IRAQI JOURNAL OF MEDICAL SCIENCES

Background: A whole blood culture started with mononuclear cell fraction would contain several different cell types. Nevertheless, the T-lymphocytes can be cultured specifically and will out grow the others, eventually resulting in highly enriched population.

Objective: The study was conducted as a trial of establishment of lymphocytes cell lines. This series of experiments were done for five selected subjects. The same protocols were applied to all individuals.

Method: One ml of heparinized blood (HB) was cultured in tissue culture flask containing 9 ml stimulation medium. The flask was incubated at 37ºC in CO2 incubator for 3 days. Then every three days 1ml of whole blood culture from the flasks was subcultured into other tissue culture flask containing 9 ml stimulation medium, until visible suspension of mononuclear cells intervening agglutinated red blood cells were seen within two weeks of culture.

Results: After the whole blood mononuclear cells cultures were maintained up to two weeks, the mononuclear cells were separated. Twenty four-hour incubation of these separated lymphocytes in stimulation medium, pure rich mononuclear cells were obtained and seen under inverted microscope.

Conclusion: A new method for cultivation of lymphocytes from whole blood was developed for the first time and probably no other reported comparable method conducted elsewhere until know. Pure lymphocytes cultures were established, and maintained cell division. The potentiality of human peripheral lymphocytes themselves to act as precursor has been demonstrated in vitro by the cloning of established lymphoblastoid cell line. Different procedures for generation of T- cell lines were outlined. No feeder cells were needed in our protocol or the addition of IL2.

Key words: lymphocyte culture, cell line, Phytohemagglutinin

Background: Visceral leishmaniasis (Kala-azar) is an important endemic disease in Iraq (WHO 2000) .The disease appears to affect infants and young children mostly under 2 years old .The disease is very dangerous and fatal if it is left without treatment .Trace elements have an important role in the treatment and prognosis of different types of parasitic infection

Objective: Study the relationship between serum trace elements and the disease which may be used as an indicator of the course of the disease

Methods: 14 male and 12 female patients (positive IFAT) their age were between 6 months and 15 years were used in this study .Serum copper (Cu), zinc (Zn), and magnesium were measured using atomic absorption spectrophotometer.

Results: There is a significant increase (p<0.05) in serum Cu and significant decrease in serum Zn of kala-azar patients.

Conclusions: Body reaction against parasite infection is associated with different changes in serum level of trace elements.

Keywords: kala-azar, trace elements, copper, zinc, magnesium, visceral leishmaniasis

Background: Adolescents struggle to achieve their identity, independence and to cope with all aspect of life. Diabetes may slow the psychological development of adolescents.

Objective: to through a light on the school achievements of adolescents with type I diabetes mellitus.

Methods: 160 diabetic adolescents were included in this study. Full information including age, sex, age of onset, duration, sport activity and admission to the hospital collected. Multiple regression analysis was used to examine the association between the school achievement and the independent variables.

Results: School achievement was significantly associated with visits to diabetic clinics and sport activity.

Conclusion: Visits to diabetic clinics and sport activity improve the school achievement among diabetic adolescents.

Keyword: Adolescents, diabetes mellitus, school achievements

Background: Hepatitis C virus (HCV) infection is responsible for the majority of cases of post-transfusion hepatitis. Biochemical analysis of liver enzymes used to estimate the severity of liver injury in HCV infected patients.

Objective: To estimate the aspartate aminotransferase to alanine aminotransferase (AST/ALT) ratio as non-invasive parameter for assessment of liver injury in HCV infected patients.

Methods: Two groups of subjects were included in this study. 238 thalassemic children from Al-Zahrawi Hospital (172 were seropositive and 66 were seronegative for HCV specific antibody) and 58 pregnant women (32 were seropositive and 26 were seronegative for HCV specific antibody) as a control group. Serum AST and ALT and AST/ALT ratio levels estimated for each subject.

Results: The mean serum AST/ALT ratio levels for anti-HCV seropositive and seronegative thalassemic children were 3.38  4.34 and 2.56  3.09 respectively, while for anti-HCV seropositive and seronegative pregnant women 1.62  1.34 and 0.59  0.42 respectively.

Conclusion: The mean serum AST/ALT ratio is higher among HCV infected subjects than among the non-HCV infected ones.

Keywords: aspartate aminotransferase to alanine aminotransferase ratio, Hepatitis C virus

Background: Thalassaemia is considered the most common genetic disorder worldwide. β thalassaemia has emerged as a huge public health problem worldwide. The classic changes of untreated thalassaemia major are now regularly seen only in countries without resources to support long-term transfusion programs.

Objective: To study the different clinical features of patients with anemia attending the center for anemia of Mediterranean origin in Ibn-Albalady Hospital in Baghdad for blood transfusion. To correlate different clinical features with the different demographic characters among the sample patients and with the blood levels of hemoglobin, some trace elements, minerals and albumin.

Methods: Cross-sectional study was conducted in the center for anemia of Mediterranean origin in Ibn-Albalady Hospital, 157 patients were randomly selected using convenient sampling and patients attending the center for blood transfusion. Blood samples were taken from all the studied sample. Tests were done for different serum levels of trace elements, minerals, albumin and hemoglobin.

Results: showed that out of 157 patients studied, there were 112 (71.3%) from Baghdad and 107 (68.2%) from urban areas. The mean age on diagnosis was 1.6 years and that thalassemia major was found in 121 (77.1%), there were 108 (68.8%) who require blood transfusion between 2-4 weeks, and desferol treatment frequency was >4 times week in 99 (63.1%) and under nutrition was found in 76 (48.4%) patients.

Conclusion: More centers for thalassemia are to be established in different areas in our country, with increase efficiency as to include gene frequency. Programs based on carrier screening and counseling of couples at marriage, preconception or early pregnancy to be established. Prenatal diagnosis by mutation analysis on PCR amplified DNA from chorionic villi.

Key word: Mineral, Trace elements, Thalassemia

Background: Thalassaemia is considered the most common genetic disorder worldwide. β thalassaemia has emerged as a huge public health problem worldwide. The classic changes of untreated thalassaemia major are now regularly seen only in countries without resources to support long-term transfusion programs.

Objective: To study the different clinical features of patients with anemia attending the center for anemia of Mediterranean origin in Ibn-Albalady Hospital in Baghdad for blood transfusion. To correlate different clinical features with the different demographic characters among the sample patients and with the blood levels of hemoglobin, some trace elements, minerals and albumin.

Methods: Cross-sectional study was conducted in the center for anemia of Mediterranean origin in Ibn-Albalady Hospital, 157 patients were randomly selected using convenient sampling and patients attending the center for blood transfusion. Blood samples were taken from all the studied sample. Tests were done for different serum levels of trace elements, minerals, albumin and hemoglobin.

Results: showed that out of 157 patients studied, there were 112 (71.3%) from Baghdad and 107 (68.2%) from urban areas. The mean age on diagnosis was 1.6 years and that thalassemia major was found in 121 (77.1%), there were 108 (68.8%) who require blood transfusion between 2-4 weeks, and desferol treatment frequency was >4 times week in 99 (63.1%) and under nutrition was found in 76 (48.4%) patients.

Conclusion: More centers for thalassemia are to be established in different areas in our country, with increase efficiency as to include gene frequency. Programs based on carrier screening and counseling of couples at marriage, preconception or early pregnancy to be established. Prenatal diagnosis by mutation analysis on PCR amplified DNA from chorionic villi.

Key word: Mineral, Trace elements, Thalassemia

Background: increased membrane lipid peroxidation in patients with thalassemia has been reported suggesting that superoxide radicals generated in excess following auto-oxidation of isolated hemoglobin chains is an important contributor to the hemolytic process.

Objective: This study was undertaken to evaluate the extent of lipid peroxidation and antioxidant status of patients with beta-thalassemia in comparison to healthy people.

Methods: Red cell superoxide dismutase (SOD) activity and red cell catalase activity were measured in the biochemistry department for the period from January 2003 to October 2003, 76 patients with beta-thalassemia, 14 patients with beta-thalassemia minor and 19 healthy controls were studied.

Results: Erythrocytes of patients with beta-thalassemia major had significantly higher SOD than control (p<0.0004). Red cell catalase activity of thalassemia minor patients was significantly higher than that of the control (p<0.05). In thalassemic patients, the more anemic patients have significantly higher SOD activity, but this correlation was not present between anaemic patients & catalase activity.

Conclusion: Red cell superoxide dismutase activity was greatly increased in homozygous beta-thalassemia, and inversely correlated with severity of anaemia.

Keyword: SOD, Catalase, Thalassemia

Background: Angiogenesis means the creation of new blood vessels, a critical natural process that occurs in the body both in health and in disease.

Objective: Quantitative assessment of tumor vascularization in different grades of prostatic tumors.

Methods: 23 paraffin blocks of prostatic biopsies (8 cases of benign prostatic hyperplasia and 15 cases of protatic carcinoma equally distributed in well, moderately and poorly differentiated (Gleason’s grade 2, 3 and 4&5 respectively). Processed routinely and stained with hematoxylin and eosin, elastica Van Gieson, and Masson Trichrome stain. The vascular surface density (VSD), the microvessels number (NVES), and the maximum microvessels number (NVES-MAX) was assessed by means of stereology, and the results were related to grade of tumor differentiation.

Results: NVES and NVES-MAX showed a significant increase with rising tumor grade ranging from 16.1 in BPH to 109.0 microvessels/mm2 in poorly differentiated (grade 4&5) tumors. Discrimination of different tumor grades was more accurate with NVES-MAX. The VSD was significantly higher in low-grade tumors compared with BPH, whereas there was continuous decrease from low grade (11.6mm-1) to high-grade tumor areas (5.1 mm-1).

Conclusions: The present study shows a correlation between tumor grade and vascularization.

Key words: Prostate cancer, angiogenesis, vascularization.

Background: Trace elements particularly copper and zinc have a great role in a number of biological processes, therefore estimation of these metals in serum of Rheumatoid Arthritis (RA) patients may ameliorate the understanding of trends in the relationship between the serum copper and zinc levels and activity of disease.

Objective:To determine the serum copper and zinc levels and its relation with the degree of disease activity and compare with a normal group.

Methods:The investigation was carried out on forty-three healthy (25 females, 18 males) and fifty-four(37 females, 17 males) sick adults.The patients were subdivided according to the activity of the disease(Tentative EULAR Criteria) in to two groups. Of them 29 patients (21 female, 8 male) had low disease activity [age range 32-65 years] and twenty-five patients(16 female, 9 male) had high disease activity [age range 22-52 years]. They were compared with 43 healthy control [age range19-64 years].
Serum copper and zinc were determined by using the atomic absorption specrtophotometry.

Results: Serum copper level and copper/zinc ratio in patients with RA in both groups were significantly
increased than the control group. In addition the serum zinc level in patients with low activity RA was significantly decreased and more in high activity disease.

Conclutions: As a result, the alteration of copper and zinc levels in the sera patients with RA can related to degree of disease activity and enable to shed more light on the role of trace elements in both physiological and pathological states.

Key words: Background: Trace elements particularly copper and zinc have a great role in a number of biological processes, therefore estimation of these metals in serum of Rheumatoid Arthritis (RA) patients may ameliorate the understanding of trends in the relationship between the serum copper and zinc levels and activity of disease.

Objective:To determine the serum copper and zinc levels and its relation with the degree of disease activity and compare with a normal group.

Methods:The investigation was carried out on forty-three healthy (25 females, 18 males) and fifty-four(37 females, 17 males) sick adults.The patients were subdivided according to the activity of the disease(Tentative EULAR Criteria) in to two groups. Of them 29 patients (21 female, 8 male) had low disease activity [age range 32-65 years] and twenty-five patients(16 female, 9 male) had high disease activity [age range 22-52 years]. They were compared with 43 healthy control [age range19-64 years].
Serum copper and zinc were determined by using the atomic absorption specrtophotometry.

Results: Serum copper level and copper/zinc ratio in patients with RA in both groups were significantly
increased than the control group. In addition the serum zinc level in patients with low activity RA was significantly decreased and more in high activity disease.

Conclutions: As a result, the alteration of copper and zinc levels in the sera patients with RA can related to degree of disease activity and enable to shed more light on the role of trace elements in both physiological and pathological states.

Key words: Rheumatoid Arthtitis, copper, zinc, and serum.
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Background: Early pregnancy and unplanned childbirth may have far-reaching physical, psychological and social consequences for adolescent girls and her off spring. Therefore, public health issues of concern because of the growing cultural and social sensitivity and controversy over reproductive health issues.

Aim of the study: Studying mother age at marriage in association with different socioeconomic characters in the family, which might affect reproductive health of mothers.

Subject & methods: A cross-sectional study conducted taking data obtained from 800 randomly selected healthy mothers, during their visits to five primary health centers, which selected randomly from different areas in Baghdad city; this done during the period from June- November 1994. Information from the mothers obtained using well-studied questionnaire form.

Results: Significant relationship between mother's age at marriage and maternal education, birth interval, father age at marriage, number of pregnancies, under 5 years children in the family, crowding index, degree of consanguinity (P <0.001). Significant relationship found with father occupation, under 5 years death in the family (P <0.01). No significant relationship with number of abortion and type of family (P > 0.05) found.

Conclusion: maternal age at marriage is an important determinant of reproductive health of women when it studied with different socioeconomic variables.
Emphasis should be made on young people to have better access to health information schools, and the medical profession needs to work together both to provide information and to help young females to develop confidence to use available information sources.

Key words: reproductive health

Background: The limbs bud development is induced by the apical ectodermal ridge. The trace elements were found to have important role in biological growth of tissues such as tumor tissues.

Objectives: This study was done to reveal the possible biological role of trace elements as zinc, copper, and magnesium in the limb development induced by the apical ectodermal ridge.

Methods: Chick embryos of Hamburger and Hamilton stages 20-26 were used. Trace elements were measured in limb buds with and without apical ectodermal thickening.

Results and discussion: The decrease in zinc concentration found in limb buds tissues having no apical ridge suggested a relationship between this trace element and the inductive effect produced by the apical ectoderm for limb buds formation. The detectable concentration of copper only in buds having no apical ridge was correlated with the embryonic organization of the limb buds. The lower magnesium concentration in the limb buds was considered as a criterion for the metabolism accompanies the functioning apical ectoderm during the embryogenesis of the limb buds.

Conclusions: Trace elements may have a significant role in the embryonic process of budding.

Keywords: Limb buds, trace elements, zinc, copper, magnesium, development.

Background: Male infertility is the inability to conceive a baby in the absence of female causes. Most causes reflect an abnormal sperm count or quality. Zinc is a component of semen and plays an important role in the process of reproduction and sexual maturation.

Objectives: To asses the relationship between concentration of zinc in serum, seminal plasma and semen quality among infertile and fertile men to clarify the possible impact of zinc in male reproductive system.

Methods: Fifty-eight male (infertile group) partners who were undergoing investigation for infertility and thirty-seven men (fertile group) whose wife were pregnant and have normal sexual life studied as a control group.
Seminal fluid analysis, reproductive hormones (luteinizing hormone, follicular stimulating hormone and testosterone) were analyzed by using radioimmunoassay method (RIA) while serum and seminal plasma zinc concentration were determined by using colorimetric methods.

Results: All semen properties (count, motility and morphology) for the infertile group were lower than for the fertile group. No significant differences were found in the levels of L.H. and F.S.H. between the two groups while testosterone levels were significantly lower in the infertile men group than in the fertile group (p<0.005).
It was also found that the mean level of serum and seminal plasma zinc concentration were significantly lower in the infertile group compared to the fertile group (p<0.0001). No correlation was found between the concentrations of zinc in serum and seminal plasma in both groups. A lack of correlation was also found between zinc concentrations in serum and seminal plasma with semen properties.

Conclusion: The study revealed the importance of zinc in fertility through its direct and its indirect effects on spermatogenesis.

Keywords: Male infertility, Zinc, semen, spermatogenesis

Objective: Comparison of two protocols regarding efficacy and toxicity of intravesical mitomycin C versus mitomycin C and S2 complex sequential therapy for superficial transitional carcinoma of urinary bladder.

Methods: A prospective, randomized parallel two lines of treatment groups. Seventy-three patients were evaluated after transurethral resection of superficial bladder cancer with median follow-up of 26 months. In group A, 37 patients received intravesical mitomycin C 30mg on day1 weekly for 6 weak and monthly for 12 month, while group B (36 patient) received in addition to mitomycin C, intravesical S2 complex 3ml on day 2. Statistical analysis performed by Kaplan-Meier methods.

Result: After follow-up of 26 months, 46% of patient given mitomycin C were disease free compared to 70% for that of group B patient who received mitomycin C and S2 complex, with no significant difference in incidence of the adverse effects.

Conclusion: The results show that intensive intravesical instillation of sequential mitomycin C and S2 complex; were highly effective in eradication and/or prophylaxis of superficial transitional bladder cancer.

Key ward: Transurethral resection; bacillus Calmitte-Guerin; complete response; mitomycin C, carcinoma in situ

Background: Tuberculosis of udder is not a rare disease in animals especially cows but it is rare in human female breast and extremely rare in male breast.

Objectives: Looking for involvement of women breast with tuberculosis.

Methods: From the 1st of July 1992 to the 1st of July 2002, 15 female patients, all in reproductive age were studied for their breast problems under the suspicion of tuberculosis, 14 cases appeared to be tuberculosis diagnosed by FNA cytology and biopsy and treated by anti TB drugs therapeutic trial.

Results: Treatment with anti-tuberculous drugs cured 14 cases.

Conclusion: The tuberculosis of human breast is not very rare disease and should keep in mind when breast infection, ulcers, sinuses and inflammatory masses are not responding to traditional drugs. Tuberculosis of the breast responds very well to anti-tuberculous drugs and cure completely.

Keywords: Breast, tuberculosis, anti-tuberculous drugs

Background: Asthma is a diffuse obstructive lung disease with hyperreactivity of the airways to variety of stimuli. The prevalence and severity of the disease are steadily increasing. In addition to broncho-constriction and viscid secretions, inflammation is an important patho-physiological factor, eosinophil play important role in this inflammation. Eosinophil peripheral blood count in Asthmatic patient is our concern in this study.

Objective: Study the relationship of eosinophil peripheral blood count and Asthma.

Methods: A total number of 55 asthmatic children subjected to a prospective study regarding the severity of asthma, which assessed by clinical examination and spirometry and for each patient a sample of blood, were collected and eosinophil count was calculated.

Results: 35 of a total 55 asthmatic patient found to have moderate to sever asthma of this category 82.8% (29 patients) were having high eosinophil count >400 / mm3 while 17.2% ( 6 patient) of less eosinophil peripheral count < 400 / mm3. The other 20 patients were mild to moderate severity, of these 80% (16 patients) were of low eosinophil count < 400 and 20% (four patients were of high eosinophil count).

Conclusion: There is an increase in eosinophil peripheral blood count in Asthmatics and the more the severe the attack, the more the eosinophil count.

Key words: Asthma, Eosinophil, Severity

Background: Evidence for a disturbance of mineral metabolism in diabetes has accumulated since the eighties of the last decade. Calcium ion shown to play an important role in the biosynthesis, storage, release and activity of insulin, in addition, to glucose tolerance in human beings.

Objective: To examine if serum calcium level (SCaL) is influenced in patients with type II diabetes mellitus (type 2 DM).

Methods: The study comprised one hundred twenty subjects of both sexes. Sixty patients of newly diagnosed type 2 DM with a mean±SD age of 47.6±11.6 years and 60 healthy controls with a mean age±SD of 35.2±14.3 years. Main outcome measures (SCaL) and serum glucose level (SGL) in fasting blood samples.

Results: Serum calcium level and SGL were significantly higher in newly diagnosed type 2 DM as compared to healthy non-diabetic controls. Furthermore, there was no correlation between SCaL and hyperglycemia in diabetic patients.

Conclusion: Hypercalcemia may be a result of other factors in diabetes mellitus rather than hyperglycemia.

Key words: Type 2 diabetes mellitus, calcium, glucose, hypercalcemia, hyperglycemia

Background: Congenital hypothyroidism is one of the most encountered endocrine diseases in childhood and the importance of this diagnosis is because early and adequate treatment prevents developmental retardation and other squeal of the condition.

Objective: Looking for the congenital hyperthyroidism in Iraqi children.

Methods: A retrospective study involved 40 children who were attended Pediatric Endocrine and diabetic Clinic for children in Al-Kadhimiya Teaching Hospital, College of Medicine, Al-Nahrain University Baghdad, Iraq, over period from Jan 1993-Jan 2003 .

Results: Of the 40 patients, 24 were female and 16 male. Female to male ratio 1.5:1.A history of parental consanguinity was positive in 36(80%) of the patients and 25(62.5%) had family history of hypothyroidism, and 24(60%) of the patients were from urban area 16(40%) from rural area west to Baghdad. Ten children (25%) detected in first month of life, 15(37.5%) in first 3 months and 25(62.5%) within the first 6 months. Seven patients had aplasia of thyroid gland, five had ectopia,and 8 had thyroid in normal position . Developmental assessment performed on all patients, also clinical manifestation in 20 patients diagnosed before 6 months of life.

Conclusion: Although we do not know much about the overall prevalence of congenital hypothyroidism in Iraq, the first observation to make is that it is not a rare disease in this country. A genetic explanation suggested by the involvement of multiple siblings and the high rate of consanguinity in this population.

Key Words: Congenital hypothyroidism, Retrospective

Background: Myasthenia Gravis, a neuromuscular disorder causing skeletal muscle weakness involving respiratory muscles which some times sever enough to need assisted respiration. Approximately 30% of patients with MG develop some degree of respiratory weakness, mysthenic crisis most often precipitated by systemic infection (40%), thymoma (30%) and aspiration pneumonitis (10%).

Objectives: To evaluate respiratory function status with MG and to determine the triggering factors for respiratory dysfunction and effect of thymectomy.

Method: 50 consecutive cases of MG, 33 females and 17 males with an age range between 16–60 years old, 29 of them underwent thymectomy.
The study was done throughout the period October 1999 to June 2001 in Al-Kadhiymia Teaching Hospital.

Results: 46% of patients show respiratory muscles involvement. 47.82% of cases show respiratory involvement in the first 4 years. 68.9% of thymectomized patients show no respiratory muscles involvement while 66.7% of non-thymectomized show respiratory muscles involvement. Infection is the highest triggering factor (39%).

Conclusion: Respiratory dysfunction seems to develop in the first 4 years of the disease course. The incidence of respiratory dysfunction is less frequent in thymectomized patients. Infection is the main triggering factor.

Keywords: Myasthenia Gravis, Neuromuscular, Thymectomy, Respiratory failure

Background: Hyperprolactinemia (HPRL) is the most common endocrine disorder of the hypothalamic-pituitary-ovarian axis. The most important and common cause is pituitary tumor.

Objectives: 1. Analysis of the presenting features. 2. Role of MRI in the diagnostic evaluation of HPRL. 3. MRI measurements and correlation between MRI findings and serum prolactin concentration (PRL) in Iraqi women. 4. Literature review and work-up for HPRL.

Method: clinical assessment, basal PRL and pituitary and cranium MRI performed in a case-series study for 82 Iraqi HPRL female patients attending gynecologic clinic after excluding secondary HPRL.

Results: sub-fertility, galactorrhoea and menstrual irregularities were the commonest features. MRI abnormalities found in 41.46% of the patients. 88.24% were pituitary abnormalities. Their PRL was significantly higher than those with idiopathic HPRL (p=0.03). Right pituitary adenomas were more common than the left. The pituitary gland occupied 81.73% of the sella turcica in case of pituitary hyperplasia. There was no significant correlation between adenoma size and PRL (p=077), while there was significant positive correlation between pituitary and sella areas in those with normal MRI (p=0.007) as well as those with pituitary hyperplasia (p=0.04).

Conclusion: PRL of 18.5ng/ml considered as the cut-off value to perform high-resolution pituitary and cranium MRI. Primary pituitary hyperplasia may carry a risk of parasellar extension during pregnancy. There is positive correlation between pituitary and sella turcica sizes. MRI considered as the gold-standard imaging method for the pituitary while sella X-ray should be abandoned.

Key words: Hyperprolactinemia, Pituitary adenoma, Pituitary hyperplasia, MR imaging, MR measurement, Iraqi

A 20-year-old female was diagnosed as a case of epilepsy since 1995. The patient was diagnosed as a case of myasthenia gravis in April 2002. Since 1999, her complaint became more announcing over two years. Until April 2002, when the patient consulted a neurologist, she was diagnosed as case of Myasthenia gravis.
The patient diagnosed as a case of multiple sclerosis then after. The key to the clinical criteria for the diagnosis was lesions disseminated in space and in time.
This case may represent an association of multiple neurological diseases of dysimmune reaction.

Key worlds: Multiple Sclerosis, Myasthenia and epilepsy