IRAQI JOURNAL OF MEDICAL SCIENCES

Background: Renal transplantation offers a realistic therapeutic option to patients with end-stage renal disease (ESRD).

Objective: To evaluate one- year (patient and renal allograft) survival and comparing age and HLA-matching results as possible risk factors.

Methods: Fifty (50) patients underwent renal transplantation in the renal transplantation unit of Surgical Specialties Hospital-Baghdad from September 2000 to October 2002. None had diabetes mellitus or clinical evidence of symptomatic cardiac disease. All the transplanted kidneys were from living donors. Direct matching between the serum of recipient and lymphocytes of the donor was negative. HLA class I matching was performed. Recipients were followed for one year following renal transplantation clinically and by regular laboratory tests. Ultrasound and color Doppler examinations were performed when there was evidence of decreased urinary output, allograft dysfunction, or clinical suspicion of rejection. Graft nephrectomy, when needed, was done in the same center.
Results: Thirty-nine patients (78%) continued their lives one year following renal transplantation while

eleven patients (22%) died during the first year following renal transplantation, due to cardiovascular complications and sepsis. Death following renal transplantation was compared with age and HLA- matching as possible risk factors. The comparison was not statistically significant. In thirty-eight patients (76%) the transplanted kidney was functioning normally after one year from renal transplantation. Twelve (12) patients (24%) needed graft nephrectomy on the basis of clinical picture of acute rejection aided by conventional sonographic and color Doppler examinations. Acute rejection was not confirmed by histopathological examination prior to graft nephrectomy.

Conclusions: Cardiovascular disease is common in renal transplant recipients and is a major cause of mortality in this population followed by sepsis. Age of recipient and HLA- matching results were not correlated to the one-year recipient mortality.

Key words: Acute rejection, cardiovascular diseases, one-year survival, renal transplantation.

Background: Infection is a frequent and important cause of morbidity and mortality in the neonatal period.

Objective: This work was carried out to investigate the prevalence of bacterial infection and the frequency of different pathogens among newborns admitted to the Neonatal Intensive Care Unit (NICU) at Tripoli Medical Center (TMC), Libya.

Methods: The case records of all neonates admitted to the NICU of TMC, Libya for the period Sept. 1996 through August 1997, inclusive, were reviewed. Blood and/or CSF cultures were used to establish the diagnosis of bacterial infection. The admissions were categorized as sterile and unsterile.

Results: A total of 1123 newborns were admitted to NICU over the period of the study, 129 (11.5%) of them were proved to be bacterially infected, 10.6% and 24% of the sterile and unsterile admissions, respectively, had bacterial infection. Blood culture was positive in 115 (10.2%) of the admitted newborns, while CSF culture was positive in 24 (2.1%) of them. Gram-negative bacteria were the predominantly isolated bacteria. Serratia spp. was isolated from 38.3% and 50% of blood and CSF cultures, respectively. Klebsilla pneumoniae was isolated from about 25% of both blood and CSF cultures. Coagulase negative staphylococcus (CONS) was isolated from 11.3% of blood cultures.

Conclusion: It can be concluded from this study that neonatal infection is still a problem facing the country and there is a need for study of bacterial colonization of anogenital tract of Libyan pregnant women and its relation to neonatal infections .

Key words: neonatal infection, gram-negative bacteria, Libya

Background: Patients with acute asthma are usually presented with dyspnoea, wheezing and cough, but some are presented with chest pain, which is usually overlooked. The pain may be part of the clinical features or due to associated ischaemic heart disease.

Objective: To assess the origin of chest pain in acute asthmatic patients.

Methods: Tow hundred patients with acute asthmatic attacks were studied for their symptoms and those with chest pain were especially selected and studied by Electrocardiography (ECG) with other investigations. ECG was done on admission and repeated 48 hours later.

Results: Thirty cases out of the total 200 with acute asthma were found to have chest pain [15%] as alone or part of the clinical features. The cases with chest pain were commoner in patients older

Than 50 years [80%]. ST depression and T wave inversion were the most common abnormalities to be found in cases with chest pain [67%]. After 48 hours some of the ECG changes return back to normal and the remaining cases with ECG changes were [40%] which was considered as a substantial ischaemia.

Conclusion: It appears that chest pain occurring in some of the acute asthmatic cases may be due to ischaemia rather than only as a apart of the clinical presentation and it is recommended to be investigated by repeated ECG in all cases.

Key words: Asthma, Chest pain ,Ischaemic heart disease

Background: Measurement of pleural fluid adenosine deaminase (ADA) and Lactate dehydrogenase (LDH) enzymes activity has gained increasing popularity as a diagnostic test for tuberculous and non-tuberculous pleuritis, especially in countries where the prevalence of TB is high. It carries a high sensitivity, inexpensive and easy.

Objective: To demonstrate the diagnostic value of increased level of ADA and LDH in pleural effusion correlated with the cytological, biochemical and bacteriological assessment.

Methods: seventy-five patients presented with pleural effusions were studied (53 males and 22 females) their mean age was 43.8 years. In all cases after the clinical assessment, evaluation of the pleural fluid was done and this included cytological exam with biochemical tests (adenosine deaminase "ADA" enzyme, lactate dehydrogenase "LDH", protein and glucose level) and bacteriological tests (Gram stain, and Ziehl-Neelsen stain).

Results: From the clinical data and lab tests, patients were divided into six groups according to the etiology of pleural effusion. Most (32 patients) were tuberculous, malignant effusion13 patients, infection 10 cases, heart failure 8 cases, idiopathic effusion 6 cases and miscellaneous 6 cases. Significant difference was found in ADA level in different effusions (P<0.005). Highest value of ADA was in TB effusions (the mean was 76.6 u/l), compared to malignant effusions (the mean was 32.4 u/l) and less values in other effusions. LDH highest value was in malignant and TB effusions (mean 321.1 and 314u/l respectively).

Conclusion: Increased ADA levels in TB effusions can be used to differentiate tuberculous from non-tuberculous effusions. And high LDH levels were useful in confirmation malignant effusions.

Keywords: ADA, Pleural effusion, TB.

Backgroud: There is considerable variation in the incidence of bleeding and thrombotic complications noted among patients with myeloproliferative disorders (cMPDs).

Objective: To explore the rate of thrombotic and hemorrhagic complications in cMPD and to identify parameters that might be associated with these complications.

Methods: Fourty five patients with various entities of cMPDs were enrolled in this study, which was conducted from January, 2003 to July, 2004 and involves three medical centers in Baghdad. Additionally, 25 apparently healthy individuals were included as control group. The patients and healthy subjects were submitted for the following investigations; (plasma fibrinogen concentration, factor VIII:C, factor VII:Ag, plasma factor X:Ag and plasma D-Dimers.

Results: The total rate of haemostatic complications among cMPD patients was 20 %. These complications was significantly associated with increasing patients' ages (P=0.005) and inversely correlated with the disease duration (r =-315, P<0.05). Factor VII:Ag level was found to be significantly lower in CML patients in comparison to control (P=0.001). Concerning the plasma factor VIII: C, FX:Ag levels and plasma D-Dimer, no association was found between any of these three parameters and the occurrence of thrombohaemorrhagic complications.

Conclusion: Bleeding and thrombosis are frequent complications in patients with cMPD.

Keywords: bleeding, thrombosis, chronic myelogenous leukemia.

Background: A number of studies have demonstrated that chlamydia trachomatis plays a prominent role in disorders of the human reproductive system.
Objective: This study was carried out to determine antibody levels of Chlamydia trachomatis among mothers with either normal deliveries or had cesarean section and their newborn babies, and the effect of various epidemiological, obstetric, and medical factors on antibody levels among the studied groups.
Method: Serum specimens from 166 women with normal deliveries and their babies (group one) and 32 women with cesarean section and their babies (group two), were screened for C. Trachomatis antibodies by Micro ELISA method.
Result: C. Trachomatis infection rate was 24% and 20.5% among women and babies in-group one,


while it was 40.6%and 38.1% in-group two. History of bleeding (significant negative correlation), discharge and urinary tract
Infection (significant negative correlation) during pregnancy, weight of newborn, had higher rate among group two, while fever and anemia during pregnancy, number of previous abortions were higher among women in group one.
Conclusion: Chlamydia trachomatis infection rate was higher among women and their babies following cesarean section than among those with normal delivery.
Keyword: chlamydia trachomatis antibodies in women after delivery

Background: Asthma in Latin means difficult breathing; it's the most common chronic illness in children. Asthma defined as reversible airway obstruction due to hyper- reactivity of the airways, and its still raising a lot of concern regarding mortality and morbidity, which are still increasing regardless of the advance of management.
The Serum level of Magnesium (Mg) in asthmatics & if any variation from normal children is the subject of this study.

Aim: Aim of the study is to measure the serum level of Mg in asthmatics with different degrees of severity & compare it to normal children.

Patients and method: A total number of 100 patients subjected to study, 50 asthmatics patients & 50 controls patients.

Assessment of asthmatics attacks & measurement of serum Mg for the cases & measurement of serum level of magnesium for the non-asthmatics controls.

Results: The results show that there is lower serum Mg in asthmatics than the control group but no significant correlation to severity of asthma.

Conclusion: Serum magnesium is important element to look for in asthma hence the low serum level compare to other children, which may help in management.

Key words: asthma, magnesium, and severity

Background: neonatal death is the death take place in the first 28 days of life.
Although the neonatal mortality has been declining more rapidly than the post neonatal mortality in the recent decades, neonatal mortality continue to account for close to two third of all infants death.
Aim: to review the main causes of neonatal death among the neonates admitted to the nursery care unit (NCU) in Al- Kadhimiya Teaching hospital for ten years period. in order to prevent or treat the treatable ones.
Patients and Methods: Through a retrospective study, analysis of the medical records of all the admitted neonates to the NCU in Al- Kadhimiya Teaching Hospital during the period between 1995 -2005, the medical information were analyzed to find the important causes of neonatal deaths.
Results: the number of admitted cases during this period was 2683 cases and the total numbers of deaths were 982 cases (36.6%). We found that the main causes of death were Respiratory distress syndrome (RDS), neonatal sepsis, birth asphyxia, congenital anomalies, meconium aspiration and infant of diabetic mother.
Conclusion: the most important causes of deaths were sepsis, birth asphyxia and congenital anomalies. Prevention of prematurity as a major cause for RDS will lead to a decrease in neonatal mortality and morbidity, and a significant reduction will depend on genetic counseling and prevention of congenital anomalies.

Key Words: Neonatal Death, NCU, RDS .

Objectives: Total lactate dehydrogenase (LD) in the pleural fluid (PF) is of little value in the discrimination of various types of exudative effusions such as malignant from non-malignant effusions.
The aim of this study is to assess the diagnostic value of LD isoenzymes activity in serum & pleural fluid in the differentiation between various exudative pleural effusions.

Methods: Sixty-Six patients with pleural effusions were included in the study. Activity of total LD & isoenzyme were measured in pleural fluid & serum. Isoenzymes were separated by agarose gel electrophoresis & the quantity of each isoenzyme was measured by spectrophotometer.

Results: Exudative (inflammatory, neoplastic) effusions had a relatively high LD levels compared to transudates.
LD isoenzymes pattern was significantly different between transudates & exudates.
PF LD isoenzymes pattern differs from that in serum. Our results showed that mainly the pattern of LD3 in pleural fluid & serum was helpful in discriminating inflammatory exudates from neoplastic exudates.
Conclusion: The LD isoenzyme pattern differed between pleural effusions of transudative and exudative origin. Moreover including the LD isoenzyne activities in the biochemical work up of pleural effusions reveal an additional discriminatory value in the separation between various exudative effusions, especially between inflammatory exudate & neoplastic exudates.

Keywords:Pleural effusion,lactate ehydrogenase isoenzymes

Background: Diseases of the maxillary sinus may create symptoms that the patient might interpret as of dental origin, and conversely, dental diseases may adversely influence the health of the sinus

Objective:To interpret the panoramic radiograph of maxillary sinus in a sample from Anbar population,

Methods:120 subject aged from 30 to 70 years, mean age 58 years , who underwent orthopantomographic examination for different medical & dental treatment purposes including males (56%) and females (44%) . Panoramic radiographs were taken in
College of Dentistry, Anbar University, Ramady City, Anbar. With Cranex – Soredex panoramic x-ray machine (Helsinki, Finland).

Results: Normal maxillary sinus were found in (58%) while radiographical changes (maxillary sinus findings) were found in (42%) including mucosal thickening were (32%) and (4%) of the findings were classified as mucous retention cysts.

Conclusion:The maxillary sinus findings were more common in fifth decade of life and slightly higher percentage in male group and the majority of findings were found in dentate subjects.
Key words :axillary sinus,OPG,Mucosal thickening.

Background: iron deficiency anemia (IDA) is a medical and public health problem of prime importance, causing few deaths, but contributing seriously to the weakness and substandard performance of millions of people.
Objectives: To determine the prevalence of anemia, 10 years after sanction among women, at reproductive years in rural areas.
Patients & Methods: The study was carried out in September 2002 within field application for university of Mosul on women in reproductive years in Badoosh areas, 20 Km to the North of Mosul city. The study was conducted in rural areas, where 98 women were evaluated clinically, after a questionnaire with 17 items including age, marital status, and social status, number of children, lactation, and menstrual blood loss. A blood sample was taken to evaluate hemoglobin level (Hb), Hematocrit (hct), serum iron level (SI), total iron binding capacity (TIBC), and transferrin saturation (TS).
Results: The mean age of the women with all tests available was 28.75±10.6 years (range15-50 years); the mean number of previous pregnancies in parous women was 5 pregnancies. 58 women were found to be anemic (57.14%). The mean values of their Hb, hct, SI, TIBC and TS in anemic and non anemic group were; (106.8g/l,126.79g/L),(0.32L/L,37.9L/L),(13.53µmol/dl,15.42µmol/L),(69.85µmol/L,62.55 µmol/L) and( 19.37%,24.7%) respectively, while the over all results for the same values for all women were 115.4g/L, 0.34L/L, 14.34 µmol/L, 61.01µmol/L and 23.50% respectively. In the anemic group 37


women were married (66.07 %),10 women (17.3%) were lactating, 28women (48.3 %) had more than 4
children, 98 % of the sponsors of the family were workers of low socioeconomic status, 12 (12.3%) married women had heavy menstrual cycle and 84(85.7%) of the families had more than 6 persons in the house.
In the present study the level of Hb was lower and TIBC was higher in anemic as compared to non-anemic patients (p< 0.05), while there was no significant difference in the levels of hct, SI, and TS% in anemic patients from that of non-anemic patients (P>0.05).
Conclusions: Almost all the anemic women were suffering from iron deficiency (ID), which is mainly due to nutritional factors and low socioeconomic status, multiparity, lactation and heavy menstrual loss. This may reflect the effects of the blockade on the nutritional and social status in the rural areas.
Recommendations: For girls ages 12-18 and non-pregnant women of childbearing ages, it is recommended to screen for anemia every 5 years, and annual screen for women with risk factors for iron deficiency anemia, and more frequent in pregnant women. Give iron supplements to all women in reproductive years in rural areas.

Key words: IDA, reproductive years of women life.

Background:Aflatoxins are one of the toxigenic fungi that draw attention for researcher, they are a group of closely related mycotoxins that can contaminate food. The problem of using contaminated food with toxigenic fungi is still one of the most important stigmas in the field of nourishment of human and animals.
Objectives:This study was designed to determine how Aflatoxin B1 contaminated food and feeding regimen might affect and induce specific changes in the muscle resident cells.
Methods:Two groups of animals were studied one fed with Aflatoxin B1 contaminated food and the other fed with Aflatoxins free diet. Rats were fed daily with diet contaminated with the spore. The Extensor digitorum longus muscle was removed and cut into small pieces and prepared by the method of Torikata (1988). Semi thin sections were obtained and stained by a nuclear differentiation stain.
Results:Animals treated with Aflatoxin B1 have shown a marked increase in body weight. Aflatoxin B1 showed pronounced effects on muscle nuclei and on the vascularity of skeletal muscle fibers.
Conclusions:lt has been concluded that AFB1 have marked effects on the number of cells found in skeletal muscles.

Keywords: Aflatoxins B1- Skeletal muscle- nuclear differentiating stain

Background: Chronic myeloid leukemia (CML) is a clonal proliferation of stem cells that is characterized by granulocytosis with granulocytic immaturity. The molecular abnormality involving the ABL gene on chromosome 9 and the BCR gene on chromosome 22 have been established as being the proximate cause of chronic phase CML.

Objective: To study the clinical, and hematological responses to imatinib mesylate and the main side effects in Iraqi patients with CML in the three phases of disease.

Methods: Three hundred and sixty two patients with CML were enrolled .they were diagnosed by peripheral blood and bone marrow aspirate examination and were treated with imatinib mesylate 400 mg/day as one single dose orally and followed up every 4 weeks for clinical , hematological responses and evaluation of side effects.
Results: The frequency of CML cases by residence was 17. 40%, 21.8% and 61.6% from south, north



and middle regions of Iraq respectively. The age of patients ranged 14-70 years, 192 males (53%) and 170 females (47%). Complete clinical and hematological responses were observed in 325 (90%) of patients within 3 months from the initiation of imatinib in the chronic phase of the disease, only 4/10 responded in the accelerated phase at higher dosage of 600-800mg/day , no one in the blastic phase responded. Side effects were generally mild and tolerable.

Conclusion: Imatinib mesylate is effective and safe in achieving high clinical and hematological responses in chronic phase CML patients, but has poor response in accelerated and acute blastic phases. Side effects are generally mild.

Key words: Chronic Myeloid Leukemia, Imatinib Myseglate

The incidence of heterotopic pregnancy increased in the recent years with wide spread of ovulation induction drugs and assisted reproduction techniques. There is delay in the diagnosis of heterotopic pregnancy and about 50% of patients are admitted for emergency surgery following rupture. Early diagnosis and treatment of heterotopic pregnancy lead to decrease maternal mortality, morbidity, and salvage of intrauterine pregnancy.

Clinical History
A 29 years old woman gravida 2 Para 0 abortion 1 conceived after ovulation induction using clomiphine citrate; her last menstrual period (LMP) was on the first of October. She was admitted as a case of acute abdominal pain of 2 days duration on 23.12.2004; she was 12 weeks pregnant. The pain was all over the abdomen with radiation to both shoulders. She consulted two hospitals before she came to our hospital, where she received an intravenous fluid and analgesics and discharged home. The pain increased in severity, and her general condition was deteriorating in the last day. She was attending a private doctor who did for her3-ultrasound examinations were normal except for the diagnosis of cervical incompetence for which cervical cerclage have been done.
On admission, the patient was severely pale, her rate was100 pulse per minute BP 110/50. There was a generalized abdominal distention

In this case report I present a case of heterotopic pregnancy complicated by rupture with review of literature.

Key words: Heterotopic pregnancy

Brugada syndrome is a clinical and electrocardiographic diagnosis based on syncopal sudden death episodes in patients with a structurally normal heart and characteristic ECG pattern composed of right bundle branch block (RBBB) and a specific shape ST-segment elevation in V1 to V3 2.
The first report on this syndrome was published in 1992, although some reports on a similar condition has been reported since 1989, since 1992 there has been an exponential increase in the number of patients recognized all over the world (9). Its incidence and prevalence are difficult to estimate, however asymptomatic subjects with Brugada type ST-segment shift were present at a rate of 0.14% in the general Japanese population 1, 3.

Key words: Brugada Syndrome, Ventricular arrhythmia, sudden cardiac death.