IRAQI JOURNAL OF MEDICAL SCIENCES

Background: The Foxp3 gene is exclusive. It found in nTregs and correlates with the suppressive activity of these cells.
Objective: To detect Foxp3 expression in infiltrating cells in the rheumatic mitral valve tissue lesions and its correlation with the extent of histopathological abnormalities when considered naturally occurring CD4+CD25+ regulatory T cells (nTregs) as the main expressers for this protein.
Methods: Rheumatic mitral valve surgical fragments were taken from a total of 48 Iraqi patients with chronic rheumatic heart disease underwent mitral valve replacement in Ibn Al-Bitar Hospital for Cardiac Surgery-Baghdad-Iraq from October 2006-September 2007. Formalin-fixed paraffin-embedded mitral valve tissue sections were prepared. Foxp3-expressing cells were detected by using immunohistochemical staining technique, and histopathological picture was visualized by using hematoxylin and eosin staining.
Results: Our results showed that there were no significant association between Foxp3 expression and the history of acute rheumatic fever (negative or positive), and/or the frequency of attacks (single or multiple) among all groups under study (p > 0.05). Also, we found a significant negative correlation between the percentage of Foxp3 strong positive cells and the extent of histopathological abnormalities.
Conclusions: There was a negative correlation between Foxp3 strong positive expression and the extent of histopathological abnormalities which reinforce the immunosuppressive role of nTregs against the inflammatory and autoimmune reactions in chronic rheumatic heart disease.
Key words: Foxp3, CD4+CD25+ regulatory T cells, mitral valve

Background: Obesity and diabetes mellitus are the most common health problems with both macro- and micro-vascular complications and consequences of end organ damage. The alteration in trace elements could have deleterious effects on the health of the diabetic patients. Magnesium (Mg) is an important factor for enzymes involved in carbohydrate metabolism and good evidence suggests the presence of an important role for hypomagnesaemia in insulin resistance and metabolic control.
Objective: To evaluate the relation of hypomagnesaemia with insulin resistance (IR), and glycemic control in obese and non obese diabetic people.
Methods: The study included 65 patients with type 2 diabetes mellitus (Type 2 DM) who were all on oral hypoglycemic drugs only. They were divided according to their body mass index (BMI) and the presence or absence urinary protein, into three groups. The results were compared with those of another 52 normal controls grouped on the same bases.
Fasting venous blood specimens were aspirated for the measurement of glycated hemoglobin (HbA1c) by A1c variant reader, glucose, urea, creatinine, protein and albumin by routine enzymatic chemical and colorimetric methods, insulin by immuno-enzymometric assay and magnesium by atomic absorption spectrophotometer, while Mg ions and Quicki test (for IR) were estimated by calculations. Morning urine specimens from each subject were examined for the presence of protein by dip Stick.
Results: As compared with the healthy controls the study reveals a significant reduction in Quicki test (increased IR) and low serum Mg2+ in all diabetic patients, with the presence of a significant positive correlation between the two parameters. Serum Mg2+ was significantly lower in the normal weight non proteinuric diabetics than the normal weight controls. In diabetic patients the presence of proteinuria caused a further reduction in serum Mg2+. Glycated hemoglobin (HbA1c) negatively correlated with total serum Mg2+ in all diabetics and their controls.
Conclusions: Insulin resistance and poor glycemic control are important events associating hypomagnesaemia in type 2 DM. Proteinuria is an additional factor which may aggravate hypomagnesaemia, which involves both ionized and total Mg to the same degree.

Key words: type 2 diabetes mellitus, magnesium, Insulin resistance, HbA1C, proteinuria

Background: Pilonidal sinus disease can be managed surgically either by excision & primary closure, or by excision and leaving the wound to heal by secondary intention. This study is designed to show the difference between these two methods.
Objective: To assess the difference between excision and primary closure versus excision and healing by secondary intention in treatment of pilonidal sinus disease.
Methods: Between January 2005 and January 2009, 60 median aged patients with Pilonidal sinus disease were studied in Al-Kadhimiya Teaching Hospital, Baghdad, Iraq; 30 cases were operated by excision and primary closure (group І); the remaining 30 cases were operated by excision and healing by secondary intention, without closure (group II). The principle outcome measures recorded were duration of hospital stay, operative time, duration of complete healing, wound infection and recurrence rate. Satisfaction and comfort of patient was monitored by using visual analogue scale during first five days post-operatively. Data were statistically analyzed by using SPSS & Chi square.
Results: A total of 60 patients were divided into 2 groups, 30 patients operated by using primary closure (group I), and 30 patients operated without closure (group II). Age range of patients was from (16 - 37 yrs). Duration of hospital stay and duration of complete healing was longer in patients of group II than those of group I (p ≤ 0.001). Operative time in group I is more than that in group II (p ≤ 0.001). Pain scores were lower in group I than group II (p = 0.004). The frequency of wound infection and recurrence rate after one year follow up were more in group I than group II, this was statistically of little significance.
Conclusions: Excision and primary closure is recommended as a preferred procedure in the management of chronic sacral PNS disease. It has the advantages of short hospital stay, early wound healing, rapid return to work.

Key words:pilonidal sinus, primary closure, secondary intention

Background : Thyroid disorders are amongst the commonest endocrine disorders in women of childbearing age. Population-based infertility data of women with subclinical hypothyroidism are not available.
Objective: Assess the role of subclinical hypothyroidism in female infertility.
Methods: A prospective clinical study of 40 infertile women with subclinical hypothyroidism treated with thyroxine after exclusion of the basic causes of infertility in Wasit Governorate-Iraq from June 2006 until June 2009 (3 years).
Result: 24 of the women (60%) were complaining of primary infertility with infertility period ranged from 1-6 years and 16 (40%) with secondary infertility with infertility period range from 1-5 years. Pretreatment mean TSH level was 7.6 mIU/L which normalized after treatment to a mean level 1.9 mIU/L. Conception was recorded in 14 (35%) women during the period of the study however, only 11 pregnants succeeded to continue pregnancy resulting in a live birth rate of 27.5%.
Conclusions: Our results support the role of subclinical hypothyroidism as a predisposing factor for female infertility that should not be forgotten.

Key words: subclinical hypothyroidism, female infertility, thyroxine supplementation

Background : There is increasing evidence that localized irradiation of the tumor may also modify the tumor microenvironment and generate inflammatory cytokines.
Objective: This study is aimed to clarify the effect of proton beam radiation on the interferon (IFN-α, IFN-β, IFN-γ) and nucleotide.
Methods: The Microsoft "The Stopping and Range of Ions in Matter (TRIM-SRIM)" version 1998, and 2003 was used. A model of targeting certain interferon (IFN-α, IFN-β, IFN-γ) as well as the nucleotide pair was created. Each target was subjected to proton radiation of hydrogen [H], helium [He], or carbon [C] at different range of energy seeking for the Bragg's peak.
Result: The results showed that the cross sections IFN-α, IFN-β, IFN-γ and nucleotide targeted by proton therapy were 0.9776, 0.8317, 0.8297 and 0.7305 [keV/(µg/cm2)] for hydrogen ion, and 2.3354, 2.3414, 2.3377, 2.0842[keV/(µg/cm2)] for helium ion, and 8.3032, 8.3198, 8.3109, 7.5394 [keV/(µg/cm2)] for carbon ion respectively.
Conclusions: It concludes that targeting of well precise located tumor with proton beam radiation therapy resulted in nucleotide damage of cancer cell without affecting the immune system in term of interferon surveillance.

Key words: Proton, Nucleotide, Interferon

Background: Apoptosis is a physiological type of cell death plays an important role in the regulation and maintenance of cell populations in tissues upon physiological and some pathological conditions.
Objective: To evaluate the hormonal status and peripheral blood lymphocyte apoptosis in normal menstruating female during normal menstrual cycle.
Methods: 50 healthy menstruating females with regular cycles were studied. Two samples of peripheral blood were aspirated; the first during the ovulation day and the second at the first day of the menstrual cycle. Lymphocyte separation was done; by Trypan blue exclusion test, and the morphological features of lymphocyte apoptosis by the DNA binding dye (Hoechst stains). Hormonal assessments of FSH, LH, Estradiol, and progesterone were also done.
Results: Lymphocyte apoptosis in the first day of cycle was (9.31%±1.7) using Trypan blue exclusion test and (9.76%±1.36) using Hoechst stain while at the day of ovulation the percentages were (2.33%±0.7) and (1.38%±0.84) respectively with P value < 0.00001. Serum level of hormones were FSH (5.76±1.77; 9.14±3.34), LH(3.65±1.4; 28.35±18.94), Estradiol (40.05±14.73; 206.38±70.3) and Progesterone (0.35±0.13; 1.41±0.98) in the first day of the menstrual cycle and during ovulation respectively which showed a highly significant difference with P value <0.00001.
Conclusion: The increment in the lymphocyte apoptosis in the first day of the menstrual cycle compared with ovulation day is mostly due to low ovarian steroid hormones and gonadotrophins. This might confirm the hypothesis that FSH, LH, estrogen and progesterone act as survival hormones for different tissues including peripheral blood lymphocytes.

Key words: Lymphocyte apoptosis, FSH, LH, estrogen, progesterone, Hoechst stains

Background: Psoriasis is a chronic inflammatory skin disease characterized by well-demarcated erythema and scaly plaques. The pathogenesis of psoriasis still remains unclear. An increased reactive oxygen species (ROS) and insufficient antioxidant activity associated with the pathogenesis of psoriasis lesions.
Objective: To evaluate the link between oxidative stress parameters and some trace elements like zinc (Zn) and copper (Cu) ions with the pathogenesis of psoriasis disease.
Method: Fifty patients with psoriasis were included in this study, 32 patients with localized psoriasis, and 18 with general psoriasis, another fifty healthy controls were included in this study. We measured serum malondialdehyde (MDA), super oxide dismutase (SOD), vitamins E and A, and Zn and Cu in patients and control subjects.
Results: Serum MDA in total psoriasis patients (1.8±0.2 nmol/ml) was significantly higher than those of control (0.6±0.19 nmol/ml; p<0.001). The SOD activity (9.1±1.0 U/ml) in serum of total psoriasis patients was significantly lower than that of controls (10.8±0.3 U/ml). serum vitamin A and E patients (56.8±3, 9.0±1.0 µg/ml respectively) were significantly lower than control (59.0±1.3, 9.7±0.9 µg/ml correspondingly p<0.0001), for trace elements the level of Zn in serum patients (79.0±9.1µg/ml) was significantly lower than control (83.3±5.8 µg/ml), while for Cu statistically significant higher levels were noted in patients (111.8±14.2 µg/ml) as compared with control (106.0±9.0 µg/ml).
Conclusion: Our results suggest that lipid peroxidation of cellular membrane of keratiocytes by free radicals and decreased antioxidants may associate the pathogenesis of psoriasis lesion. In addition, there was a possible benefit of an enriched diet or of a supplement of vitamins A, E and Zn in treatment of psoriasis diseases.

Key words: Psoriasis, Zinc, Copper, Oxidative Stress, malondialdehyde, super oxide dismutase

Background: Fatal flame burn injuries remain one of the most common causes of fatalities referred to Al-Sulaimania Medico-Legal Institute in spite of many recent advances in care and management. They occupied number one of all cases which were managed medico-legally.
Objective:To study, evaluate and determine the causes of death in victims of flame burn injuries.
Method:The study was conducted on 221 cadavers of flame burn injuries referred to the medico-legal institute in Sulaimania province during the period between 8th of May 2008 and 7th of May 2009. Complete classical autopsy was performed on each case as well as proper laboratory investigation (CO and renal function tests).
Results:Fatal flame burn injuries constituted (28%) of the total number of medico-legal mortalities during the period of the study. The highest percentage of flame burn deaths occurred during the 1st and 2nd day of burn which was related to the state of shock and primary toxemia in (46.08%) of the cases. Late deaths were due to septicemia, cumulative effects of the early cause and miscellaneous causes.
Conclusion:Flame burn injuries were the most common police cases managed medico legally. The vast majority of victims died within the first ten days. Staphylococcus aureus was the most common organism isolated from wounds and blood of victims.
Key words:Autopsy, flame burn, Al-Sulaimania.

Background Apoptosis of trophoblastic cells may play a role in the pathogenesis of abortion, and one mechanism of apoptosis is Fas receptor and legand system.
Objective Estimate the level of Fas and FasL in trophoblastic tissue of aborted women.
Methods In this study, 25 women with spontaneous abortion and 5 women with induced abortion were included from attendants of Gynecology department at Al-Kadhimiya Teaching Hospital in Baghdad. In-situ hybridization (ISH) tests were done to detect the level of expression of Fas and FasL in trophoblastic tissue.
Results The highest percentage of expression of Fas and FasL was found in the trophoblastic tissue of females with spontaneous abortion (34.36% for Fas and 31.86% for FasL), while the expression of them was low in induced abortion group (9.2% and 9.4%, respectively).
Conclusion The data strengthen the possibility that the apoptosis of trophoblastic cells via enhanced expression of Fas-FasL system is an important mechanism of spontaneous abortion.
Key words Miscarriage, Trophblast, Apoptosis, Fas, FasL, ISH.

Background: Tacrolimus is an immunosuppressive agent used topically, it has been found to be effective in treating moderate to severe atopic dermatitis without causing the atrophy that might occur with prolonged use of topical corticosteroids. There is a lack of studies on the effect of tacrolimus and steroid Therapy on CCR3 and CCR5 in atopic dermatitis patients.
Objective:To assess expression of some chemokine receptors in the epidermis of atopic skin (chronic lesions) and to evaluate any differences in the degree and pattern of epidermal expression before and after topical tacrolimus or steroid therapy.
Methods:Twenty five cases of atopic dermatitis before and after treatment by tacrolimus ointment and topical steroids were evaluated immunohistochemically for the epidermal expression pattern and intensity of some chemokine receptors namely CCR3 and CCR5 before and after treatment.
Result: CCR5 and CCR3 positive epidermal cells seem to be produced in situ in higher amount before treatment compared with that after treatment. Although these cells are predominantly CCR5+.
Conclusions:Enhanced expression of CCR3 and CCR5 on the surface of epidermal keratinocytes may be significant for the determination of atopic reactivity in general and also observed differences in frequencies of these activation markers before and after treatment by topical steroids-tacrolimus therapy.
Key words: Atopic dermatitis, CCR3, CCR5, Immunohistochemistry, Tacrolimus

Background:Thyroid function has been extensively evaluated in patients with chronic kidney disease, however the results are variable.
Objective:The study was designed to investigate the thyroid dysfunction in uremic patients clinically and biochemically.
Methods :The study was conducted in the department of medicine and dialysis unit in AL-Kadhimiya Teaching Hospital in Baghdad. Three groups were taken sixteen patients with end stage renal disease undergoing regular hemodialysis, 22 patients with chronic renal failure treated conservatively and 21 healthy volunteers with no previous history of thyroid disease and their renal function were normal(control group), serum TT3, TT4 and TSH were estimated in all patients and control group by RIA Kits. The results were tabulated and statistically analyzed using Chisequare and t-test.
Results:Fifty nine persons included in this study divided into three groups (regular hemodialysis 16, conservative treatment 22 and the control group were 21). Goiter was demonstrated in 12.5% in hemodialysis group, 4.54% of the conservatively treated group. Uremic patients kept on conservative treatment or on regular hemodialysis showed significant reduction of TT3 and TT4 in comparison to the control group, however the level of TSH didn’t show significant alterations, and there were no significant deference in TT3 andTT4 between the patients on conservative management and those maintained on regular hemodialysis.
Conclusions:Low TT3 and TT4 are often observed in clinically euthyroid patients with chronic renal failure. These abnormalities do not appear to change significantly after the institution of regular dialysis, on other hand TSH values in clinically euothyroid patients with chronic renal failure were within the normal range, this normal TSH may indicate functional euthyroid status.
Key words:Hemodialysis, Chronic renal disease, Triiodothyronin (T3), Thyroxin (T4), Thyroid stimulating hormone (TSH)

Background:Human infection with Brucella spp. had been able to evoke humeral immune response containing both IgG and IgM.
Objective:This study designed to compare results obtained from Rose Bengal Test (RBT), Tube Agglutination Test (TAT) and Enzyme Linked Immunosorbent Assay (ELISA) employ serum are described and compared for the detection of human IgG and IgM anti-brucella antibodies.
Methods:Serum samples from 105 subjects were collected. 90 were clinically infected with human brucellosis, and 15 were age and gender matched controls. RBT and TAT are the two screening tests routinely recognized, while the 2-mercaptoethanol test (2ME) is the confirmatory assays currently in use. In order to improve the serological diagnosis of human brucellosis, an indirect IgG, IgM and IgG-IgM ELISA kits were evaluated
Results:Totally, 90 cases were positive in RBT, from those only 92% shows positive TAT, and by ELISA there are IgG (27.78%), IgM (14.44%) and (57.78%) were Positive for both immunoglobulins.
Conclusion:Although RBT and TAT are widely applied tests, they cannot differentiate acute and chronic states of brucellosis. Our data suggest that IgM ELISA may be a suitable test for diagnosis acute brucellosis.
Keywords: Brucellosis, ELISA, Tube Agglutination.

Background:Gallstone diseases remain a common health problem for human, affecting millions of people throughout the world. In Iraq, recent years has shown an increasing number of patients with gallstones with concurrent decreasing age of presentation, risk factors have been assessed taking in consideration the effect of stressful life events that Iraqi peoples had been suffered during these years on the development of gallstone diseases.
Objective:To give an idea about, and possible causes for the changing in number, age of presentation and trend of surgical management of gallstone diseases in Iraq.
Methods :Clinical assessment and risk factors assay including stressful life events were done for 1226 patients who have been cholecystectomised over seven years from Jun 2002 to Jun 2009 in Al-kadhimiya Teaching Hospital.
Results:Significant increases in the number of symptomatic gallstone cases were noted, nearly 50% of them presented with abdominal pain, more than half of patients were young in the 3rd and 4th decades, female to male ratio was 5.9:1 and decreasing with age, 74% of patients had BMI > 25% (over weight), impact of stressful life event was obvious in the recent years on nearly two third of patients with gallstone diseases, minimal invasive technique (laparoscopic surgery) was evolving and most of the cases now done by this method.
Conclusions:Gallstones diseases are increasing in our country with obvious decrease in the age of presentation, this might be due to stressful life events to which Iraqi peoples had been exposed, and also the revolution of minimal invasive surgery had a great impact in the management of this disease.
Key words:Pattern, Incidence, Gallstone diseases.

Background Sepsis is common in the neonatal period which may be acquired in utero through the placental or trans-cervical routes and during or after birth and because the immunological system of neonates is not well developed which make this infection serious and fatal if not treated in accurate manner.
Objective To identify the most common causes of sepsis in Al-Kadhimiya Teaching Hospital and its mortality rate.
Methods Across-sectional study was conducted during the period between 14th of February 2009 to 25th of February 2010 on 127 neonates with sepsis who were diagnosed clinically and they were admitted in Al-Kadhthimyia Teaching Hospital, they were divided into two groups according to the time of appearance of the symptoms which were early onset sepsis and late onset sepsis. Blood was taken from them and sends to Hospital laboratory for culture.
Results The most common clinical presentation in early onset sepsis (EOS) were, poor feeding, lethargy and fever (94.12%, 91.76 %, and 52.94 %, respectively), which is similar to late onset sepsis (LOS) (95.24 %, 92.86 % and 57.14 % respectively). The most common organisms responsible for EOS were Staph. aureus, Enterobacteria, and staph. epidermidis (25.89 %, 21.18 % and 21.18 %, respectively) while in LOS Staph. aureus, Enterobacteria and E. coli (21.43 %, 16.67 % and 11.90 %). The overall mortality was 29.92 % which was slightly more in LOS (30.95 %) than in EOS (29.41%) also it was more common in males than females in both groups.
Conclusion Staph. aureus, Enterobacteria were the leading causes of sepsis in both groups while staph. epidermidis were more common in EOS and E. coli was more common in LOS.
Key words Early onset, late onset, sepsis, neonate

A 28-year-old non smoker male who had undergone kidney transplantation and has been taking immunosuppressive drug for the last 15 months was presented to the Hospital of Special Surgery/Baghdad with low grade fever, productive cough, shortness of breath, purulent sputum and bilateral chest crepitation. Laboratory investigations showed low Hb percentage (11.9%) with normal blood urea and creatinine (42 mg/ dL and 0.9 mg/ dL respectively). Chest x-ray revealed homogenous shadow. Initial antibiotic and anti-tuberculosis therapy was not helpful. Laboratory examination of sputum indicated the causative agent was Nocardia.
Key words Pulmonary nocardiosis, kidney transplantation