IRAQI JOURNAL OF MEDICAL SCIENCES

Background: Lymphomas are a heterogenous group of malignancies of B or T cells that usually originate in the lymph nodes. They are divided into Hodgkin and non-Hodgkin’s lymphomas. Disruption of the physiological balance between cell proliferation and death is a universal feature of all cancers. There has been an increasing interest in the role of apoptosis in tumorogenesis of lymphoma. On the molecular base apoptosis is caused by activation of the caspases through extrinsic and intrinsic pathways. Extrinsic pathway centers on tumor necrosis factor family, where the ligand will bind to the cell surface receptor and this in turn will induce apoptosis. Fas receptor is a member of the TNF/NGF receptor superfamily. Fas family is constituted of the receptor, ligand and soluble form. Soluble Fas will compete with Fas receptor for binding to ligand, thus interfering with Fas-L-mediated apoptosis.
Objective: To measure the level of serum sFas in non-Hodgkin lymphoma (NHL) and to determine the correlations of it with certain clinical and hematological parameters and chemotherapy treatment.
Patients and Methods: This study included 30 patients with NHL (19 males and 11 females), of them 14 patients were newly diagnosed along with 30 apparently healthy controls were involved in this study. The patients were interviewed with history taking, clinical examination and aspirating blood sample for estimation of serum sFas concentration using sandwich ELISA kit (from Chemicon). Also serum CRP level, plasma LDH level, hemoglobin concentration, platelets count, WBC count and peripheral blood film were all performed using standard techniques.
Results: This study revealed that the serum sFas concentration was significantly higher in NHL patients than in healthy controls (p = 0.0001). This increase was significantly higher in pretreated patients and closely related to the pathological grade of NHL (p = 0.0002 and 0.0035 respectively).
Conclusions: Serum sFas is a simple, non-invasive and clinically useful laboratory parameter .It maybe used as an auxiliary marker to assess the prognosis and the therapeutic planning in NHL.
Keywords: Fas, NHL.

Background: Breast carcinoma is the most important malignant tumor in female population. There are many indications for the use of adjuvant chemotherapy in its treatment, which need a special selection of patients especially those with high risk &this is judged by several prognostic parameters such as patient’s age, tumor size, histological grade and others.
Nuclear morphometry has shown to be a good objective, quantitative method for the evaluation of prognosis, in which the Mean Nuclear Area &
Standard Deviation of Nuclear Area showed an increase from the baseline value of normal breast epithelium to invasive carcinoma &found to be strongly correlated with the recurrence rate within 2.5 years.
Objective:To evaluate some prognostic parameters of breast carcinoma by the use of computerized nuclear morphometry.
Material &Methods:
Fifty-four cases of a histologically diagnosed invasive breast carcinoma of ductal type with a known tumor grade, size &patient’s age were reviewed. In each case an average of 5-10 microscopical fields were screened &30 consecutive nuclei were determined at x400 magnification by the use of an image analysis system. Statistical analysis was performed using ANOVA, Tukey’s and t-test.
Results:
The mean values of nuclear area varied between the three histological grades (grade I, II and III) by using analysis of variance (p>0.01).



These values increased with increasing histological grade, (Tukey’s test: p>0.01).
Similarly the mean values of nuclear area were significantly higher in tumors measuring more than 5cm in diameter than those less than 5cm in diameter. (t-test :p>0.01).
On the other hand, the nuclear area in tumors of patients less than 50 years and more than 50 years of age showed no significant difference. (t-test: p<0.01)
Conclusions:
The Mean Nuclear Area was of value in the assessment of the histological grade, in which higher figures seen in higher grades. The same relationship found between tumors more than 5cm and those less than 5cm in diameter, in which higher values seen in tumors more than 5cm in diameter. On the contrary the importance of the Mean Nuclear Area was restricted when comparing tumors in patients less than 50 years and those more than 50 years of age.
In conclusion our data suggest that adapting a nuclear morphometric parameter e.g. nuclear area, which was performed on this study, may be a valuable objective tool in evaluating various prognostic indices.
Keywords: Breast carcinoma, nuclear morphometry , and prognosis.

Background: Partial (focal or localization related) epilepsy is the most common seizure disorder encountered in patients with epilepsy. These seizures are focal at onset that is emanating from localized region of the brain. Certain structural and metabolic abnormalities in the brain will predictably lower the epilepsy threshold. Seizure can result from either primary central nervous system dysfunction or underlying systemic diseases. The incidence of structural abnormalities was higher with increasing age of the onset of seizure and declined with long duration of history of epilepsy
Objectives:
1) Identify the cause of partial seizure.
2) Clarify the association of these causes and the age of the patients.
Study: Prospective cohort study.
Setting: Al-Kadhimiya Teaching Hospital.
Patients: 106 patients presented with partial seizure, the age of them ranged between 6-73 years, 52 males and 54 females
Result: The abnormal neuroimaging occurred in (61%) of patients. Tumors occurred in about (19.7%) of patients most of them below 40 years of age while infarctions in about (25.5%) of patient above this age.
(83.7%) of complex partial seizure patients had temporal lobe foci and (16.2%) in frontal lobe, while (49%) of simple partial seizure patient had frontal lobe foci, (22%) frontoparietal and (13%) had parietal lobe foci.
(75.4%) of patient with simple partial seizure and (35.1%) with complex partial seizure had brain(structural) lesion.
Conclusion:
1. Infarction is a common cause of partial seizure in patients above the age of 40 and below this age was a tumor.
2. Partial seizure is associated mostly with organic brain lesions.
3. The incidence of structural lesion was decrease in patients with long history of partial epilepsy.

Key words: Seizure, Epilepsy

Background: Paratyphoid infection remains an important public health problem with marked host specificity for humans or higher primates but not naturally virulent for mice except that using high inoculum of the paratyphoid bacilli.
Objective:
1. Study the bacterial dissemination through the organs of white mice.
2. Study the pathological changes associated with this experimental disease process
Methods: One LD50 of the microorganism corresponded to 8x107 bacterial Cell/ml. However 10LD50 doses were intraperitoneally used for mice to produce extensive disease process in mice. Following inoculation of mice the course bacterial dissemination and pathological lesions were studied at specific intervals and for 3 days post inoculation.
Result: The microorganisms were persistent in the spleen and liver for 21 and 17 days postinoculation respectively, where as the



microorganisms persisted in the mediastinal lymph nodes and lungs for 9 days and kidney and heart blood for 5 days postinoculation. The main pathological lesions were initiated as a mild infiltration of neutrophils and edema in the spleen liver and lymph node the neutrophils iflteration will be gradully replaced by mononuclear cell infiltration and finally with fibroblasts proliferation.

Conclusion: The Salmonella paratyphi-A is of lower pathogenicity and virulence for white mice, through their dissemination in organs of white mice and associated pathological findings.

Keywords: Salmonella paratyphi-A infection white mice

Background: Duchenne Muscular Dystrophy (DMD) is a dismal disease, which exhibits an X-linked mood of inheritance, characterized by progressive proximal muscular weakness, beginning in early childhood, wheel chair dependency by early teens and death from cardiopulmonary complications by the end of the second or third decade. Although the majority of carriers of DMD and Becker muscular dystrophy (BMD) are asymptomatic but they can be identified through minor clinical changes like limited weakness or occasionally bulky calves, and some may have elevated CPK levels and mild EMG changes, and as DMD is incurable disease, and carrier detection and genetic counseling are an important aspect of the global approach to limiting the number of patients with DMD and BMD and of carriers.
The Objective of the study is to test the value of CPK and conventional needle EMG muscle testing in detecting carriers in a group of Iraqi females with their sons having DMD and BMD.
Patients and Methods: The study was conducted in AL-Kadhimiya Teaching Hospital Section of Neurology from October 2002 to December 2003, where a group of 20 female carriers of DMD and BMD, from 15 families were studied and compared to other Control group of 20 females randomly picked up. To each female studied full medical history, neurological examination, including manual muscle power testing, and
Pedigree analysis taken, and to each female in the study CPK testing, ECG, with cardiac Echo, and Conventional needle EMG were done.
Results: Only one female carrier (5%) had mild proximal muscle weakness, cardiac involvement only one (5%), had mildly dilated left ventricle but with normal systolic function.
11 (55%) female carriers had mildly elevated CPK above the upper reference range (170 U/L); 10 (58.8%) DMD, and 1 (33.33%) of BMD. And there is significant (p<0.05) difference in CPK activity between the two groups.
There is negative correlation between the age of female carriers and the CPK activity.
9 female carriers (45%) total, (52.94%) of DMD had proximal myopathic EMG changes, which were more prominent in the upper limbs. And there is significant (P< 0.05) difference in mean amplitudes of motor unit action potentials of Biceps Brachii, and Vastus Medialis muscles.
Conclusion: As the CPK and EMG testings are simple, non costly and readily available tests, and as they can be positive to some extent in a proportions of carriers so they can be performed on all possible carriers in the families of DMD & BMD as a simple screening test, especially the CPK, better to perform at an earlier age, and the EMG at an older age because it requires cooperation.
This has a significant impact on genetic counseling, aiming at preventing the spread of this bleak disease.

Keywords: Duchenne, Becker, Musclar dystrophy, Female carriers, CPK and Conventional EMG.

Background: diabetes mellitus (DM ) is associated with a markedly increased mortality rate from cardiovascular and renal disease, not explainable by traditional risk factors. Although data are not yet conclusive, oxidative stress, dyslipidemia, glycemic control and possibly lipid peroxidation has been increasingly implicated in the pathogenesis of diabetic micro- and macrovascular disease. Little is known, however, about the role of copper in type 2 diabetes.
Aim: The present study includes measurement of free radical activity marker (lipid peroxides expressed as malondialdehyde MDA) along with the serum and urine copper, serum lipid profile, glycated haemoglobin (HbA1c) in addition to urinary protein : creatinine ratio in 55 patients with type 2 DM (T2DM) .
Results: The patients were divided according to the spot urine albumin excretion (urinary albumin ug / mg creatinine ratio) into two groups:- microalbuminurics & normoalbuminurics.
The results were compared with those obtained from 37 age-matched apparently healthy control subjects.
There was a significant elevation in serum malondialdehyde MDA , the percentage of

oxidized non high-density lipoprotien (ox. non-HDL%) and serum copper with a significant reduction in the percentage of oxidized high-density lipoprotien (ox. HDL%) in the diabetic patients (particulary in the microalbuminurics) as compared with the control subjects. Serum MDA was significantly and positively correlated with serum copper in microalbuminurics and HbA1c% in both diabetic groups.
LDL size index was significantly increased in microalbuminuric T2DM patients as compared to the controls and normoalbuminurics indicating smaller LDL size in the diabetics in general and in microalbuminuric in particular.
Conclusion: the results of present study suggest an increase in free radical activity , dyslipidaemia and serum copper level favoring atherosclerotic state more in poor glycemic control in type 2 DM particularly in microalbuminurics.
The suggested mechanisms underlying these events are discussed.
Key words: Copper, lipid peroxides, diabetes mellitus., Microalbuminuria

Background: Viral infections are implicated in the pathogenesis of type 1 diabetes mellitus (T1DM) in a number of studies, and playing a role in the initiation of beta-cell damaging process.
Objective: To evaluate the T- cell proliferation in response to enterovirus antigens including coxsackievirus B and poliovirus in addition to adenovirus in an HLA- matched population of children with T1DM and children who were healthy, in addition to screening for specific anti-viral IgG antibodies.
Subjects and methods: A total of 60 Iraqi T1DM children were included in the presents study. They were newly diagnosed diabetics. For the purpose of comparisons, 50 apparently healthy children were selected. HLA typing was measured by microlymphocytotoxicity, while MTT assay was used for lymphocyte proliferation by culturing peripheral blood lymphocytes (PBLs) with Con-A, Coxsackievirus B5 (CVB5), Adenovirus 3, 4, and 7 serotypes, and Poliovaccine. Serum IgG against these viruses were detected quantitatively with an indirect ELISA.
Results & conclusion: No significant differences were shown in the PBL proliferative percentage in response to Con-A mitogen and tested viruses (CVB5 and adenovirus) between T1DM and healthy controls, but PBL proliferative percentage of patients showed a significant decline in response to poliovaccine. Strong T-cell proliferation in response to the tested viral antigens were observed and was related to HLA-DR4 and HLA-DQ3 antigens, whereas the HLA-DR3 and HLA-DQ2 alleles were associated with week responsiveness to the same antigens. High significant mean proliferative percentage for all tested viruses were detected in those patients who were sero-positive IgG as compared to the sero-negative IgG diabetic children.
Conclusion: In children with new- onset diabetes, responses were generally decreased, but higher in children who carried risk HLA- class II alleles and who were sero positive to anti- viral IgG antibodies.

Key Words: T1DM, HLA class II alleles, Lymphocyte proliferation, Anti- CVB5 IgG, Anti- polio IgG, Anti-adeno IgG.

Background:In addition to hypercholesterolaemia and smoking, hypertension, a chronic disease with many cardiovascular complications, is one of the major risk factors for cardiac ischemia, and the main risk factor for cerebrovascular disease. Recent studies have demonstrated some unwanted effects on lipid profile and trace element metabolism caused by antihypertensive drugs.
Aim: To elucidate the role of oxidative stress and lipid peroxidation in hypertension and the effect of different medical therapies on these parameters.
Subjects and methods: The present study included measurement of serum lipid profile, total lipid peroxidation, oxidized HDL ( Ox-HDL), and urinary protein in 69 patients aged 30-70 years . They were three groups according to the type of therapy: (atenelol, captopril & no pharmacological antihypertensives, NPAHT).
The results were compared with those of 45 apparently healthy controls (age range = 30-66 years).
Results: showed a significant elevation in serum malondialdehyde (MDA) and the percentage of oxidized non high-density lipoprotein (OX.non-HDL %) with a significant reduction in the percentage of oxidized high-density lipoprotein (OX.HDL %) as compared to the controls. The disturbance in the oxidant / antioxidant balance happened despite the treatment and blood pressure control showing different pictures with different modalities of treatment, being the best with the captopril.
Conclusion: Hypertensives on different modalities of therapy experienced dyslipidemia, (High triglycerides and small dense LDL particles) and oxidative stress presented by changes in the percents of oxidized lipoproteins especially in those on NPAHT.
The suggested mechanisms underlying these events are discussed.

Keywords: hypertension, lipid peroxidation, ox-HDL. captopril , atenelol

Background: Parkinson's disease is a chronic neurodegerative disorder affects mostly people above 40ys. Studying its prevalence is crucial for health public planning especially as worldwide communities are getting older. There are some worldwide variations in the estimated prevalence rates and the figures are unknown in our country.
Objective: To estimate the prevalence of Parkinson's disease in Al-Kadhimiya district.
Methods: Community-based study was conducted as cross-sectional survey on random sample of the population of the district. Suspected cases of Parkinson's disease identified during home visits were referred to the neurological department at the University Hospital of Iraqi Medical College in order to confirm the diagnosis of the senior neurologist. Diagnosis is made by identifying at least two cardinal features of the disease (resting tremor, bradykinesia, rigidity and postural instability) in the absence of signs of secondary Parkinsonism.
Results: 25 cases of Parkinson’s disease collected from a random sample of 22,988 individuals (13 were males, 23 were females. 6 lived in rural areas
and 19 in urban). Three cases (12%) were newly diagnosed. Tremor was the predominant symptom

of onset (80%). 19 cases had bilateral involvement of the disease, in spite of the unilateral onset of all cases. The crude prevalence rate was 108.75 per 105 populations. Age adjusted prevalence rates showed constant increase with age. Gender-adjusted prevalence rates were calculated for male 114/105 populations and for 103/105 populations. Residency-adjusted prevalence rates were 114,3 and 94,3 per 105 populations for urban and rural living respectively.
Conclusion: Prevalence rate of Parkinson’s disease is just lower than the figures in Europe and North America, but higher than those of Africa and China. It increases constantly with increasing age. There was no significant gender or rural difference in the prevalence rates. The prevalence figure can be applied to the population of Baghdad City because of the similar population structure and characteristics to those of Al-Kadhimiya district.
Keywords: Parkinson disease, prevalence, Baghdad, cross sectional study

Background: Tumor growth and metastases require the development of new vessels (angiogenesis), and the extent of angiogenesis predicts metastases and correlate with early death. Recently developed color Doppler mapping can detect the tumor flow signals in breast cancer and help to distinguish it from benign lesions.
Objective: Evaluation of differences between the blood supply in benign and malignant breast lesions by the use of color Doppler image assessment of the lesions vascularity.
Method: Clinical assessment, ultrasound examination and color Doppler mapping were done for 83 female patients with breast lesions. The following flow data analyses were undertaken; presence or absence of color Doppler signal, number of blood vessels, architectural arrangement and the maximum systolic velocity of blood vessels in the lesions and around it.
Results: Histopathological reveals that 21 cases had carcinoma of the breast and 62 had benign lesions. 27 patients provisionally diagnosed as having malignant lesions; of them 15 cases were truly malignant (sensitivity: 71.5%) and 56 benign one; of them 50 lesions were truly benign (specificity: 80.6%).




An increasing number of blood vessels found in malignant lesions; (85.7%) showed more than 3 vessels in a given lesion, while this figure found only in (8%) of benign lesions. For a cutoff of more than 3 vessels sensitivity and specificity are (85.7%), (91.9%) subsequently.
Architectural differences in the form of penetrating central neoplastic vessels were present in 18 (85.7%) of the malignant lesions with sensitivity (90.4%), while only in 3 (6.1%) of the benign lesions with specificity (93.8%).
The maximum systolic velocity of tumor vessels showed an increasing velocity in malignant lesions, for a cutoff more than 15 cm/s the sensitivity was (90.4%) and specificity was (91.8%).
Combination of the three parameters gave (90.4%) sensitivity and (96.7%) specificity.
Conclusion: Color Doppler imaging considered as an adjuvant primary investigation tool in addition to the ultrasound examination in improving differential diagnosis of breast lesion.
Keywords: Color Doppler, Breast diseases, Benign, Malignant.

Background: Ovarian tissue transplantation is a new method of restoring fertility to women whose ovaries are not functioning normally. Young women who undergo chemotherapy or radiotherapy for cancer face serious consequences to their reproductive health and severely affect the ovarian follicular store, especially.
Objective: the aim of this study was to demonstrate induction of the folliculogenesis from ovarian tissue (OT) transplanted under kidney capsule in the presence or absence of gonadotropins support.
Materials and Methods: Forty-eight healthy female mice were anesthetized and abdominal cavity is open. From one side of the body, small piece (~1 X 1 X 1 mm) of OT was transplanted to the subcapsular membrane of kidney at another side, and surgical operation is closed. Then, female mice were classified into three groups according to the time of gonadotropins injection. Group-1: mice injected with sterile normal saline (control group). Group-2: mice injected with gonadotropins directly for four days. Group-3: mice injected with gonadotropins for four days after eight days of surgical operation. Follicular growth, quality of retrieved ova and histological changes for transplanted OT were assessed.

Results: In general, no deletion for transplanted OT pieces and no side effects post-operation on mice of all groups were recorded. Best follicular growth of transplanted OT was achieved for groups 1 and 2. Graafian follicles were obtained from transplanted OT of group-2, and less degree for group-1. However, least degree for follicular growth of transplanted OT was reported for group-3 as compared to other groups. Immature and mature oocytes with corona and cumulus cells collected by squashing of transplanted OT.
Conclusions: The present data demonstrate that the ovarian tissue transplantation is possible to undergo follicular growth subcapsular of the kidney. Also, physiology of the body supports the ovarian follicular growth in another site other than normal position. Further studies are recommended on in vitro maturation and fertilization of retrieved ova and embryo transfer.

Keywords: Mice, Ovary, Transplantation, Folliculogenesis, Gonadotropin.


Background: Ovarian tissue transplantation is a new method of restoring fertility to women whose ovaries are not functioning normally. Young women who undergo chemotherapy or radiotherapy for cancer face serious consequences to their reproductive health and severely affect the ovarian follicular store, especially.
Objective: the aim of this study was to demonstrate induction of the folliculogenesis from ovarian tissue (OT) transplanted under kidney capsule in the presence or absence of gonadotropins support.
Materials and Methods: Forty-eight healthy female mice were anesthetized and abdominal cavity is open. From one side of the body, small piece (~1 X 1 X 1 mm) of OT was transplanted to the subcapsular membrane of kidney at another side, and surgical operation is closed. Then, female mice were classified into three groups according to the time of gonadotropins injection. Group-1: mice injected with sterile normal saline (control group). Group-2: mice injected with gonadotropins directly for four days. Group-3: mice injected with gonadotropins for four days after eight days of surgical operation. Follicular growth, quality of retrieved ova and histological changes for transplanted OT were assessed.

Results: In general, no deletion for transplanted OT pieces and no side effects post-operation on mice of all groups were recorded. Best follicular growth of transplanted OT was achieved for groups 1 and 2. Graafian follicles were obtained from transplanted OT of group-2, and less degree for group-1. However, least degree for follicular growth of transplanted OT was reported for group-3 as compared to other groups. Immature and mature oocytes with corona and cumulus cells collected by squashing of transplanted OT.
Conclusions: The present data demonstrate that the ovarian tissue transplantation is possible to undergo follicular growth subcapsular of the kidney. Also, physiology of the body supports the ovarian follicular growth in another site other than normal position. Further studies are recommended on in vitro maturation and fertilization of retrieved ova and embryo transfer.

Keywords: Mice, Ovary, Transplantation, Folliculogenesis, Gonadotropin.

Background: Rubella is generally asymptomatic in healthy adult, but during the first trimester of pregnancy often leads to fetal death or severe congenital defect, so it is considered as an important public health problem.
Objective: This study was conducted to determine rubella antibody levels among group of women with normal delivery with their newborn babies and another group of mothers with cesarean section and their newborn babies, and its relation to various epidemiological, medical and obstetric problems
Method: Serum specimens of 166 women with vaginal deliveries and 32 women with cesarean section and their babies were screened for rubella antibody levels by Mico ELISA method.
Result: Rubella antibody levels were < 1.00 (optical density) in 54.2% of women with vaginal delivery (group one) and 71.9% of women in group two (women with cesarean section), Age (significant for group two), mother education, and crowding index were negatively correlated with antibody levels in both groups. Germen measles vaccination had negative correlation with rubella antibody titers in both groups (significant for group one), while weight of newborn babies was significantly correlated with rubella antibody titer among babies in-group two.
Conclusion: Weakly positive antibodies were found to be higher among women and their babies following cesarean section than the group of women with normal deliveries and their babies, negative correlation were found between antibody levels and age of mothers, educational level, crowding index.

Keywords: Rubella antibody levels and mothers at delivery.

Acute promyelocytic leukemia is now the most curable subtype of acute myeloid leukemia in adult .It is characterized by 3 main features which are the presence of abnormal promyelocyte in bone marrow, the occurrence of disseminated intravascular coagulopathy and the presence of classical chromosomal translocation {t(15:17)(q22:q21)} or its variant.
The incorporation of ATRA in the induction over the past 25 years represents one of the most important advances in treatment of AML by inducing more differentiation of leukemic cells into mature granulocytes giving higher complete remission rate and resolution of the life threatening coagulopathy as well as decreases the relapse rate in comparison with chemotherapy alone.
In 1990’s, investigators from China reported that arsenic trioxide (ATO) induces complete remission (CR) in patients with relapsed or refractory APL in 90% of cases by inducing partial differentiation & apoptosis of leukemic cells.
In Al-Kadhimiya Teaching Hospital, we faced such a case of APL who relapsed for second time within 1 year duration of a previously achieved remission, and fortunately we treat the patient with ATO alone that induced CR within 1.5 month duration of treatment then followed by consolidation courses and maintenance treatment to strengthen this remission state that is still existing.

Keywords: myeloid leukemia, acute promyelocytic leukemia, M3 subtype, relapse, all-transretinoic acid, and arsenic trioxide.

Abstract: Moyamoya syndrome is a chronic progressive occlusive cerebrovascular disorder. We present a 41 years old man who had this syndrome, and presented as intraventricular hemorrhage complicated by communicating hydrocephalus. We describe in this report the clinical features and the diagnostic radiological investigations. The patient was treated by a ventriculoperitonial shunt with full recovery.

Keywords: Moyamoya, Intracranial hemorrhage, Hydrocephalus