Medical Journal of Babylon

The aim of this study is investigate the effect of incubation periods
( 90 and 120 minutes ) on the sperm functions of ten human asthenospermic specimens which are
incubated with different concentrations of progestrone medroxy-acetate (0.1 , 0.4 and 1 mg/ml ). These
concentrations were added to glucosaline medium ( control ) and used for in vitro sperm activation .
The incubation of asthenospermic specimens with glucosaline supplemented with 0.4 mg/ml
progestrone medroxy – acetate caused a significant increase ( p < 0.001 ) in sperm motility percent and
grade activity compared to control group ( glucosaline alone ) after 90 and 120 minutes . So
progestrone medroxy-acetate, when used at 0.4 mg / ml can maintain the improved sperm motion for
longer duration enough to increase the number of sperm reaching the upper reproductive tract and
increase the fertilization capacity in the assisted reproduction technique.

Total serum protein, albumin, globulins concentrations, and albumin/globulins (A/G) ratio in
the sera of patients with acute myocardial infarction (AMI) were assayed to investigate the expectant
changes in protein profile.
Fifty five patients with AMI were subjected to present study, as well as fifty four healthy
individuals as a control.
Total serum protein and serum albumin were determined colormetrically, serum globulins
were calculated mathematically.
Total serum protein was found to decrease in the sera of patients when compared with healthy
controls due to decrease in albumin. Globulins were elevated but not sufficient to substitute the
depletion in albumin. Also A/G ratio decreased more than that of healthy controls.
In conclusion serum protein might be changed as a response to the presence of oxidative stress
associated with AMI.

Background: Chronic heart failure is an increasing condition with high mortality and morbidity. Left
bundle branch block (LBBB) has been identified as an independent predictor of risk of cardiac
morbidity or mortality.
Objective: To determine the frequency of LBBB in patients with systolic LV dysfunction.
Setting: Al-Hussein Hospital echocardiographic clinic in Karbala city.
Methods: One hundred sixty patients were divided into two groups: Group A: constituted of 80
consecutive patients who had a left ventricular (LV) ejection fraction (EF) <40% and Group B:
constituted of 80 consecutive patients who had a left ventricular (LV) ejection fraction (EF) >40%.
Both groups were screened for LBBB using standard twelve-lead surface electrocardiogram.
Results: There were two patients (2.5%) with LBBB in group B, while the number was 16(20%) in
group A. P- value was <0.0005.
Conclusion: Left bundle branch block is more common in patients with systolic LV dysfunction.
Electrocardiogram should be included in the diagnostic and evaluative process of these patients.

Models for lapin septic arthritis and cryptic arthritis were developed. Joint infection was
determined using several criteria such as sluggishness, loss of appetite, loss of weight, joint swelling,
lamness and histopathology. These criteria were applied using two infection routes: the intravenous
(IV) and intrarticular( IAI).
Infection through the intravenous route showed marked joint swelling cell wall defective
rather than intact state. It failed to induce both, lameness and loss of appetite with minimal weight loss
of around 50gm. In the intrarticular route, however, there were appetite loss, weight loss, mild
sluggishness and marked joint swelling in CWD rather than intact . Intact Staphylococcus aureus in IV
was arthropathic but by IAI was non-arthropathics. Cell wall defective Escherichia coli was
arthropathic in both IV and IAI. Both intact and CWD E.coli were arthropathic by IAI .
Thus human arthropathic E.coli isolates showed lapin arthropathy both as intact and cell wall
defective but in CWD state there were more severe clinical outcomes, while, human arthropathic
S.aureus isolates showed lapin arthropathy in cell wall defective state but not in intact state .

Thirty patients showing clinical symptoms of arthritis with negative culture results were
negative as done by the clinical laboratories. With cooperation of senior rheumatologist synovial fluid
samples were collected .
The routine culture were repeated, serial, dilution, leucocyte lysate and biphasic cultures were
done for them , in addition to direct exam .Cell-Wall Defective (CWD ) colonies were found as tiny,
pouched egg appearance in 13 instances: Staphylococcus aureus CWD, Escherichia coli CWD,
Streptococcus pyogenes CWD and Klebsiella pneumoniae CWD. In 13 serial , dilution , lysate and
biphasic culture and 2 routine culture as well as the remaining were culture-negative. Thus CWD S.
aureus and CWD E . coli were the dominant arthropathic organisms.

Glutathione (GSH), Glutathione- S- transferase (GST) in patients with proved breast cancer
have been estimated to find the possibility of using such parameters as a biomarker in the diagnosis of
breast cancer patients compared to control.
Sera of ( 100 ) breast cancer patients has been taken to estimate the levels of GSH and GST. All
studied patients samples were female with mean age ( 51.16 ) years old
The result of the study revealed that serum GSH concentration and GST activity decrease in breast
cancer patients; however the relation between GSH concentration and GST activity is reversible. Stage
II is the most common stage with breast cancer patients where there were 71 cases of stage II. The most
common of age is the range age from 40-49 years old. So this study recommends the use of these bio
marker for early detecting of the disease and bringing special equipment to measure it.

This study was applied on fifty patients having urinary bladder cancer, proved by histopathological
study for the biopsy taken from the bladder by cystoscopy performed under general anesthesia.
In this study the type of cancer was transitional cell carcinoma of urinary bladder of different stages.
In this study changes in malondieldehyde as biomarker of lipid peroxidationhave been studied the
result revealed significant elevation in patient groups compared with control, and glutathione level
(GSH) which considered as antioxidant defenses mechanism are significantly reduced in patients
groups in comparison to control groups.
The changes in level of trace elements copper and zinc are study in this work, the result revealed
increase level of copper and reduced level of zinc in patients groups in comparism with control groups

This study was applied on patients having urinary bladder cancer fifty patients were chosing for this
study complaining of haematuria ,and proofed to have bladder cancer by histopathological study for the
biopsy taken from the bladder by cystoscopy performed under general anesthesia .
In this study the type of cancer was transitional cell carcinoma of urinary bladder of different stages .
In this work changes in activity of catalase as enzymatic antioxidant defense mechanism we studied in
patients and control groups ,the result revealed significant decrease in patient groups compared with
control.
The changes in level of trace elements copper and zinc are studied in this work , the result revealed an
increase level of copper and reduced level of zinc in patients groups in comparism with control groups .

Bacteremia caused by gram negative bacteria isolated randomly from 80 children aging 0-9
years was studied from first of February/ 2008- end of June/ 2008 for their susceptibility profile. The
various isolates were Escherichia coli (39 isolates,48.75%), Pseudomonas aeruginosa (23
isolates,28.75%) and Proteus spp (18 isolates, 22.5%). Males were more infected (70%) than females.
Antibiotics susceptibility pattern of these isolates against 28 different antibiotics revealed that
norfloxacin, ofloxacin, tobramycin and amikacin were effective for treatment of gram negative
bacteremia. Azithromycin, bacitracin, erythromycin, kanamycin, oxytetracyclin and rifamycin were
found to be non effective against isolated organisms. The level of CRP in sera of 71.2% patients was
more than 24 mg/dL and this concentration revealed to bactermia while the value of WBC was > 15000
/ mm in 82.5% of patients and ESR was found to be >35mm/h in 100% of patients. In this study we
found that the addition of CRP testing to that of WBC and ESR ensure the detecting of bacteremia.

The vagina is lined by stratified sequamous epithelium which is under the effect of hormonal &
environmental factors.
The vaginal epithelium is poorly studied & very little & restricted studies made about this
subject.
This cross-sectional study is aimed at studying the effect of age & parity on vaginal epithelial
cells diameter. It was conducted in Al-Bakarly primary health center in Hilla. 82 women who attend
the center for various reasons were recruited.
After taking history & physical examination, vaginal swabs were taken to obtain vaginal
epithelial cells, the slides examined under light microscope to measure vaginal epithelial cell
diameter in five epithelial cells & the mean was taken for each swab.
A significant difference in mean cell diameter was found in different age groups.The least
diameter (5.35 μm) in those aged ≤20 years while the largest diameter (6.50 μm) in those aged 3140 years.
A significant difference in mean epithelial cell diameter was also found in women of different
parity. There was a significant increment in mean cell diameter with increasing parity.
The conclusion of this study is that there is a significant effect of both age & parity on vaginal
epithelial cell diameter & these factors must be considered when interpretting vaginal swabs &
smears.

Thirty two infertile couples who have cervical factor as a cause for their infertility were
investigated in Al-Amal clinic for infertility management. Causes of negative postcoital test were
listed and treatment was stated. Significant improvement (p<0.05) of postcoital score after treatment
noticed and total pregnancy rate (PR) was 37.5%. Intrauterine insemination achieved only 10% PR,
for the patients who didn't respond to medical treatment. Cervical factor infertility needs special care
and patience from the clinician, because it's easily treatable and can achieve good results after
treatment.

Thyroid disease is the most common surgical endocrine disease, and thyroid carcinoma is the most
common endocrine malignancy. It occurs more often in people who live in areas with iodine deficiency
like our country. There is great controversy about the incidence of thyroid carcinoma.
Objectives: to evaluate the characteristics of thyroid cancer patients in regard to demographic
distribution, histological variants, mode of presentation and modalities of surgical treatment.
Method: we retrospectively audited the records of 33 patients with histological proof of thyroid
carcinoma, out of 375 goiter patients, between Jan 2005- Feb 2008 in Al-Hilla surgical hospitals.
Results: Patients with thyroid carcinoma comprise 8.8% of goiter patients. Female constitute 75.7%,
males 24.2%, with mean age (39.6) years. Male to female ratio is 1/3. Goiter was the most common
presentation, with multinodular goiter account for 57.5%, and thyroid nodule account for 27.5%. The
diagnoses confirmed by histopathological examination of thyroid specimens. The most common type of
malignancy was papillary carcinoma 60.6%, followed by follicular type 18.1%. We have one case of
metastatic carcinoma to the thyroid gland. Near total thyroidectomy was the most common surgical
procedure performed.
Conclusion: Thyroid carcinoma is not a rare tumor in our region. Better diagnostic tools should be
available to reach the appropriate diagnoses. We are in real need for activation of national cancer registry
to asses the problem on the national level.

Objective: To assess the relation between prolapsed intervertebral disc (P.I.D.) in the lumber area and
Joint mobility.
Patients and methods :Eighty patients with (PJ.D.) in the lumber area proved by magnetic resonance
imaging (M.R.L) (65 ) or Myelography (15) were compared with that in an age and sex matched controls
group without (P.I.D.) in the lumber area Joint mobility was scored on a scale of 0-8 using the method
deserbed by Beighton et al.
Results: The number of patients with hypermobile joints and the total mobility scores were comparable in
both studied groups.
Conclusion: This study showed that there is no relation between P.I.D. in the lumber area and joint mobility

It is a retrospective and prospective study for ovarian neoplasm within five years in AlNajaf city done in Al-Zahraa Teaching Hospital . The total number were 344 patients , 291 cases
were benign ovarian tumors and 53 cases were malignant ovarian tumors analyzed according to their
age groups and histopathological types of tumor .Young age groups were the most affected group
with ovarian neoplasm in this study especially the benign type. Six histopathological types of benign
and Six histopathological types of malignant were recorded; mature teratoma was more frequent for
benign while serouscystadenocarcinoma was for malignant .

Glutathione (GSH), and total alpha-L- Fucose (TF) in patients with proved breast cancer have been
estimated to find the possibility of using such parameters as a biomarker in the diagnosis of breast
cancer patients compared to control.
Sera of ( 100 ) breast cancer patients has been taken(from December 2006 to December 2007) to
estimate the levels of GSH and TF. The result of the study revealed that serum GSH concentration
decrease in breast cancer patients, while serum TF concentration increases in the same patients.
Stage II is the most common stage with breast cancer patients where there were 71 cases of stage
II.The most common of age is the ranging age from 40-49 years old. So this study recommends the
use of these biomarker to early detect the disease.

Serological tests are mainly evaluated by determining the sensitivity and specificity of the
test. These test characteristics were originally meant to be used in making diagnoses. For evaluative
purposes their usefulness is weakened by their susceptibility to selection and their dependence on the
cut-off points that are used for test positivity. The plotting of a receiver operating characteristic
(ROC) curve might be a solution to these problems. The ROC curve yields a measure for the
diagnostic power of the test expressed in one number instead of two, namely the area under the curve
(AUC). Furthermore, the ROC curve and its AUC permit easy comparison of different tests and the
performance of different interpreters of one test. In this study, for direct comparison of the
diagnostic values of IgM-RF, IgG-RF and IgA assay in the diagnosis of Rheumatoid Arthritis (RA),
we performed an ROC analysis. The calculated areas under curves (AUCs) have shown that each of
the three RF-subtypes has a different discriminative value because their curves were located at
different distances above the diagonal line. However, the IgG-RF subtype has the highest
discriminative value because of that its AUC was 0.937 and, thus, it has a very high clinical value.
IgM-RF subtype has a moderate discriminative value (AUC= 0.848), whereas IgA-RF has showed
the least discriminative power (AUC= 0.709) that may make it the least clinically useful RF as a
diagnostic test. These results clearly demonstrate the superiority of IgG-RF ELISA system as a
diagnostic test for RA over the other RFs. Using ROC to determine cutoff values has yielded several
cutoff values with variable sensitivities and specificities for each RF subtype. This may allow the
choice of the desired cutoff according to the clinical setting in which the test might used.

The current study is conducted to determine the level of malondialdehyde (MDA) as an index of
free radicals induced lipid peroxidation and catalase as an index of antioxidant enzyme in the serum
of patients with urolithiasis. Significantly high level of MDA (p < 0.05) and significantly low level
of catalase (p < 0.05) were observed in the serum of urolithiasis patients as compared to normal
controls. There was no difference in serum level of MDA and CAT between male and female
neither in patients nor controls. Also, there were no correlation between the serum MDA and serum
CAT in both patients and controls. Among patients, 21.7% were smokers. There was no significant
difference between smokers and non smokers patients regarding serum level of MDA and CAT. In
conclusion, it appears that a role of lipid peroxidation and oxidative function exists in the
pathogenesis of urolithiasis, but its mechanism is unknown.

The present study is conducted to determine the level of malondialdehyde (MDA) as an index of
free radical induced lipid peroxidation, glutathione peroxidase (GPx) and the role of N-Acetyl-
ß-D-
glucosaminidase in 60 confirmed cases of urolithiasis. Significantly high level of MDA and NAG
(p 0.05) with significantly low level of GPx (p 0.05) have been observed in serum of
urolithiasis patients as compared to normal controls. There have been no correlation between the
level of MDA and neither GPx nor NAG in serum of urolithiasis patients, and no correlation
between serum NAG and GPx (p>0.05). There has been no difference between male and female in
the levels of serum MDA, GPx and NAG. In conclusion, it appears that a role of lipid peroxidation
and oxidative function exist in the pathogenesis of urolithiasis, also the serum NAG has a role in
urolithiais, but the exact mechanism is unknown.

Breast cancer patients are routinely followed after primary treatment. Many intensive diagnostic
methods (tumor markers, chest x-ray, mammogmphy, liver sonar, bone scans) are performed periodically.
However, it remains to be determined how often attempts should be made to detect the first recurrence of breast
cancer by these methods.
To evaluate the effect of imaging diagnosis and tumor markers, we analyzed methods of detection of
first recurrence sites during intensive follow-up of breast cancer patients. Of 550 female patients who had been
surgically treated between march 2004 and December 2007, 65 recurrent cases had been diagnosed as of July
2008.
Thirty cases (46%) had been found as a result of symptoms related to the site of recurrence and 14
cases (22%) were detected by physical examination.
In the remaining 21 cases (32%), detection was by other methods: in eight cases by imaging
diagnosis, in three cases based on abnormal tumor markers and in 10 cases by imaging diagnosis and abnormal
tumor markers.
There was a significant difference between first recurrence sites (loco-regional, bone and viscera ) and the
methods of detection (symptoms, physical examination and other diagnostic methods) (p<0.0001).
However, no statistical difference in overall survival after operation was observed between the 30
cases found as a result of symptoms and the 35 cases detected by physical examination or other diagnostic
methods, Period of fellow up extend between 6-45 months post operative .

Objective: Bone changes are relatively common in improperly treated β-thalassemia major. One of
the signs of severe thalassemia is significant splenomegaly.The aim of the study is to see the
correlation of wrist circumference with splenomegaly as a sign of severity.
Methods: One hundred and five patients with thalassemia major were studied,52 patients with
significant splenomegaly and 53 without splenomegaly.Wrist circumference was measured for both
groups. Fifty nine healthy children were taken as a control regarding wrist circumference.
Results: One hundred and five patients with thalassemia were studied. Growth parameters of the
group with splenomegaly were found below the standard for their age and sex and wrist
circumference was found to correlate significantly with splenomegaly as a sign of severity(P<0.05)
and the confidence interval was 95%.
Conclusion: Wrist circumference is a measurable, reliable index to assess severity of thalassemia
major.

Oxidative stress plays an important role in the pathogenesis of hypertension, and oxidative
imbalance involved in the development of endothelial dysfunction and vascular complications like
atherosclerosis. It is important nowaday to evaluate the antioxidant effects of antihypertensive drugs
in addition to blood pressure lowering effects, since this may provide a better treatment approach
and participate in the prevention of complications of hypertension. We studied the antioxidant
effects of atenolol, captopril, and their combination on 60 hypertensive patients aged from 45 – 60
years, treated for one year with different treatment lines and compared the results with healthy
controls. Serum reduced glutathione (GSH) levels were estimated as a marker of oxidative status in
the blood and lipid peroxidation at endothelial cell membrane was evaluated by measuring its
byproduct, malondialdehyde (MDA) in the blood utilizing spectrophotometric techniques. Oxidative
imbalance was present in all hypertensive patients in comparison with controls. Serum GSH levels
significantly reduced and serum MDA levels significantly elevated in patients using atenolol and
captopril alone, while patients who used atenolol/captopril combination significantly maintained
blood GSH and MDA at levels closer to that of controls. Combination therapy was found to reduce
GSH depletion and lipid peroxidation more than captopril, and captopril more than atenolol. In
conclusion, combination therapy provides better protection against oxidative stress associated with
hypertension, and hence better prevention of complications like atherosclerosis than both atenolol
and captopril used alone.

Treatment of infective-ulcerative-necrotic lesions of diabetic foot is of great challenge and is
based on the optimization of metabolic control, correction of anemia,control of risk factor, removal
of necrotic areas and specific antibiotic treatment based on culture and sensitivity test.
Non-healed ulcerative-necrotic lesions after reasonable period of optimum therapy is suggestive
of the presence of absolute or relative ischemia (macro and micro angiopathy) and this make the
limb salvage procedures of doubtful benefit .
A prospective study done on 33 patients , who were complaining from diabetic foot and they were
undergone below knee surgical amputation, after failure of conservative treatment and appearance of
progressive complications.
This study was done at Al-Sader Teaching Hospital , Orthopedic Department (October 2005-April
2008).
Diabetic foot evaluations were based on clinical assessment , including Wagner classification ,
laboratory tests, and Doppler study to evaluate lower limb arterial system .
The selection of types of surgery whether long posterior flap or equal sagittal flap were taken
randomly by the same surgeon.
The mean of period between appearance of sign and symptoms of diabetes mellitus were 12.6 years
for patients with long posterior flap and 13.5 years for patients with equal sagittal flap.
According to Wagner classification, there were 5 cases of class 4 and 3 cases for class 5 undergone
long posterior flap, where as 3 cases with class 4 and 5 cases with class 5, undergone equal sagittal
flap.
The success rate of wound healing was 84.2% for patients with long posterior flap and 80% for
those with equal sagittal flap and so there was no statistical difference regarding wound healing of
amputated stump whether long posterior flap or equal sagittal flap.
Aim of the study:
To compare the wound healing of amputated stump regarding to the types of flap whether long
posterior flap or equal Sagittal flap.

The commonest treatment of displaced PHSCF is closed reduction and percutaneous pinning within
24 hours- 7th day, after that ORIF usually required. The purpose of this study was to review the
author's experience in treating 17 children delayed for 3 – 6.5 weeks by ORIF that otherwise left for
later corrective osteotomy. patient age, sex, mechanism of injury, time and cause of delay,
classification of fracture, associated neurovascular injury, preoperative procedures, and
complications were noted. All fractures were treated by OR from posterior approach and fixed with
2 crossed K-wires from medial and lateral condyles. Wires were removed at 4-5 weeks. Range of
motion and carrying angle were measured at follow up. A less common fracture type affecting older
children was presented, consisting of supra and inter condylar fracture requiring usually ORIF and
may affect elbow motion, and suggested to be the 5th type in Gartland's classification. Conclusion: it
is worth to attempt ORIF for late presenting displaced PHSCF even 3-6 weeks after injury.
Otherwise the resulting cubitus varus will impose functional, psychological, and cosmetic
impairments demanding later corrective osteotomy with much more complications and lower rate of
success.

Dormancy is a mycobacterial property of persistence in a viable nonreplicating form. It stands for a
real community health threat because of its contribution to drug resistance and recurrence of
tuberculosis. In order to arrange for a trial of solving this problem, the basic mechanisms by which
mycobacterium become dormant were considered in order to partially reverse these factors. Factors
that induce partial reactivation from dormancy include: presence of oxygen free radicals and Lalanine nutrient supply. For evaluating antituberculous regimens that include the test agents added to
the conventional rifampicin plus INH, both in vitro (MIC) and in vivo (mice) models were used.
Two fold serial dilution of modified Lwenstein-Jensen medium have showed equipotent inhibitory
effect of metranidazole, L-alanine and metronidazole plus ginsenoside when each added to
rifampicin plus INH but those were significantly more potent than rifampicin plus INH only
regimen; P< 0.05 at intial concentrations of 4 microgram/ ml for each except ginsenoside 8
microgram/ ml. In vivo assessment include dividing 36 mice into 6 groups 5 of them were induced
with tuberculosis by inoculation of subcutaneous aspect of left abdominal side with 5000 CFU of M.
tuberculosis and monitored for temperature, nodule diameter and intramacrophage mycobacteria
count in histopathological analysis along 4 weeks of treatment course. Regimen that included
metronidazole plus ginsenoside added to rifampicin plus INH had the more potent antituberculous
activity in comparism with other regimens in regard to prevention of increase in body temperature
and decreasing nodule diameter from 7 mm to 2 mm whereas nodular intramacrophage bacilli were
just 4 bacilli in comparison with untreated mean 8 3 . Other regimens came second in potency and
were significant in comparism with rifampicin plus INH only regimen. From the overall results,
there was a significant augmentation of antituberculous potency upon adding some dormancy
reversal metronidazole and L-alanine that could be a promising future regimen for eradicating
dormant persistant tuberculosis.