IRAQI JOURNAL OF MEDICAL SCIENCES

Background: The aetiology of breast cancer is multifactorial, in which genetic predisposition; environmental factors, hormones and even the infectious agents are thought to interact in the manifestation of disease. In this regard, alleles of HLA are important immunogenetic risk factors, but their associations show different frequencies in different populations.
Objectives: This study was established to shed light on the possible association of HLA class I alleles with BC in Iraqi female patients.
Subjects and Methods: The study included 60 subjects: 30 breast cancer patients, 12 patients with benign breast lesions as first control and 18 apparently healthy subjects as second control. Polymerase chain reaction-specific sequence primers (PCR- SSP) assay was conducted to assess HLA- typing.
Results: Out of 95 HLA class I alleles (A= 24; B= 48; C= 23), one allele (HLA- A*03010101-07, 09-11N, 13-16 allele) showed a significant variation between breast cancer patients and control groups (healthy and disease controls) (50% vs. 16.6%, OR=5, EF= 0.40, P= 0.041), (50% vs. 8.3%, OR=11, EF=O.45, P=0.024) respectively.
Conclusions: The results demonstrated that HLA- A*03010101-07, 09-11N, 13-16 allele may played a role in the etiology of the disease.

Keywords: Breast cancer, HLA, PCR.

Background: Helicobacter pylori cause gastric inflammation. Recent interest has been focused on the role of CD74 (the class II MHC-associated invariant chain expressed on the surface of gastric epithelial cells) as an adhesion molecules used by H.pylori that may contribute to the proinflammatory immune response seen during infection.
Objective: The aim of this study was to detect the CD74 mucosal expression in H.pylori infected patients and compare it with uninfected patients.
Patients and Methods: Sixty-four patients’ age mean (34± 1.7) years (14-66 years) who underwent upper gastrointestinal endoscopy because of gastrointestinal complaints, were studied.
A number of both invasive and non-invasive diagnostic tests were used for the diagnosis of H. pylori infection, as well as immunohistochemical study of biopsy specimens to detect the CD74 mucosal expression.
Results: After the diagnosis of H.pylori infection, patients were grouped as H. pylori positive,(n=47)and H. pylori negative (n=17). According to immunohistochemical study of biopsy specimens, the expression of CD74 was observed in infected subjects, and there was a significant difference in the CD74 expression (p= 0.005) between infected and uninfected patients.
Conclusion: According to immunohistochemical study of biopsy specimens an overexpression of CD74 was observed in infected subjects
Keywords: Helicobacter pylori; CD74; gastric epithelial cells; Immunohistochemistry (IHC)

Background: Antisperm antibodies (ASAs) have a main role in the immunological infertility. Antisperm antibodies negatively affect sperm movement and interfere with fertilization and may cause abortion .
Objective: to Investigate the occurrence of antisperm antibodies in sera of men and women and their role in fertilizing capacity.
Method: Sixty men and thirteen women were involved in this study . Indirect immunofluorescent test kit was used . As a counterstain , Evans blue pigment was used . The fluorescent microscope was used . For sixty males, seminal fluid analyses were performed. For thirteen females, direct microscopic vaginal tests were done.
Results: Forty five men (75%) and ten women (76.9%) showed positive reactions and antibody titres were either 1/10 or 1/32 .
Conclusions: Serum antisperm antibodies play a significant role in autoimmune infertility and should be treated.

Keywords: serum, antisperm antibodies, infertility, immunity

Background: Female fertility are affected by several factors including microbial and non microbial agents. Microbial infection is one of the most important causes for female infertility. The level of pathogenicity of microbial infections are affected by wide range of factor including age, physiological status, phase of menstrual cycle and race.
Objective: Comparison between bacterial vaginosis (B.V) and candidiasis in relation to Estradiol (E2) level and vaginal pH in some infertile Iraqi women
Methods: The study population was a subset of 109 infertile women attending Institute of Embryo Research and Infertility Treatment at Baghdad University, throughout the period from June till November 2004. Those infertile women were subjected to clinical examination by measuring vaginal pH, vaginal swabs collection to diagnosis of B.V using Amsel clinical criteria beside various micro-biological methods and diagnosis of candidiasis using mycological methods and serum collection from aspirated venous blood at late follicular phase for detection of E2 level.
Result: Forty eight infected infertile women were diagnosed with B.V from 109 infertile women. In those women the Estradiol mean was 41.17 Pg/mL near to lower limit of normal range of E2 level ( 18-147 pg/mL) and lower than E2 mean of healthy control group 132.5 Pg/mL in this study and most of them 93.75% had vaginal pH greater than 4.5. 24 cases with candidiasis were diagnosed from 109 infertile women. In those women the E2 mean was 183.2 Pg/mL higher than upper limit of normal range of E2 level and higher than E2 mean of healthy control group and candidial infection occur in normal pH range of 3.5 to 4.5
Conclusions: The results of the present study appeared that the hormonal disturbance which was associated with different infertility conditions may be predisposing factor in development of B.V and develop candidiasis among infertile women.
Elevated vaginal pH in infertile women who had B.V could be due to estrogen deficiency while normal pH in candidial infection because estrogen hormone increases cellular glycogen content which favors growth of Lactobacilli that metabolize glycogen to lactic acid and then producing an acidic environment.
Kay words: Bacterial vaginosis, candidiasis, Estradiol level, infertile women

Background: There has been an increasing appreciation of the high prevalence of celiac diseas around the world and efforts are continuing to clarify the variable diagnostic problems of the disease.
Objective: We tried to throw light over some of these problems in a group of Iraqi children.
Methods: Ninety-three patients with features of malabsorption were evaluated for celiac diseas, by assessing serum IgA tTG, both IgG & IgA AGA, serum IgA level and a small intestinal biopsy.
Results: Fifty-eight out of ninety-three patients proved to have celiac diseas according to the histopathological picture. Sensitivity of serological tests in general ranged between 50- 77%, but tTG was 100% specific. Patients with more severe histopathological changes showed more serological positivity and higher antibody titers.
Eleven cases of Giardiasis were diagnosed (on biopsy specimen) out of the whole sample, giving variable histopathological changes & serological responses.
Conclusion: celiac diseas is a prevalent problem in Iraqi children. We share with other countries the diagnostic problems of the disease, but there seems to be some additional aspects, that are peculiar to developing countries, implying the need for diagnostic strategies specific to these areas.

Key words: celiac disease, serological tests, histopathology

Background: Modern haematology analyzers are able to produce platelet counts with great precision and accuracy. However, in certain cases these analyzers produce erroneous platelet results.Therefore, the estimation of platelet count from blood smears should be syste¬matic each time the automated count is erroneous. However, in comparison with the procedure for an automated count, the examination of a blood smear using a counting Neubauer chamber is a labor-intensive and therefore relatively expensive investigation.
Objective: Verification of the reliability of the estimation technique of platelet count on the basis of red cell: platelet ratio.
Material and Methods: In the period between January 2006 and March 2006 one hundred platelet counts were executed in the National Center for Haematological Diseases by two laboratory methods: an automa¬ted count using an impedance cell counter and then a manual method by reviewing microscopic blood smears. The number of platelets per 1000 erythrocytes was multiplied by the automated RBC (x106 cells/µl) to give an approxima¬te manual count (x103 cells/µl). Two-paired t-test was used for comparison of the two methods.
Results: Platelet count using the manual method was as follow: the range was 100-499x103/µl, the mean count was 263.11±104.07 x103/µl, and the median was 247.5 x103/µl. using the automated method, platelet count ranged between 95-484 x103/µl, the mean was 258.43 x103/µl, and the median was 242.5 x103/µl. There was no significant difference in results of platelet count using both methods (P<0.05). Regression analyses gave the following equation by comparing the automated (y) to the manual method (x): y=0.9893x - 1.8621 (r= 0.966). The paired t-test showed no significant difference between the two methods (p<0.05). The ICC was equal to 0.988. The plot of the differences between the automated and manual values against their means showed that the difference mean was 2.116 with a standard deviation SD= 40.215. It was noticed that 93% of the differences were within the agreement limits (mean±2SD).
Conclusion: Red blood cell:platelet ratio method requires only an accurate RBC count performed on a calibrated hematology analyzer to calculate platelet count. This method is precise, simple, and consumes less time than using a counting chamber, and therefore, potentially should supersede ordinary manual counting.
Key words: red cell: platelet ratio, platelet count

Background: Worldwide efforts for measles elimination are made possible due to the availability of highly effective measles vaccine. In spite of that, there is high percentage of unvaccinated children in our country-making outbreak of measles easy and highly occurred.
Objective: To identify the outbreak of measles in AL-Kadhimiya-Baghdad and its common complications with fatality causes and rate.
Patients and methods: Cross-sectional study was conducted during the period between 20 th December 2008 to 30 th April 2009 on 494 patients with measles attending AL-Kadhimiya Teaching Hospital ,AL-Kadhimiya Hospital for pediatrics and two Primary Health Center (Al-Shaheed Basher Al-Jasaery Primary health center in AL-Shaula city and Al-Noor Primary health center in AL-Jawaden city)and they were divided into four group according to their age which were (below 1 year ),(1-4yr ),(5-9yr)and above 10 years ,regarding immunization status was assessed by examining the immunization card or parental inquiry on this regard.
Result: Male are nearly equal to female (49.80 %)and (50.20 %) respectively. Of 494 reported cases 97 (19.64 %) were under one year of age and 287(58.97 % )were 1-4 years old and this mean that more than two-third 384 (78.61 % ) of patient were under 4 years ,small group (10.53 %) were vaccinated against measles .Complications were Pneumonia, Diarrhea and Vomiting, Croup and Encephalitis ,in (83.85 % ) ,(11.46 %) , (2.60 % ) , (2.09 % ) respectively. Mortality rate was (2.43%) which occured most commonly in age group below 5 years (91.7 %) and slightly more in male (58.4 %) than female (41.6 %) causes of deaths were pneumonia (83.4 %) and encephalitis (16.6 %).
Conclusion: This outbreak of measles demonstrates the increased susceptibility of unvaccinated children who are below 5 years old .Pneumonia, Diarrhea and Vomiting, Croup and encephalitis are complications of measles and higher mortality rate occur in male sex and younger age group, (below 5 years old).
Key words: measles, vaccine, outbreak, complications, children.

Background: The levels of reactive oxygen species are normally limited by antioxidant defense mechanisms such as vitamin C and E that are present within seminal plasma and sperm plasma membrane. The Supplementing infertile males with antioxidant vitamin C and E is suggested as a potential treatment for idiopathic male infertility.
Objective: This study was designed to determine the effect of Ham's F-10 preparation medium supplemented with antioxidant vitamin C or E on semen samples prepared by conventional layering technique.
Methods: Liquefied semen (1ml) was layered beneath Ham's F-10 (1ml) enriched with 0.75 mg/ml vitamin C or E after in vitro sperm processing. However, semen samples were collected from a total of 60 asthenozoospermic men by masturbation after 3-5 days abstinence and allowed to liquefy at 37ºC in 5% CO2 for 30 minutes and evaluated according to standard world health organization (WHO) criteria before and after in vitro sperm activation. The semen samples were divided into three groups, one group considered as a control group which had no antioxidant added, and the other two groups were prepared in the presence of antioxidant treatment (either vitamin C or vitamin E).
Results: The supplementation of sperm preparation medium with vitamin C or vitamin E significantly (P<0.001) improved and augmented the seminal parameters including sperm concentration, sperm motility, progressive sperm motility, and normal sperm morphology when compared to that of the control group.
Conclusion: It was concluded that supplementation of medium with antioxidant vitamin C or E actually improve sperm quality, but the better improvement appeared to be with vitamin C.

Key words: Antioxidant, vitamin C, sperm preparation technique, asthenozoospermia

Background: shigella spp. reported to be the second commonest bacterial agent responsible for childhood diarrhea after E.coli.Currently, isolation of the bacterium and confirmation of the diagnosis by bacteriological and biochemical methods remains the "gold standard".
Objective: To determine the prevalence of shigella spp. among children below 3 years with acute diarrhoea and susceptibility of the isolates to commonly used antimicrobials.
Methods: This study was carried out in the outpatient's clinic of Children Central Teaching Hospital in Baghdad from May 2007 – April 2008. One hundred and fifty children below 3 years with acute dirrhea were the source of stool specimens to detect shigella spp.All isolates were diagnosed according to bacteriological and biochemical standard methods. Available antimicrobial were used to determine the susceptibility of isolates to antibiotics.
Results: Shigella flexneri type 2 was the predominate serotype out of 9 isolates.The prevalence of shigellae isolates was significantly higher in children older than one year .All patients were on artificial feeding, 78% were using untreated water for drinking. All isolates were sensitive to ceftriaxone , ciprofloxacin , nalidixic acid, norfloxacin and gentamicin. Drug resistant to 3 or more drugs was found in 56% of the isolates.
Conclusion: Shigella flexneri type 2 was the predominate serotype and most isolates were resistant to trimethoprim -sulphamethoxazole (89%).

Keywords: Shigellae , Diarrhoea, Antibiotic, Children, Iraq .

Background: A tattoo is made of particles of pigment injected into the skin. Although the body attempts to remove them, the particles of tattoo are too large to be removed and the body responds by encapsulating the whole tattoo in a wall of collagen that traps it within the skin permanently.
Objective: to evaluate Nd-YAG laser effects for removing tattoo.
Materials & Methods: The study was done on 99 tattoo lesions (in both genders) on different parts of the body (hand, foot, face and chest), ages were between 21- 60 years, and most common age group was between 20-30 years. In this work, tattoo were divided according to its colors, into black, blue, green, and red (The red color always shares with other colors), and each subdivided to amateur and professional tattoos. Quality-switched (Q-switched) 1064 nm, Nd: YAG laser, pulse width of 10 nanosecond and repetition rate (R.R) 5 Hz with different fluencies (energy/area) was used. These parameters were used for black, green, and blue tattoos. To red color tattoo 532nm Nd: YAG Q-switched laser, 7 ns pulse duration, R.R 10Hz, fluencies from 7.3 -10.3 Joule/cm2 was used. The exposure time needed for treatment was from 2-5 min. according to the size of tattoo. Time interval between two sessions was from 3-4 weeks.
Results: Black and blue color tattoo removed rather completely with faint shadow. Red color tattoo removed completely. For green color tattoo there was no responses. In this study the treatment with Q-switched Nd: YAG laser offers bloodless, low-risk, no permanent complication, no scarring, and no disfigurements in skin.
Conclusion: Laser use is considered standard treatment for patient seeking tattoo removal.

Keyword: Tattoo/ Q-switched Nd: YAG laser/ Fluencies.

Background: Hyaline membrane disease ,one of the commonest cause of sever respiratory distress early in life ,which is caused by surfactant deficiency is described not only in preterm infant but also in near term babies after cesarean section .
Objective: The study aimed to identify the occurrence of hyaline membrane disease following cesarean section (cs) in AL-Kadhimiya Teaching Hospital.
Patient and methods: The study was conducted during the period between 1st January-30 April 2009, on 372 neonate born in AL-Kadhimiya Teaching Hospital .All patients were singletons, their gestational age between 37-40 weeks, and their body weight >2.5 kg. They were grouped into 3 groups according to the mode of delivery, normal vaginal delivery (NVD), emergency or elective CS.
Result: Males were affected more than females (14.1%&9.2% respectively), occurrence of hyaline membrane disease was much higher after delivery by CS(18.5%)., than after NVD (4.76 %).There was little difference in the occurrence of hyaline membrane disease between emergency and elective CS and the lower the body weight of the neonate the more the occurrence of hyaline membrane disease was noted.
Conclusion: Normal vaginal delivery has a possible protective effect against hyaline membrane disease as the frequencies of it’s occurrence was noticed to be less in normal vaginal deliveries than in cesarean section deliveries.

Key words: Hyaline membrane disease, normal vaginal delivery, cesarean section ,elective ,emergency .

Background :Urethral reconstruction in failed hypospadias poses a significant challenge. We report our experience using tabularized incised plate method in distal type of hypospadias and excision of fistulous tract with dartos flab in more proximal types of hypospadias.
Objective: To retrospectively review our experience in a series of re-operative hypospadias repairs for distal and proximal types of hypospadias repair failure.
Materials and Methods: Between December 2006 and June 2009, 27 children (mean age 4.8 years, range 2 years to 11 years) were referred for re-operation of failure of hypospadias repair. The patients were divided into 2 groups; group1 (20 patients) with distal and midshaft hypospadias. In these cases, the Tubularized incised plate (TIP) urethroplasty was covered with an additional layer of subcutaneous tissue or dartos flap. Group 2(7 patients) with proximal shaft or penoscrotal hypospadias types that were complicated with fistula formation, excision of the fistula tract was done with closure with interrupted sutures and a second layer covering (dartos) was performed
The original location, associated complications and results were recorded.
Results: for group 1 There were 5 (25%), incidences of complications of TIP re-operation, 3 meatal stenosis, one stenosis with small fistula and one dehiscence. Re-operation was necessary in only one patient of our series (7.6%) and the others were cured by dilatation.
Group 2: 2 patients out of 7(28.5%) had failure of repair with persistence of the fistula that required reoperation
Conclusion: for distal type Hypospadias using TIP urethroplasty as described by Snodgrass, is a suitable method for treating primary and re-operative cases. While for more proximal hypospadias closure of the defect and a second layer covering to prevent fistula is a viable option treatment.
Key words: urethroplasty; hypospadias; urethral plate; tubularized incised plate (TIP)

Background: patients with genetic deficiencies of plasma coagulation factors exhibit life-long recurrent bleeding episodes into joints, muscles and closed space, either spontaneously or following an injury.
Objective: The present study aimed to determine the socio-demographic characteristics of patients with congenital coagulation disorders.
Methods: A cross-sectional study was conducted at the Centre of Congenital Coagulation Disorders in the Al-Mansour Pediatric Teaching Hospital in Baghdad for the period between 1st of March to 31st of August 2008.
The study sample was comprised of 243 patients with different congenital coagulation disorders who attended the Centre during the study period.
Data were collected through well structured questionnaire form introduced only by the researcher by interviewing with the patient or his/her relative or care giver.
Results: showed that hemophilia and Von Willebrand Disease (VWD) constituted the majority (90.1%), of the studied sample
The mean age of all patients was 14.31 ±10.42 years. About 77% of patients were from Baghdad governorate. Some families (15.6%) of the studied patients had three or more members with congenital coagulation disorders. For those patients aged ≥7 years, 41% of them had not attended or left school due to their disease. For those patients aged ≥18 years, 68.4% of them were unmarried, and 45.07% of them had no work due to their disease. Treatments were available to the majority (97.1%) of patients
Conclusions: The features in this study were similar to other studies in Mediterranean region and Western countries, except that the mean age of patients in this study was lower than that in other studies, blood groups showed no significant effect on types of congenital coagulation disorders, the disease showed adverse effects on all levels of education of patients
Key words: Study of Congenital coagulation disorders in Baghdad city

Diverticula of the male penile urethra are rare clinical entities. Urethral diverticula in males may be associated with trauma, infection, impacted calculi or stricture disease. Here in, we present an unusual case of a 55-year-old man with and a symptomatic urethral diverticulum after endoscopic urethrotomy for a bulbar urethral stricture. Surgical repair involving urethral stricture excision, end-to-end primary urethroplasty, and closure of the diverticular neck, the patient is voiding well but has persistent erectile dysfunction unresponsive to phosphodiesterase-5 inhibitors.

Keywords: urethral diverticulum, urethroplasty, stricture

Torsion of the gallbladder is a rare condition that is generally due to an abnormal anatomical variation, i.e., the presence of a long mesocyst with loss of fixation of gall-bladder to the inferior margin of the liver. The clinical features closely mimic those of acute cholecystitis. In any case, the definitive diagnosis is made during surgery (1, 2).
Keywords: Torsion gallbladder- Laparoscopy - Acute cholecystitis