IRAQI JOURNAL OF MEDICAL SCIENCES

Background: Breast cancer is a complex disease, many etiological agents are proposed to play a role in its pathogenecity, one of these factors is cytokines.
Objectives:In the present study we measured the concentration of IL-6 and IL-10 in serum of breast cancer patients and examined their association with clinicopathological variables including stages of the disease and estrogen/progesterone receptor (ER, PR) expression on tumor cells, to determine whether it associate with the disease progression.
Subjects and Methods: The study included 80 subjects, it comprised of 45 Breast cancer patients, 12 patients with benign breast lesions and 23 apparently healthy controls. ELISA method has been used for estimation the level of IL-6 and IL-10 in serum of three studied groups.
Results: There was an elevation of IL-6 and IL-10 level in the sera of BC patients with significant differences between BC and controls (p<0.001), also, this elevation was associated with progression of the tumor. In addition, IL-6 level was found to be inversely related to ER and PR expression (P< 0.05) while in regard IL-10 there was no significant differences in the median of IL-10 level between the patients who express positive and negative ER and PR.
Conclusions: These data indicated that elevated IL-6 and IL-10 serum levels are associated with BC and associate with advanced stage of disease. It was feasible that assays for serum levels of IL-6 and IL-10 can be used as predictive tests for tumor progression in BC patients.

Keywords: Breast cancer, IL-6, IL-10.

Background: Rheumatoid arthritis (RA) is a systemic autoimmune disorder causing synovitis of diarthroidal joints in which activated T-lymphocytes has a prominent position in RA pathology and may be important in prediction of disease outcome.
Objective: To evaluate cellular expression of certain activation marker on PBLs and their relevance to disease activity pattern of RA patients.
Patients and methods: this study included forty six RA patients, seven patients with Osteo-arthritis (OA) and 10 apparently healthy individuals. The collection of our baseline data based on routine laboratory and clinical assessment of disease activity Score (DAS). Blood sample was taken from each subject in all groups, at the time of attendance. Lymphocytes were separated; slides were prepared fixed on charged slides, foiled, and kept at -20ºC until assayed. CD3 and CD54 expression was detected using Immunocytochemistry staining, while CD71was detected using direct immunoflouresence staining.
Results: The results of CD3 and CD54 revealed a statistically higher percentage of expression in rheumatoid arthritis patients when compared with that of the apparently healthy and OA control groups. The CD71 showed statistically significant higher expression in minimum disease activity group without any correlation with clinical and laboratory disease activity indices.
Conclusions: we provide further evidence of a T-cell differentiation defect in RA, which could explain some of the well-characterized immunologic features of the disease but it is not related to the disease activity state.
Keywords: Rheumatoid arthritis, disease activity, lymphocytes activation, immunocytochemistry, immunofluorescence and CD marker.

Background: Classical activation of complement by antigen and antibody complex leads to formation of membrane attack complex (MAC) that leads to formation holes on the spermatozoa ending in their destruction.
Objective: To determine the complements levels and antisperm antibodies in the sera of infertile women of unknown etiology.
Patients and methods: Study group consisted of 45 infertile women consulting Kammal El-Sammarei Hospital for Infertility and In Vitro Fertilization from Jun -2008 to June-2009. Twenty-four (53.3%) patients had primary infertility and the rest had secondary infertility. Control group: consisted of thirty fertile women. Blood samples were collected from them and anti sperm antibodies in the serum were detected by indirect immunofluorescence test (EURO IMMUNE –GERMENY). In addition to that serum were tested for complement levels (C3 and C4) using single radial immune diffusions test (BINDARID) KIT BIRMINGHAM .UK.
Results: Detections of antisperm antibodies in the serum of infertile women were (64.4%) which is significantly (p<0.05) higher from control group using indirect immunofluorescence test. There was a significant (p=0.000) difference in the complements levels among infertile women who had ASA positive and ASA negative and control group.
Conclusions: These higher levels of complement components may be due to activation of classical pathway by ASA that directed against sperm antigens ending in defect in function and motility of the sperms.

Key words: Infertility, antisperm antibody, complement.

Background: Epithelial cells have evolved a variety of cell-and tissue-specific mechanisms for bacterial detection to enable cells to modulate the inflammatory response depending on the particular situation in a specific organ. These mechanisms provide a means of maintaining a proper balance between defense, tissue injury and their combined effects on organ function, and the molecule CD14 may have a role to play.
Objective: to find any correlation between CD14 marker expression and bladder cancer.
Material and methods: The immunoexpression of CD14 in paraffin sections from 96- bladder cancer tissues and 36-bladder tissues from patients with other bladder disease rather than cancer was investigated using immunohistochemical assay (IHC). The patients were divided into three groups: Group-1: Newly diagnosed bladder cancer patients, 69(43.9%), Group-2:Post-chemotherapy patients, 27(17.2%), Group-3: Other bladder disorders rather than bladder cancer 36(22.9%). The final diagnosis of patients with bladder cancer was established by clinical examination confirmed by cystoscopy and histopathological examination for bladder tissue specimens.
Urinary tract infections were studied for all groups by culturing urine samples using specific culture media.
Results: The results showed that CD14 protein was over expressed in 68.57% of the patients with approximately equal frequent IHC score among patients(23.8%) for each of weak and intense immunoreactions, and (21.0%) for moderate one , and there was no significant difference in the scores of positive IHC CD14 expression in bladder tissue of the cancer patients when compared with non-cancer patients, but there was significant difference between cancerous patients in correlation to the tumor grades.
Positive urine cultures were detected in 28(40.6%) of group-1, 13(48.1%) of group-2, and 12(33.3%) of group-3, while all healthy subjects were free of infection, and a significant difference between bacterial infected patients with and without bladder cancer, in which there was highly CD14 immunoexpression in bladder tissue in Gram-negative bacterial infected patients .
Conclusion: CD14 expression correlated significantly with Gram-negative bacterial infection, but not with cancer.

Key words: Immunohistochemistry, CD14, bladder cancer

Background: Free radicals in cigarette smoke may cause oxidative damage to macromolecules, contributing to cardiovascular diseases and cancer. Decreased plasma antioxidant concentrations in smokers may indicate cigarette smoke–related oxidative stress.
Objective: We compared the effects on serum antioxidant concentrations in confirmed active smokers with those in nonsmokers, independent of differences in dietary intakes and other covariates.
Methods: Serum samples from 60 smokers, and 40 nonsmokers aged 15-60 years were analyzed for ascorbic acid (vitamin C), α-tocopherol (vitamin E), and retinol (vitamin A), by using high performance liquid chromatography (HPLC). The measurement of serum lipid profile, and total lipid peroxidation, oxidized HDL (Ox-HDL) was done as well.
Results: Showed significantly lower serum antioxidant vitamins (A, C & E) concentrations in smokers more than in nonsmokers. Smokers had significant elevation in serum malondialdehyde (MDA) (p<0.001) 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 control (p<0.001).
Conclusions: These results indicate that cigarette smokers have a significantly lower serum antioxidant status than do unexposed nonsmokers, independent of differences in dietary antioxidant intakes with an increased oxidative stress in smokers' sera.

Key Words: Oxidized HDL, ascorbic acid, α-tocopherol , retinol , cigarette smokers.

Background: Despite the controversy about the role of electroconvulsive therapy (ECT) it is still widely used in the treatment of some psychiatric disorders.
Objectives: The aim of the study is to identify characteristics of the psychiatric inpatients and the role of ECT in the treatment of their disorders.
Methods: Medical records of all inpatients admitted to Al Kadhymia teaching hospital; psychiatric unit were studied carefully. A special form was designed to collect the data. Diagnosis was made according to the International Classification of Diseases, the Tenth Revision (ICD-10).
All the patients were examined physically.
Results: The 145 inpatients included were 76(52.4%) males and 69(47.8%) females with age distribution of 17-75 years. Males were younger than females and 64.7% of the total sample was under the age of 40 years. Average duration of admission was 4.6 weeks.
Schizophrenia made the most frequent diagnosis (41.4%) followed by depression (25.5%) and Mania (7.6%). All patients received psychosocial and psychotropic treatment. Only 13 classical medicines were used.
ECT was received by 42% of the sample. There was higher numbers of males who received ECT than females and the difference was significant. There was no association between ECT and age. Only 5 patients aged between 60 and 66 years and 4 of them aged 17 years had ECT.
The primary usage was for Schizophrenia which represented 69% of ECT recipients followed by depression (23%). It was significant that males received ECT more than females.
Conclusion: The findings suggest that majority of the inpatients can be treated with medications alone but still there is high rate of using ECT for many different disorders including schizophrenia.
Key words: ECT, Psychiatry, inpatients

Background: soluble interleukin-2 receptor (sIL-2R) is secreted by lymphocytes upon activation and has been used as a marker of immune activation in several diseases.
Objective: This study aimed to assess the potential clinical utility of serum level of serum soluble interleukin-2 receptor (sIL-2R) as a diagnostic tool in rheumatoid arthritis disease (RA). The study investigated also the association between serum sIL-2R levels with other parameters used for assessment of RA such as rheumatoid factor (RF), erythrocytes sedimentation rate (ESR), C-reactive protein (CRP), and uric acid.
Methods: Serum sIL-2R levels, measured by ELISA, were evaluated in 25 RA patients who have positive rheumatoid factor (RF) and compared with those of 25 normal controls. The correlations with the other parameters were analyzed.
Results: Compared with the healthy control group, RA patients tended to have significantly higher serum sIL-2R and ESR concentrations (P<0.001). While no significant difference between both groups in serum uric acid was seen. Positive serum CRP (CRP level>6mg/dl) was found in 56% of patients. The sIL-2R level was positively correlated with RF and ESR, while a slight positive correlation with uric acid was noticed. Serum sIL-2R showed a high sensitivity and specificity for the patients with positive RF.
Conclusions: A sIL-2R level is a sensitive and specific marker and can be useful for diagnosis of RA.
Key words: C-reactive protein, Erythrocyte sedimentation rate, Rheumatoid arthritis, Soluble interleukine-2 receptors.

Background: most hepatitis A viral infections in children are asymptomatic or have mild non specific manifestations but some are complicated.
Objective: to evaluate all cases of hepatitis A viral infection in children who were admitted over one year period and enlighten out the abnormal presentations and predict complications.
Patients and methods: during the period from 1st of June 2005- 1st of June 2006, fifty cases of hepatitis A viral infection (who had hepatitis A virus IgM +ve) were studied and analyzed regarding the clinical presentations, coarse of the illness, complications and outcome.
Results: fifty patients enrolled in the study, with male to female ratio of 1.8:1 and 32 (64%) of them presented in the age of 1-5 years.
Fulminant hepatic failure was found in 7 (14%) cases, 5 (10%) had prolonged cholestasis , 5 (10%) had exacerbation of pre- existing chronic liver disease, 2 (4%) had recurrent or relapsing hepatitis A viral infection, and 5 (10%) cases had extra hepatic manifestations , 3 (6%) were G6PD deficient patients who had sever hemolysis.
Conclusions: hepatitis A viral infection can present in different ways.
The level of consciousness, presence of ascites and severely abnormal biochemical and hematological values were of great help in predicting complicated cases of hepatitis A viral infection.

Key words: hepatitis A, abnormal presentations, children.

Background: The axis vertebra is the strongest cervical vertebrae; the characteristic feature of it is the presence of strong bony element, the dens (odontoid process). Several investigations have shown its relation with certain congenital anomalies.
Objective: The aim of this study was to evaluate the value of some morphometric parameters measured from the odontoid process of the axis vertebra to judge the degree of retroflexion of the odontoid process in relation to the morphological architecture.
Method: 30 randomly selected dry bones of adult second cervical vertebrae were used. These vertebrae were examined grossly and morphometrically, and the data obtained were analyzed by using global lab image/2 computer program.
Results: Morphometric results of this study showed that the retroflexion of the dens should be related to dorsal deviation, if the anteroposterior distance of the dens is fixed. The thicker anteroposterior dens is longer, wider, but less dorsally deviated.
Conclusion: We may be able to consider the dorsally deviated dens and the anteroposterior thickness of the dens as indicator for the degree of retroflexion of the dens.
The study may elaborate the possibility of using the above parameters as markers for the retroflexion of dens in cases of Chiari I malformation. Thus a preliminary diagnosis could be achieved.

Key words: morphometry, dens, congenital anomaly.

Background: Breast involvement by immunolymphoproliferative disorders is rare. Primary & secondary malignant lymphomas of the breast are much more common than multiple myeloma, of which only 18 cases were reported in previous literature, till the year 2000.
Case presentation: We report a young female patient presented simultaneously with bilateral multiple breast masses & pathological fracture in right humorous that proved later on via histopathological examination to be a case of multiple myeloma associated with extramedullary plasmocytoma involving breasts.
Discussion and Conclusion: There were diagnostic difficulties caused by the lack of specific radiological & sonographic features that differentiate between primary or secondary breast tumor & breast infiltration by immunolymphoproliferative disorders.

Key words: Plasma cell diseases, plasmocytoma, multiple myeloma, breast mass