS WITH TYPE 2 DIABETES MELLITUS WITH NO DEPENDENCE ON HEMOGLOBIN A1C LEVEL

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Background: Diabetes mellitus (DM) is a pandemic disease that leads to several complications. Platelet reactivity plays a major role in diabetes complications. Mean platelet volume (MPV) is a marker of platelet size that is easily determined on routine automated blood counters. Studies have been found that MPV is enhanced in patients with DM. Objective: To assess any relationship between MPV in type 2 Diabetic persons and with glycohemoglobin (HbA1c) level. Methods: The study included a total of 130 subjects who were referred to Samenol Aemme and Mehregan hospitals in Mashhad city, Iran, between April 2013 and November 2014 for a routine check-up. All subjects were divided into two groups as following: Patients with type 2 diabetes group, which comprises 63 subjects and non-diabetic control group, which comprises 57 individuals. Blood sample from each individual was collected after a 12-hour overnight fasting. MPV, HbA1c and fasting blood sugar (FBS) were also monitored. Results: MPV values were found to be 8.7±0.36 fl (p<0.001) and 9.8±0.42 fl (p<0.001) for control and study groups respectively. FBS values were found to be 95.9±10.3 mg/dl (p<0.001) and 202.8±5.1 mg/dl (p<0.001) for control and study groups respectively. MPV values were found to be 9.8±0.28 fl and 9.8±0.46 fl (p=0.813) for diabetic subgroups with HbA1c <7 and HbA1c ≥7 respectively. Conclusion: The current study showed that׃ i. MPV was enhanced considerably in patients with DM in contrast to healthy controls. ii. Its increase was not dependent on glycemic control reflected by HbA1c. Keywords: Platelet reactivity, HbA1c measurement, diabetic patients. Citation: Khalili-Hezarjaribi H, Mahdavian S, Mirsadraei M, Farahmand-Bovanlou R, Jahanabad AJ. Remarkable enhancement of mean platelet volume in iranian patients with type 2 diabetes mellitus with no dependence on hemoglobin A1c level. Iraqi JMS. 2017; Vol. 15(4). 377-382. doi: 10.22578/IJMS.15.4.8.


Article
9.PREVALENCE AND DETERMINANTS OF DEPRESSION AMONG TRAUMATIC SPINAL CORD INJURED PATIENTS ATTENDING IBN-AL-QUFF HOSPITAL, BAGHDAD, IRAQ

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Background: Depression is a common consequence of spinal cord injury. Objective: To identify the prevalence and potential risk factors of depression among spinal cord injured inpatients, and assessment of the severity of depression. Methods: A cross-sectional study conducted at Ibn Al Quff Hospital for spinal cord injury rehabilitation. All inpatients with traumatic spinal cord injury were recruited excluding severely injured and those injured due to congenital and medical causes. Socio-demographic variables, spinal cord injury characteristics and comorbidity were compiled. Self-Reporting Questioner (SRQ-20) was used to identify mental symptoms. DSM-IV criteria for depression and Hamilton-17 Scale, for assessment of severity of depression were used. Results: A total of 274 spinal cord injured inpatients were approached; 93% responded; Paraplegics 75.7% and tetraplegics 24.3%. Violence was the major cause of injury. Seventy four percent (74.1%) had depression; 44% of them had severe and very severe depression. Depression was significantly associated with age (P=0.001), gender (P=0.001), education level (P=0.038), occupation (P=0.003); smoking habit (P=0.035), duration of injury (P=0.003), times of admission (P=0.000), and comorbidity (P=0.018). Conclusion: prevalence of depression is high and frequent among spinal cord injured inpatients. Demographic and spinal cord injury variables are significantly associated with depression and are the most important determinants of depression. Keywords: Depression, spinal cord, violence, prevalence, Iraq. Citation: Al Abbudi SJR, Ezzat KI, Farhan MS, Zebala AA, Al-Beedany MSJ, Hamdy DJ. Prevalence and determinants of depression among traumatic spinal cord injured patients attending Ibn-Al-Quff Hospital, Baghdad, Iraq. Iraqi JMS. 2017; Vol. 15(4). 383-395. doi: 10.22578/IJMS.15.4.9.

Keywords

Depression --- spinal cord --- violence --- prevalence --- Iraq.


Article
10.THE ROLE OF ATG16L1 (THR300ALA) GENETIC VARIANTS AND AUTOPHAGY IN DEVELOPMENT OF ACUTE AND CHRONIC URINARY TRACT INFECTION CAUSED BY UROPATHOGENIC ESCHERICHIA COLI

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Background: Uropathogenic Escherichia coli (UPEC) is the major cause of urinary tract infection (UTI), establish quiescent intracellular bacterial reservoirs (QIRs). These latent reservoirs, which persist indefinitely, are resistance to antibiotic therapies and can induce recurrence. Autophagy related 16 like 1 gene (ATG16L1) Thr300Ala genetic variant confer an increased risk for the development of urinary tract infection caused by UPEC. This study aimed. Objective: To determine the possible relationship between the ATG16L1 Thr300Ala genetic variant and UPEC for the development of acute and chronic urinary tract infection. Methods: A total of 100 urine and blood samples were collected from patients complain from UTI, 20 blood samples of apparently healthy during the period between (November 2014 to May 2015) from two hospitals in Baghdad; Al-Imamein Al-Kadhimein Medical City and Al-Yarmauk Teaching Hospital. The age range exactly with mean ± SD or SE. E. coli were isolated by ordinary methods and the identification of non entero-pathogenic E. coli was performed at a group level by slide agglutination test with specific antisera. UPEC isolates were tested for their susceptibility to 12 antimicrobial agents by disc-diffusion method. ATG16L1 T300A genotyping was done by Species Specific Primer – Polymerase Chain Reaction (SSP-PCR), after genomic DNA extraction from each blood sample. Results: A total of sixty E. coli were isolated from 20 acute UTI (16 females and 4 males) and 40 chronic UTI (32 females and 8 males). There is a high rate of acute UTI among the age range exactly groups (≤10-20 years) and chronic UTI among age groups (21-40 years). Overall isolates had a complete resistance to Ampicillin and Gentamycin (100%), high resistance to Nalidixic acid (88%), Piperacillin (86%), Trimethoprime+Sulfa (84%), Cefotriaxon (80%), Ciprofloxacin (78%) and Cephalosporin (66%). Moderate resistance to Azithromycin (51%) and Cephalothin (50%) were seen. Whereas these isolates were highly susceptible to Imipenem and Nitrofuranton with the resistance rate 8% & 27% respectively. Ninety percent of the isolates were resistant to three or more antibiotics. The SSP-PCR result showed that a (89%) and (92%) of acute positive E. coli infection (P=0.009) and chronic positive E. coli infection (P=0.006) respectively were carried allele-G. While the occurrence of allele-G was (62%) in acute negative E. coli infection, and (30%) in chronic negative E. coli infection. Conclusion: There is a relationship between allelic variants of ATG16L1 gene with acute and chronic UTI. In the other hands, the risk of the present allele G was associated with increased susceptibility to infection by UPEC, which developing chronic and acute UTI. Keywords: Escherichia coli, autophagy, Thr300Ala genetic variant, PCR Citation: Abd GH, Abd Al-Rahman TR, Ghazi HF, Kadhim HS. The role of ATG16L1 (Thr300Ala) genetic variants and autophagy in development of acute and chronic urinary tract infection caused by uropathogenic Escherichia coli. Iraqi JMS. 2017; Vol. 15(4). 396-403. doi: 10.22578/IJMS.15.4.10


Article
11.DETECTION OF LISTERIA MONOCYTOGENES IN PLACENTA OF ABORTED WOMEN

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Background: Listeria monocytogenes (L. monocytogenes) is a Gram-positive, facultative intracellular bacterial pathogen that can cause a severe invasive disease (listeriosis), mainly in immunocompromised, elderly individuals, and pregnant women, characterized by sepsis, neonates and miscarriage. Objective: To evaluate the association of listeria monocytogenes in abortion in a group of Iraqi women. Methods: A cross-sectional study was designed and included 250 placenta tissues obtained from aborted women, each placenta sample was divided into two parts each about 50 gm in weight, one stored in 10% formaldehyde solution to use for histopathological study using Hematoxylin and Eosin (H&E) staining procedure, while the second part cut into small pieces about 15 gm and washed and stored in 5 ml normal saline solution 0.85% to use in detection of the presence of the bacterium using conventional bacteriological methods. Results: Out of 425 placenta samples only 250 were diagnosed to be placentitis and only 15 isolates of L. monocytogenes were isolated and constitutes 6% of the total number of placentitis. Distribution of placentitis due to listeria and age groups have been shown no statistical significant differences (P = 0.099). Also, there was no statistical significance difference between the percentage of isolated L. monocytogenes and the time of gestation in aborted women with placentitis (P value was 0.689), and also no significance in association between number of abortion and isolation of L. monocytogenes (P = 0.689). Conclusion: No association between L. monocytogenes and recurrent abortion or with time of gestation or the age of the patients. Keywords: Listeria monocytogenes, placenta, aborted women Citation: Qassim KW, AL Attraqchi AAF, Khatab YI. Detection of Listeria monocytogenes in placenta of aborted women. Iraqi JMS. 2017; Vol. 15(4). 404-410. doi: 10.22578/IJMS.15.4.11


Article
12.CO2 DIODE LASER HEMORRHOIDECTOMY: CLINICAL EXPERIENCE WITH 150 PATIENTS

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Background: Hemorrhoids are the most common benign anorectal conditions. About half of population are affected by hemorrhoids during their life time. Conventional surgical hemorrhoidectomy, which was the standard treatment for many decades are associated with remarkable and intolerable pain that may last up to 3 to 6 weeks, which makes more patients reluctant to surgery. Laser hemorrhoidectomy is relatively new promising modality with less postoperative pain and less complications with fast wound healing and early return to work. Objective: To assess the validity, feasibility and the outcomes of using the CO2 diode laser for treatment of symptomatic hemorrhoids. Methods: A prospective study conducted for the period from September 2013 to April 2015, included 150 patients (135 male and 15 female), with symptomatic first, second and third degree piles with age ranged from 24 to 83 years (mean 48.7 year) submitted to CO2 diode laser hemorrhoidectomy with either the coagulation mode or cutting mode of 30 Watt diode laser surgical machine. The procedures were done under local anesthesia as a day case surgery by single surgeon. Results: The results showed that the operative time ranges from 15 to 30 minutes (mean 23.5 minutes). Postoperative pain scores by visual analog scale (VAS) in the first, second and third postoperative days were 2.9, 2.1, 1.8 respectively. The pain decreased rapidly after the first week and reached to zero after 14 days postoperatively. The complications rate recorded in this work was 7.3%. All these complications were mild and can be dealt with conservatively; redo surgery was not required in any case. All patients were discharged 2 to 4 hours postoperatively and were followed for 3 to 6 months. Conclusion: Hemorrhoidectomy by CO2 diode laser is effective, and very quick outpatient procedure with very mild postoperative pain and low or negligible rate of complications. It associated with rapid healing and fast recovery that most patient can return to normal daily activity within 2 to 5 days. These results are considered a big advantage upon conventional hemorrhoidectomy. Keywords: Hemorrhoids, laser hemorrhoidectomy, CO2 diode laser Citation: Noori IF. CO2 Diode Laser hemorrhoidectomy: clinical experience with 150 patients. Iraqi JMS. 2017; Vol. 15(4). 411-419. doi: 10.22578/IJMS.15.4.12


Article
13.EVALUATION OF ANTEMORTEM AND POSTMORTEM LEVELS OF ORGANOCHLORINE PESTICIDES IN A SAMPLE OF IRAQI PEOPLE

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Background: Organochlorine pesticides have long been widely used in agriculture and in public health as highly effective pest control agents. They are lipophilic and have prolonged half-lives of years to decades; as a consequence, they accumulate in human adipose tissues and can cause chronic toxicity after long-term exposure. Objective: To detect and measure the concentrations of organochlorine pesticides (trans-nonachlor and oxychlordane) in postmortem organs and fatty tissue as well as their concentrations in antemortem serum and fatty tissue samples and study their correlation with lipids in order to reveal the need for human monitoring. Methods: The study was conducted on 40 antemortem samples of blood and fatty tissues and 41 postmortem samples of blood and different organ tissues to determine their lipid concentrations and detect metabolites of organochlorine pesticides and asses their correlations using spectrophotometer and HPLC techniques. Results: The study observed that there was normal serum concentration of triglyceride (TG) and elevated cholesterol level, which were verse correlated with elevated serum concentrations of trans-nonachlore and oxychlordane pesticides. Serum concentrations of TG were (153.75 mg/dl) within “normal” range while mean serum of total cholesterol was (209.89 mg/dl) elevated above normal range. Percentage of concentration of serum to lipid trans-nonachlordane was (40.28 mg/dl) higher than that of oxychlordane was (28.42 mg/dl) in living subjects. The study observed that elevated concentrations of trans-nonachlor more than oxychlordane in postmortem tissue organs. Conclusion: The study revealed that traces of organochlorines (trans-nonchlore and oxychlordane) were detected in human serum, fatty tissue and postmortem organs and positively correlated with some lipid profiles indicating the presence of human contamination. Both trans-nonchlore and oxychlordane were higher in lipid tissue than in serum and other tissues among postmortem cases. Keywords: Organochlorine, trans-nonachlore, oxychlordane, postmortem, lipid profile Citation: Hmood HS, Ali NM, Al-Qazzaz MA. Evaluation of antemortem and postmortem levels of organochlorine pesticides in a sample of Iraqi people. Iraqi JMS. 2017; Vol. 15(4). 420-430. doi: 10.22578/IJMS.15.4.13

Table of content: volume:15 issue:4