IRAQI JOURNAL OF MEDICAL SCIENCES

Background: Hemodialysis patients often do not complete their full length of time on dialysis. However, neither the magnitude nor the potential reasons for this problem are known.
Objective: The prevalence and causes of early termination of hemodialysis sessions were prospectively studied at Al-Kadhimiya Teaching Hospital Hemodialysis Unit.
Methods: This unit provided a total of 272 hemodialysis sessions in a three months period to an average of 39 patients.
Results: There were a total of 42 early terminations (15.44%) during this three months period. The most common causes of early termination were chest pain (23.8%), followed by hypotension (16.66%), extracorporeal clotting (11.9%)and a late-start treatment (9.52%).
Conclusion:In sum, approximately 83% of early termination due to medical
and hemodialysis related problems, whereas most of the remainder occurred because of either started treatment late or noncompliance with the dialysis prescription.
This information should be of value when designing programs intended to
reduce the number of early terminations in hemodialysis patients.

Background: Asthma, which is one of the most important chronic disease in pediatric age group, with increase incidence and mortality rate, there are two important factors for occurrence of It, genetic predisposition and triggering factors like cigarette smoking
Objective: to investigate the relation ship between cigarette smoking in the family and the occurrence of asthma in the children (as passive smoker).
Methods: across sectional study was done on 285 patients whose age beginning from few months to above 5yr. they were libeled as having asthma according to repeated attack of obstructive airway manifestation and positive family history of asthma associated with good response to bronchodilator. They were studied for the period between 7th of January to 20th of February 2008 who were attending the pediatric department in AL.kadhimiya teaching hospital, same number of children 285 were taken control group who are free from any respiratory problem.
Results: males were slightly more than female in affected children the percentage was 58.25% and 41.75% respectively...Group A-75% of affected children had positive family history of smoking while in control group 21.43% had positive family history of smoking .in Group B family history of smoking were found in 73.79% of affected and 21.49% of control children . Group C show that67.31% of affected children had positive family history of smoking and 28.57% of control children do so.
in Group D 65.96% of affected children and 35.56%of control had positive family history of smoking .in Group E and Group F positive family history of asthma in affected children were 69.45% and 70.97% respectively.
In all age group there is significant relation between smoking and occurrence of asthma since p value was < 0.05 Conclusion: The study expresses the strong relation ship between occurrence of asthma and smoking as one of the important triggering factor for appearance of asthma

Background: Laparoscopic cholecystectomy is the gold standard treatment for most gallbladder diseases. Identification of group of patients who are at increased (risk) for conversion from laparoscopic (LC) to open cholecystectomy (OC) has proven to be difficult.
The purpose of our study is to identify factors that may be predictive of cases that will require conversion.
Identifying these factors will help the patient,the surgeon, and the hospital.
Objective: To identify the group of patients who are at increased risk for conversion from laparoscopic to open cholecystectomy.
Patients and Methods: In this prospective study, we reviewed 85 patients undergoing laparoscopic cholecystectomy during the last three years (January 1, 2005 to January 31, 2008) at Al-Kadhimiya teaching hospital and Al-Husseiny hospital in Kerbala and recorded reasons for conversion to OC. Statistical analysis was then performed to identify factors predictive of increased risk for conversion.
Results: Of the 85 LC initiated, 18 (21%)required OC for completion. The significant risk factors for conversion to OC were: little experience of the surgeon, male sex patient,increasing age of patients and gall bladder wall thickness >4 mm by preoperative ultrasound image.
Conclusion: The need for conversion to laparotomy is neither a failure nor a complication, but an attempt to avoid complications.
We conclude that no factor alone can reliably predict unsuccessful LC, but that combinations of factors (multifactorial) result in high conversion rates. Patients with the defined risk factors may be counseled on the increased likelihood of conversion. However, LC can be safely initiated for gallbladder removal with no excess morbidity or mortality should conversion be required.

Background: Measurement of Sinoatrial Conduction time from the sinus node electrogram record is an accurate and useful method. It gives idea about the function and integrity of the sinus node.
Objective: To record normal sinus node electrogram as a first experience in Iraq, and obtain normal values of Sinoatrial Conduction Time (SACT), which is measured directly from sinus node electrogram. Then to make a correlation between directly measured SACT from sinus node electrogram and indirectly measured SACT from premature atrail stimulation.
Method: The study was conducted during the period between June 2005 to October 2006 on 70 patients suffering from syncopal or palpitation attacks attending the Cardiac Care Unit in Al-Kadhimia Teaching Hospital. In 62 patients sinus node electrograms were successfully recorded and Sinoatrial conduction time was measured indirectly by both Strauss Method (Premature Atrial Stimulation method), and Narula Method (Continuous Aatrial Pacing Method).
Results: Seventy subjects were undergone cardiac electrophysiological study. Sinus Node Electrogram (SNE) was recorded successfully in 62 subjects and the Sinoatrial Conduction Time (SACT) was measured. In the control group with normal sinus node function (N=33),mean SACT was 81.2 ± 11.6 msec (mean ± SD). In patients (N=29) with sinus node dysfunction, 16 out of 29 mean SACT was 88.2 ± 6.3 msec. In the rest 13 patients the mean SACT was 206.8 ± 14.8 msec., which is significantly prolonged. In 33 subject of the control group, SACT had been measured indirectly using continuous atrial pacing (Narula method) in addition to premature atrial
stimulation technique (Strauss method). The mean SACT were 83.5 ± 13.1 msec. and 82.4 ± 11.7 msec. by Strauss and Narula methods respectively, which indicates no significant differences between the indirect method (Strauss and Narula), from the direct method measured from the SNE (p>0.01).
Conclusion: SNEs that were recorded for the first time in Iraq, in subjects with apparently normal sinus node function, were comparable to the measured values obtained by different world wide laboratories. The significant correlation between the indirect methods [continuous atrial pacing (Narula method) and premature atrial stimulation technique (Strauss method)] and the direct method (SNE) makes SNE a precise method for the measurement of SACT.

Background: The exact cause of preeclampsia is unclear but one of the hypotheses in this regard is that preeclampsia caused by vascular endothelial dysfunction due to increase in circulating free radicals such as lipid peroxides which are determined by malondialdehyde.
Objective: To evaluate the possible involvement of lipid peroxidation in form of malondialdehyde (MDA) in the pathogenesis of pre-eclampsia.
Methods: The present study conducted on a total of 100 Kurdish women in their 3rd trimester of pregnancy admitted to the Gynecologic and Obstetric hospital in Sulaymania city at period of February to June 2007. Maternal blood was collected for determination of basal and post delivery MDA levels of the studied preeclamptic patients and normotensive pregnant controls. In addition, cord blood was collected immediately after delivery from a 25 preeclamptic patients and a 25 normotensive pregnant women delivered by cesarean section.
Results: Statistical analysis reveals that there is significantly higher levels of MDA both in maternal and cord blood of preeclamptic patients compared to normotensive pregnant control (P<0.0025, P<0.015) respectively.
Furthermore, a significant positive correlation between maternal serum and cord blood MDA was found in preeclamptic pregnancies (r=0.59, P<0.0005). A significant increment of basal serum MDA level was demonstrated in normotensive pregnant women delivered by normal vaginal delivery (NVD) (P<0.018). On the other hand, no statistical significant
changes were observed in serum MDA level of normotensive women delivered by cesarean section (P>0.77). Serum MDA in preeclamptic patients rose significantly above the preoperative value within one day postoperatively (1.48±0.55; P<0.01) then tend to fall significantly (0.9±0.46; P<0.02) toward the normal basal level (0.89±0.6) after two days post operatively.
Conclusions: High levels of MDA in the serum of preeclamptic patients and their placenta may play a role in the pathogenesis of preeclampsia.

Background: In Type 1 Diabetes Mellitus (T1DM), numerous changes in the cellular as well humoral immune response have been identified. However, it is not known whether both the CD4+ and CD8+ subpopulation or only
one of these or CD19+ contains increased numbers of activated cells.
Objective: The aim was investigate the expression of CD38 as activated marker on the peripheral blood lymphocytes of T1DM children at the onset of the disease.
Patients and methods: A total of 60 T1DM patients who were newly onset of the disease (diagnosed less than five months) were included in the present study, all the patients were treated with daily replacement doses of insulin. Fifty apparently healthy control subjects underwent the peripheral blood lymphocytes (PBL)phenotyping. Phenotyping of surface antigens was done by direct Immunoflurocent (IF)technique using mouse antihuman CD38.
Results: Increased percentage of activation marker CD38+ cells were observed in T1DM patients (24.72%, 23.83%) as compared with the control group (16.86%, 15.97%) in the age group ≤10 years and >10 years old respectively. These differences were highly significant (P1=0.0001)
between the patients and healthy individuals, but failed to reach a significant level (P2= 0.44)between the patients in both age groups.
Conclusion: A significant elevated percentage of CD38+ activation marker cells were detected in the patients.

Background: Cancer patients show increased susceptibility to thromboembolic disease, as compared with the general population, suggesting that disorders of coagulation are very common in this disease, although clinical symptoms occur less frequently. D-dimer test is simple and sensitive test to detect intravascular coagulation and fibrinolysis in patients with solid malignant tumors.
Objective: To identify those patients suffering from solid malignant tumors complicated with intravascular coagulation and fibrinolysis (ICF) by use of D-dimer, and the interrelation of plasma D-dimer level with histologic type of the tumor and metastasis. Patients and methods: From January to July 2004, a total of 40 patients with solid malignant tumors of various tissues and of miscellaneous histopathologic type and grades.
there were 26 were included in this study, males and 14 females, their age ranged from 36 to 73 years for males and from 38 to 70 years for females. Thirteen of all patients were admitted to Al-Yarmouk Teaching Hospital and the other 27 patients were seen in the Hospital of Radiation and Nuclear Medicine clinics. All patients were to have malignancy, and clinical information including full medical and surgical history as well as laboratory data were included from patients' files and formed the basis of this study. All patients were investigated for an "intravascular coagulation and fibrinolysis syndrome" (ICF) using D-dimer test on blood samples.
Results: The results presented in this study were based on analysis of 40 patients with solid malignant tumors, 26 males (65%) and 14 females (35%),their age ranged from 36 to 73 years for males and from 38 to 70 years for females .
D-dimer concentration in all healthy controls included in this study was negative(i.e. <0.5 μg/ml), and there was a statistically significant difference in the plasma D-dimer concentration between healthy control group and patients with solid malignant tumors (P value =0.002).
All patients were screened for ICF by the use of plasma D-dimer. Twenty two patients (55%) were found to have D-dimer < 0.5 μg/ml (i.e no evidence of ICF syndrome) while 18 patients (45%) were found to have D-dimer ≥ 0.5 μg/ml (evidence of ICF syndrome).
Regarding the rate of positivity of D-dimer,it was more with adenocarcinoma than other types of solid malignant tumors but the differences failed to reach the level of significance (P value 0.18). On the other hand, this rate was more in patients showing distant metastasis and this difference was statistically significant (P value ≤ 0.001).
Conclusion: Plasma D-dimer test forms a good simple applicable test for assessment of ICF syndrome. Positive D-dimer test is higher in patients with solid malignant tumors compared to normal healthy controls and it is higher in patients with metastatic tumors compared to those with localized tumors and in adenocarcinoma in comparison with other histologic types.

Background: Heart rate variability (HRV) measurements are usually performed from ventricular beat- to-beat intervals because of the difficulty to precisely locate the P-wave fiducial point in surface ECG recordings. Intracardiac electrogram can be recorded by pacemaker device. This provides useful signals to measure atrial and ventricular heart rate variability.
Objective: to describe a method which measure the atrial and ventricular heart rate variability using intracardiac electrogram recorded and stored by pacemaker devices.
Method: The study was conducted on 14 patients with dual chamber pacemakers. Those were suffering from intermittent sick sinus diseases or intermittent advanced A-V block attending the Cardiac Care Unit in Al-Kadhimiya Teaching Hospital. The atrial and ventricular intracardiac electrograms were transmitted with the telemetry channel of the pacemaker to an external recorder for 20 minutes. The resultant intervals were used to calculate the standard deviation of all N-N intervals (SDNN), the squared root of the mean squared differences of successive N-N intervals (RMSSD), and the percentage of successive interval differences> 50 ms (pNN50). The differences between atrial and ventricular heart rate variability indexes (HRVIndexes)were assessed for each patient with a cut-off point of 1%. Differences >1% were analyzed in detail.
Results: Fourteen patients with dual chamber pacemakers were included in this study. A total of 18788 heart cycles were analyzed. A manual correction due to false or not triggered atrial or ventricular events was necessary in 0.8%. The overall differences between atrial and ventricular pNN50 was -0.5%±2.1% and differences > 1% were observed in 4 patients. The N-N50 events occurred in the atrial and related ventricular interval in 84%. N-N50 events occurred only the atrium in 6% and only I the ventricle in 10%. The mean differences between atrial and ventricular SDNN and RMSSD were 0.4±2.1 ms and -0.1±3.5 ms with individual differences <1%.
Conclusion: This study describes the utilization of intracardiac electrograms to analyze differences between atrial and ventricular HRV. The differences for pNN50 indicate that ventricular HRV does not reflect the changes of sinus node activity in all patients.

Background: Toxoplasma gondii infection in humans is widespread through out the world, approximately half a billion humans have antibody to T. gondii.
Objective: The present study aimed to isolate and identified the local strain of Toxoplasma gondii from diaphragmatic muscles of naturally infected farm animals (sheep&goat) through studying the localization of the parasite in different organs of experimentally infected albino rats.
Methods:The parasite was isolated from minced diaphragmatic muscles from naturally infected farm animal by digestion with acid–pepsin mixture .Fourteen albino rats were inoculated intraperitoneal with freshly prepared parasite, serodiagnosis was performed for all experimental rats after (6) weeks of inoculation using LAT.
Post mortem examination and giemsa stained impression smears from internal organs were done at the end of the experiment.
Results: Crescent or arc shaped with pointed one end and rounded other end, with typical gliding movements of tachyzoite was the important features of the parasite isolated from digested diaphragmatic muscles of farm animals .Impression smears from internal organs revealed presence of the parasite in,brain;lymph node; spleen; heart; liver; and kidney, and absent in,lung; peritoneum; uterus; and skeletal muscles.
Conclusion: The parasite T. gondii was isolated successfully by acid -pepsine digestion procedure ;and experimentally infection.The most affected organs are, ,brain;lymph node;spleen; heart; liver; and kidney.

Background: Visceral leishmaniasis is a sever and often fatal disease caused by Leishmania donovani .Therapeutic failures have been reported either due to initial failure to respond to treatment or relapse. The extracellular proteolytic activity is one of the several hydrolytic activities described for Candida albicans. Acidic proteinase is an important virulent factor which improved it,s antibacterial activity. From this study we found that this enzyme has an anti leishmanial in vitro.
Objective: To detect anti-leishmanial effect of proteinase enzyme produce by Candida albicans.
Method: C.albicans standard strain (ATCC 10230) was cultured on wheat bran mediun PH 8.5 to produce proteinase enzyme in shaker incubater at 370C. The enzyme activity was determined by using 1% hemoglobin, pH 2.0,
as a substrate16 .The enzyme was precipitated with 0.5% and 50-75% ammonium sulphate consecutively. Leishmania donovani (MHOM/IQ/82/BRC1) was used. Promastigotes were cultivated in RPMI medium, the number of parasites was adjusted to 1x106cell/ml. The crude enzyme (1ml) was added at different concentrations.
Results: Intact proteinase and dilution of 1:2 were found to be effective on the growth of leishmania strain.
Conclusion: Candidal proteinase enzyme have an anti leishmanial activity (promastigote stage) and this may be considered as a good clue for the probability of using this enzyme as treatment agent for this parasite after trying it,s activity on animal models.

Back ground: Trypanosomiasis is one of the transmissible, zoonotic diseases that infect man & animals.
Objectives: The present study was designed to investigate the immunization of adult Balb/mice with the immunomodulatoreLPG alone or mixed with NPGor BCG, by studying the hematological, immunopathological changes and immune response against Trypanosoma evansi infection.
Methodes: 50 male Balb/c mice at (3-4) weeks of age divided in to 5 equal groups, animals of groups 1&2 were considered as control groups,
animals of groups 3, 4&5 were injected 4 times i/p with equal dosage of different biological adjuvant as antigens: LPG, LPG+BCG, LPG+NPG; 20/0.08, 20/0.08+50/0.1, 20/0.08+50/0.25; μg/ml/mice, respectively.
Immunized & +ve control animals were infected with trypanosome evanci by injection of parasite, experiment conducted for 12 days..Hematological parameters were determined using the MS9 .Immunopathological changes were refereed as liver and spleen weight /body weight Immune response detected by using IHA test.
Results: Results revealed a significant variation in hematological, and liver &spleen weight between immunized infected, and non immunized infected animals. The biological adjuvant (LPG alone or mixed with BCG orNPG) had high immunogenic and less toxicity against the experimental infection of Trypanosoma evansi.
Conclusion: The most successful immune responses (increase Ab) was in combination between LPG +BCG.While the more effective in decrease of severity of the disease(hematological & pathological changes)was in combination of LPG+NPG.

Background: Non toxic multinodular goiter had been treated primarily by subtotal thyroidectomy, but the high incidence of recurrences and the higher risk of morbidity following a second operation lead to the introduction of total thyroidectomy as an alternative procedure.
Objectives: To compare the safety and the efficacy of total thyroidectomy with subtotal thyroidectomy for treatment of nontoxic multinodular goiter.
Methods: Six hundred forty cases were assessed preoperatively clinically and biochemically by thyroid function tests, U/S of the neck & thyroid scan, serum calcium level, indirect laryngoscopy,x-ray of the soft tissue of the neck and thoracic inlet, Chest x-ray and ECG. 494 cases were treated by total thyroidectomy, 146 cases were treated by subtotal thyroidectomy.
Results: Total thyroidectomy was conducted in 74% of the cases while only 26% of patients underwent subtotal thyroidectomy. Temporary recurrent laryngeal nerve palsy occur in 3% of cases in the first group and 0.6% in the second group. Permanent recurrent laryngeal nerve palsy was not reported in both groups. Temporary hypoparathyroidism was reported in 6.9% of the cases in first group and in 2.7% of the cases in second group. In first group 1.4% of the cases develop permanent hypoparathyroidism, while no case of the second group developed this complication. Only one patient (0.6%) of the subtotal thyroidectomy group developed immediate post operative hemorrhage that needs urgent reexploration which was not reported in the total thyroidectomy group. Acute laryngeal edema occurs in 0.6% of the cases in the first group and in 1.4% of the cases in the second group.
Conclusion: Total thyroidectomy had been found to be safe with comparable rate of complications with subtotal thyroidectomy as primary management of bilateral nontoxic multinodular goiter.

Background: The testes are paired organs that lie within the scrotal sac which is subdivided into two compartments by the scrotal septum,and supported by the tunica vaginalis, which is formed of 2 layers. In most normal subjects,small amount of fluid (1-2mL) can be seen within the leaves of the tunica vaginalis. Hydrocele is exist when an excessive amount of fluid is present. Hydrocele is divided into congenital & acquired. Virtually all hydroceles are congenital in neonates and infants, whereas most of the acquired causes of hydrocele are idiopathic. Other causes of acquired hydrocele include: infection, tumors, trauma, and torsion and trradiation therapy. Hydrocele is the most common cause of painless scrotal swelling.
Objective: to determine whether there is an effect of hydrocelectomy on testicular size in adult patients with unilateral idiopathic hydrocele.
Patients and Methods: This prospective study was done in the ultrasound unit of ALkadhimyia teaching hospital from the period of July 2006 to November 2007. Thirty three patients with a mean age of 35.8 years who had unilateral idiopathic hydrocele and who underwent unilateral hydrocelectomy were included in the study. The ultrasound examination was done in the supine position & included the preoperative evaluation of the hydrocele, & assessment of the testicular volume of the involved and uninvolved sides before and after surgery. Calculating the testicular volume from the formula: volume = length × width × depth × 0.52.
Results: a statistically significant differences in the testicular volumes between the normal side (mean ± SD, 18.42± 2.02 mL) and the side with the hydrocele (23.23± 2.31 mL) before surgery (p < 0.001), and in the volumes in the side with the hydrocele before (23.23± 2.31 mL) and after (17.77± 2.22 mL) surgery (p <0.001). No such difference in volume was seen in the normal side before (18.42± 2.02 mL)and after (18.46± 2.05 mL) surgery (p =0.200). Also no significant difference in the testicular volumes of the normal side (18.46± 2.05 mL) and the side with hydrocele (17.77± 2.22 mL) after surgery (p = 0.150). The mean reduction in volume in the testis with the hydrocele after hydrocelectomy was 23.22%.
Conclusions: There is an association between the development of an idiopathic hydrocele and testicular size. We believe that the increment in the volume is due to an increase in the impedance to venous and lymphatic flow. Surgeons should be aware that there is a decrease in testicular volume after hydrocelectomy so they do not misdiagnose this change as post-operative trauma or atrophy often in correlation with clinical symptoms, clinical examination & assessment.

Background: Rubella is an acute febrile illness that affects children and young adults. However, infection during early pregnancy may result in serious abnormalities of the fetus. Live attenuated vaccine controls rubella infection in industrialized countries.
Objective: To determine the antibody response to rubella virus in seropositive volunteers after vaccination with live attenuated rubella vaccine.
Methods: Fifty two rubella virus seropositive volunteers have been included in the study, their ages ranged between 15-45 years. 26 of them were vaccinated with rubella vaccine and the rest were injected with diluent supplied with the rubella virus vaccine (placebo).
Antibodies against rubella virus were detected in volunteer's sera prior to, one and four weeks after vaccination, using ELISA method.
Results: There was elevation in the serum antibodies after vaccination. The Optical Density (OD) readings were 1.69 and 2.02 during first and fourth week respectively. Data analysis showed that there was a significant difference of OD value among seropositive vaccinee. And there was a significant elevation of serum antibody in the first week, but the fourth week had very high OD readings, which may reflect an increase in the concentration of antibodies.
Conclusion: Rubella vaccine was safe, and effective, and there was an elevation in serum antibody titer among vaccinee.

Background: CA19-9 has been regarded as an important tumor marker that is related to the presence of colon and rectal tumors.
Objective: To determine the concentration of serum CA19-9 and immunoglobulins in patients with benign and malignant colotrectal tumors, in addition to the determination of the correlation coefficients between the concentrations of CA19-9 and the different types of immunoglobulins.
Materials & Methods: Patients: The subjects were 31 patients with malignant colorectal tumor, 31 patients with benign colorectal tumor and 31 volunteers healthy subjects.
Methods: The determination of the total concentrations of CA19-9 was carried out according to the procedure of IRMA, while the determination of the concentrations of immunoglobulins (IgA, IgM and IgG) was carried out using the radial immunodiffusion method RID.
Results: Results of the present study showed that the concentration of serum CA19-9 was significantly elevated in patients with stages B, C and D (modified Duke classification) of colorectal carcinoma, while there was no significant variation in the concentrations of CA19-9 in sera of patients with benign lesion in comparison with control individuals. The results also showed that there was a significant correlation coeficient (r = 0.875) between the concentration of serum IgA and that of CA19-9 in patients with malignant tumors.
Conclusions: The humoral immunity, reflected by immunoglobulins was characterized by an increase in IgA level in serum of patients with colorectal carcinoma and this was concomitant with an increase in serum CA19-9.