IRAQI JOURNAL OF MEDICAL SCIENCES

Background: Human Respiratory syncytial virus (HRSV) is one of the major causes of severe bronchiolitis and pneumonia in infants.
Objective: Isolation of virus from specimens from infants with severe bronchiolitis and pneumonia, and study the histopathological changes in laboratory animals.
Methods: Specimens collated from infants with lower respiratory tract infection were tested with Respi-Strip kit for the presence RSV antigens; the positive samples were inoculated in HEP-2 for 6-7 passages, and using neutralization test and fluorescent antibody techniques for detection of the isolated virus.
Also 20 mice's 10 weeks old divided into 2 groups one inoculated by dropped in nasal 0.5 ml of 100 TCID50/ml and the other 0.5 ml media as control. The lungs removed for histopathology study and the isolation of the virus in 2-7 days after inoculation.
Results: The Human RSV was successfully isolated in HEP-2 cell line from five specimens collected from infants with respiratory tract infection, previously tested for presence of RSV antigen by using Respi-Strip kits, where viral cytopathic effect (CPE) was first detected on 3rd passage with characteristic giant cell or syncytia type formation after 3 days post inoculation. Viral isolates were identified by using homologous reference antiserum by applying indirect immunofluorescent technique (IFAT) and neutralization test (NT). Experimental infection of mice with the isolated virus revealed histological changes in infected lung mainly characterized with evidence of acute interstitial pneumonia; in addition viruses were re-isolated from infected lung specimens after 2-7 days of experimental infection.
Conclusion: Human RSV replicated well in HEP-2 and cytopathic effect appeared in passage three, also the virus can be isolated and cause pathologic change in lung of infected mice.
Key words: RSV, HEP-2, Neutralization test.

Background: Cytokines have been used as biomarkers in research for prognosis and have been associated with symptoms and adverse outcomes in multiple conditions, including breast cancer.
Objectives: To estimate the concentration of IL-1-α and TNF-α in serum of breast cancer (BC) patients compared with control groups and to detect if there is association of serum levels of these interleukins with disease development.
Subjects and Methods: The levels of IL-1-α and TNF-α were measured by ELISA method in sera of 45 BC patients, 12 patients with benign breast lesions and 23 apparently healthy controls.
Results: Present study was demonstrated that IL-1-α and TNF-α levels were significantly elevated in serum of BC patients as compared with controls (p<0.001), this elevation were significantly associated with poor prognostic factors including advanced stage and estrogen and progesterone receptors-negative status.
Conclusions: Evaluation the serum level of IL--α1and TNF-α may be helpful as predictive non-invasive tests for tumor development in breast cancer patients.
Keywords: Breast cancer, IL--α1, TNF-α.

Background: This is a cross-sectional, clinical study, implemented in the Department of Otolaryngology / Sulaimani Teaching Hospital; from July 15th 2004 to April 15th 2005.
Objectives: The aim of the study is to describe the demographic characteristics, aetiological factors and therapeutic measures for epistaxis in Sulaimani region, to improve our experience in the management of this common condition.
Methods: This study included 100 patients of different age and sex who attended ENT department during the period of the study.
Results: At the end of the study we found that most cases of epistaxis can be treated by simple measures like application of lubricants to nose, or cauterization and anterior packing.
Conclusion: Active intervention should be done when indicated.
Keywords: epistaxis, lubricants, cauterization, anterior packing, active intervention.

Background: Hematological values at birth encompass broader ranges of normal than at any other time in life, and despite advances in perinatology over the past years, the exact influence of perinatal factors on hematological values in cord blood in normal pregnancy is still unclear. Moreover there was a wide variation and overlap in values between normal and abnormal infants with early symptoms and signs of neonatal sepsis.
Objectives:
1. To obtain the values of hematological parameters including complete blood picture, red cell indices, nucleated red blood cells and reticulocyte count in healthy full-term neonate and compare these values in neonates delivered by normal vaginal delivery and those delivered by cesarean section whether as elective or emergendy cesarean section.
2. To evaluate the effect of the gestational age, duration of rupture of membrane, duration of labor, Apgar score and birth weight on some hematological parameters.
Subjects, Materials & Methods: A total number of 300 healthy full term newborn were included in this prospective study. They were delivered in Al-Kadhimiya Teaching Hospital / labor room from October 2007 to January 2008. Those newborns were categorized into three groups, including those delivered by normal vaginal delivery (n = 200), by elective cesarean section (n = 80) and by emergency cesarean section (n = 20).
From each newborn 5 ml of venous cord blood was aspirated, and the estimation of hematological parameters was performed by Sysmex (automated hematology analyzer). Calibration of the analyzer was performed manually. Additionally the blood film was stained with Leishman,s stain and differential count was done for each slide and reticulocyte count was done by standard method using brilliant cresyl blue stain.
Statistical analysis were done by students t test and correlation test taking P value < 0.05 as the lowest limit of significance.
Results: This study revealed that the total white blood cells and absolute neutrophil count were significantly lower in those delivered by elective cesarean section compared to those delivered by normal vaginal delivery (NVD) and emergency cesarean section (CS/L)
Moreover the reticulocyte count and nucleated red blood cells of neonates delivered by ECS and NVD were significantly lower than those delivered by CS/L, while the red distribution width (RDW) was significantly lower in those delivered by NVD than those delivered by ECS and CS/L.
Whereas the duration of rupture of membrane before delivery, duration of labor, gestational age, birth weight and Apgar score had no influence on cord blood hematological parameters and there was no statistical difference between the three groups.
Conclusion:
• This study revealed the total WBC count and absolute neutrophil count in those delivered by ECS were significantly lower than those delivered by NVD and CS/L.
• The mode of delivery had an influence on RDW in that neonates delivered by NVD had significantly lower RDW than those delivered by ECS and CS/L (p < 0.05).
• The mode of delivery had an influence on nucleated red blood cell (NRBC) and reticulocyte count in that neonates delivered by ECS and NVD had significantly lower NRBC and reticulocyte count than those delivered by CS/L (p < 0.05).
• The mode of delivery had no statistically significant effect on: lymphocyte, eosinophil, monocyte, RBC, Hb, PCV, MCV, MCH, MCHC, platelet, PDW and MPV.
• Duration of labor, duration of rupture of membranes before delivery, gestational age, Apgar scores and birth weight had no influence on cord blood hematological parameters.

Key words: Haematolgical parameters; mode of delivery; newborn.

Background: Chronic Myeloid leukemia (CML) is a myeloproliferetive disorder associated with chromosomal abnormality, Philadelphia chromosome (Ph), in more than 95% of CML patients. The resulting BCR-ABL fused gene is markers for this type of leukemia. In CML, the product of the fused BCR-ABL gene is typically an oncoprotein termed P210BCR-ABL, a constitutively active tyrosine kinase, activates numerous signal transduction pathways, leading to uncontrolled cell proliferation and reduces apoptosis.
Objective: Primary diagnosis of CML patients by screening the presence of BCR-ABL protein in patients' venous blood lymphocytes using immunocytochemistry technique (ICC).
Method: A total of 42 CML patients, 10 Acute Lymphoid Leukemia(ALL) patients, 2 Acute Myeloid Leukemia (AML) patients, 1 Chronic MyeloMonocytic Leukemia ( CMML) patient and 8 healthy individuals were screened. Lymphocyte was separated from heparinized venous blood sample from each subject, smeared and fixed on positive charged slides. Monoclonal antibody specific for BCR-ABL protein was used as primary antibody.
Results: The results showed that all the 42 cases of CML were positive for BCR-ABL protein and all the other cases were negative.
Conclusion: The results indicate that the Immunocytochemistry assay has clinical application as a primary qualitative diagnosis tool of BCR-ABL protein.
Key words: BCR/ABL protein, CML- Immunocytochemistry.

Background: Preeclampsia is a form of high blood pressure manifested during pregnancy; however, its etiology is unknown. Also, the status of ionized calcium (Cai) during pregnancy and its complication preeclampsia have not been described adequately. In addition to calculation method described for Cai, the calcium-binding dye murexide has become a widely-used tool for measuring changes in the ionized calcium (Cai) concentration in biological systems.
Objective:to demonstrate the level of Cai during preeclampsia with respect to normal pregnancy; and to demonstrate the correlation between calculated Cai and actual Cai.
Subject and methods: the present study is a case-control study conducted during the period from February 2007 until the end of June 2007, which includes measurement of total, corrected and ionized calcium (Cai) in 60 patients with preeclampsia that are classified according to gestational age into preeclamptics in the second trimester G1 (n=30) and preeclamptics in the third trimester G2 (n=30).
The results are compared with 60 apparently healthy pregnants controls that are classified according to gestational age into two groups G3 (n=30) and G4 (n=30).
Results: the serum corrected total calcium; serum calculated ionized Cai and actual Cai are significantly reduced in preeclamptics in the third trimester (G1) compared with normal pregnants (G4) (P<0.001) and even when compared with preeclamptics in the second trimester (G2). The same significant reduction in serum corrected total calcium (P<0.001); but not in serum ionized Ca (calculated and actual Cai) is found in preeclamptics in the second trimester (G2) compared with normal pregnants (G3). Both calculated Cai and actual Cai are significantly correlated (r=0.7, P<0.001 in all study groups apart from preeclamptic in the second trimester where r=0.5, P<0.001).
Conclusion: all preeclamptics have certain factors that reduce vasodilation, enhance vasospasm. This is supported by the finding of low ionized calcium which is essential for the synthesis of endothelial-derived NO. A mathematical equation can be used in clinical practice for expressing ionized calcium.

Key words: preeclampsia, calculated ionized calcium, actual ionized calcium.

Background: DNA damage reflects a balance between oxidative stress and DNA repair ability which associates with breast cancer risk.
Objective: Assessment of the oxidative DNA damage in women with breast tumors using comet tail length (CTL) and comet tail moment (CTM) to measure the extent of single strand DNA breaks in addition to 8-hydroxy deoxy guanosine (8-OHdG) levels and numbers of DNA lesions.
Methods: Blood leukocytes and post operative tumor specimens were taken from 40 females with newly diagnosed breast tumors (age 24-75 years) and leukocytes of 40 healthy controls (age range 24-50 years). The cells were subjected to single cell agarose gel electrophoresis and the severity of DNA damage was quantitated by computer image analysis. The level of the 8-OHdG was measured by ELISA and numbers of DNA lesions was estimated by special formula.
Results: There were highly significant differences(P<0.001) in the mean levels of leukocyte CTL, CTM, serum 8-OHdG and DNA lesion in benign and malignant breast tumor as compared to the control groups with augmented elevations in these analytes in malignant breast tumor tissues as compared to the benign ones. A Significant increase (p<0.001) in the mean tissue 8-OHdG values was reported in the invasive malignant carcinoma as compared with noninvasive subgroup. The leukocyte means of CTL, CTM, 8-OHdG of malignant breast tumor patients with an age ≤ 48 years and BMI >24 were significantly higher than their counterparts (p<0.05, P<0.001, respectively). There were strong positive correlation between both leukocytes ( r=0.71, r=0.83; P<0.001) and tissue (r=0.69, r=0.83; P<0.001) CTL, CTM with the concentration of serum 8-OHdG in total breast tumors.
Conclusion: The 8-OHdG and comet assays are useful, sensitive markers for monitoring the severity of DNA modification and damage in breast tumor and could be used to identify persons with increased cancer susceptibility.
Keywords: Comet test, 8-hydroxy deoxy guanosine, oxidative DNA damage, Breast tumors.

Background: There are many different surgical procedures that can be employed when treating women with stress urinary incontinence. The surgeon is somewhat overwhelmed with choice. Sub-urethral autologous slings have been used since the early 1900s.
Objectives: to evaluate the surgical results after cruciate suburethral sling procedure with autologus rectus fascia in the cure of stress urinary incontinence in females.
Methods: in a prospective study done between June 2005 to January 2007 we enrolled ten women with stress urinary incontinence demonstrated by positive cough test, filling cystometry, and urethral hyper mobility (straining cotton swab ≥ 30◦), with different grades of vaginal wall prolapsed underwent cruciate sub urethral sling procedure using rectus fascia flap. Demographic criteria, complications during surgery and post operative period, and subjective cure rate at three months were assessed.
Results: the average age of the patients was 42 years, median parity was 4. The mean operative time was (90±3.8 minute), mean blood loss was 300 ml. there was no bladder or urethral injury. One patient developed acute urinary retention in the fourth post operative day; urinary tract infection occurred in three patients postoperatively. Follow up examinations three months after surgery revealed that 80% of patients report subjective cure and one patient felt that her symptoms improved significantly. Only one patient has remained incontinent.
Conclusion: The cruciate sub urethral sling procedure with autologous rectus fascia is an effective treatment for Stress urinary incontinence in females.

Key words: suburethral, sling procedure, autologous rectus fascia, stress incontinence.

Struma ovarii is a highly specialized form of ovarian teratoma, characterized by the presence- entirely or predominantly- of mature thyroid tissue. Its most important complications, although rare, are malignant transformation and thyrotoxicosis. In the present 'case report' we describe a case of a 25 year old married woman that seeks medical advice for recurrent lower abdominal discomfort. The diagnosis of complex ovarian cyst confirmed by ultrasound examination of the abdomen, the operative findings were multilocular ovarian cyst treated by oophrectomy. The histological examination demonstrated typical elements of mature thyroid tissue that confirmed the diagnosis of struma ovarii.

Keywords: ovarian teratoma, struma ovarii, thyroid tissue