IRAQI JOURNAL OF MEDICAL SCIENCES

Background Patients with diabetes have an increased risk of developing microvascular complications, diabetic retinopathy, diabetic nephropathy and diabetic neuropathy, which if not predicted, early detected and treated, place a significant burden on individual’s health and can reduce life expectancy.
Objective To determine the main risk factors (predictors) that associated with microvascular complications in diabetes aiming to construct a module that can detect microvascular complications depending on these predictors.
Methods A cross sectional descriptive study was carried out with 364 diabetic patients. Data about diabetes microvascular complications (retinopathy, clinical peripheral neuropathy, and nephropathy) and their potential risk factors were collected. Primary point was detecting the < 0.01 level of significant association of risk factors with these complications to determine the predictors. These predictors were assessed for each individual’s micro vascular complication and also as a composite outcome by logistic regression analysis.
Result Of the examined 364 diabetic cases, 174 (47.80%) patients were found with microvascular complications. Neuropathy, nephropathy, and retinopathy were detected in 66 (18.13%), 62 (17.03), and 46 (12.64%) patients, respectively. Out of 12 potential predictors, only six (age, smoking habit, duration of diabetes, uncontrolled hyperglycemia, hypertension, and macrovascular complications) found to be significantly associated with the presence of microvascular complication (p < 0.01) as compared with patients who had no such complications. Uncontrolled hyperglycemia was the first predictor in neuropathy and nephropathy groups, while diabetic duration was ranking first in retinopathy group.
Conclusions Microvascular complications in diabetic patients can be predicted, and avoided, by detecting their risk factors. Logistic regression equation provide suitable module for evaluation of these risk factors simultaneously.
Key words Microvascular complications, diabetes, logistic regression

Background Thyroid cancer is more common in subjects with blood group A and O. Estrogenic receptors in some cases of goiter were observed. Obesity is associated with increased risk of thyroid carcinoma possibly by mechanism of production of estrogenic steroids by adipose tissue.
Objective This study was done to determine and compare the progesterone and estradiol in sera and tissue of female patients with various thyroid disorders.
Methods In this prospective study, Serum and thyroid tissue homogenate were analyzed by measuring progesterone and estradiol in fifty normal healthy women volunteers as a control, in addition to ten patients with malignant thyroid nodules proved by histopathology, and thirty seven patients with benign thyroid nodules from March 2008 to August 2009 in Al-Kadhimiya Teaching Hospital and Al-Dirgham private hospital in Baghdad.
Results Serum estradiol and progesterone levels for both malignant and benign thyroid nodules patients were less than noticed in healthy control, while tissue estradiol and progesterone levels in malignant thyroid tumor were significantly higher than those in benign thyroid nodules.
Conclusion Tissue estradiol and progesterone levels can be used in the diagnosis and differentiation between malignant and benign thyroid nodules.
Key word: progesterone, estradiol, Thyroid nodules

Background The adverse effects of corticosteroids are widely recognized but there are few qualitative data on which they adversely act on the tissue of thyroid gland, in this paper we scrutinize how these corticosteroids affect the thyroid tissues.
Objective To investigate the histological and histochemical changes, due to the effects of dexamethasone sodium phosphate, in the thyroid gland of female rabbits using a light microscope.
Methods Two groups, each one with seven female rabbits were used in this study. The control group received 0.9% saline solution intramuscularly and the treated group received a daily intramuscular injection of dexamethasone sodium phosphate (1.5 mg/kg b.w.) for 15 days, the thyroid glands obtained from these animals were dehydrated, cleared and embedded in paraffin and then sectioned and stained by Haematoxylline and Eosine and histochemically were stained by periodic acid- Schiff reagent, periodic acid- Schiff reagent with enzyme diastase, Toludine blue and Masson′s trichrome.
Results Marked changes were observed in the thyroid glands treated with dexamethasone. Histolgically, these changes include a decrease in the height of the follicular cells to become low cuboidal and even squamous, and the follicles distended with colloid accumulation. These changes affected both central as well as peripheral follicles. Histochemically, the thyroid follicles showed a low positive reaction to glycoprotein which might indicate a decrease in the activity of the follicular cells of dexamethasone treated thyroid glands.
Conclusion Dexamethasone causes morphological changes in the thyroid gland consistent with a decrease in thyroid activity and is considered as side effects of this drug.

Key words: Dexamethasone, histochemistry of thyroid gland, rabbits

Background Hypercholesterolemia, one of the major risk factors of atherosclerosis, is a major health problem in the world that enhances the free radical generation in various ways. The level of antioxidants was decreased in hypercholesterolemic patients. This depletion of antioxidants may increase in type 2 diabetic patients with hypercholesterolemia, which also may increase the risk of complications from the most common form of diabetes mellitus.
Objective To evaluate serum reduced glutathione and glutathione reductase as an antioxidant, and gamma-glutamyl transferase as a marker of oxidative stress in both hypercholesterolemic and diabetic-hypercholesterolemic patients.
Methods The study involved 33 diabetic hypercholesterolemic patients, 37 hypercholesterolemic and 54 healthy control subjects. Ten ml of blood were collected from each patient and normal control subject after an overnight fast for the measurement of gluathion (GSH) glutathione reductase (GR) and gamma-glutamyl transferease (GGT), glucose, lipid profile, urea, creatinine and glycated Hb (HbA1c). The last was for the diabetics only.
Result Showed a significant decrease in GSH and GR in diabetic-hypercholesterolemic patients compared with hypercholseterolemic patients and a significant increase in GGT in both groups compared with controls. There was a negative correlation between cholesterol with GR in both groups of patients involved in this study and a negative correlation between HbA1c and each of GSH and GR in the diabetic-hypercholesterolemic patients.
Conclusions High levels of oxidative stress and reduced antioxidants in people with coronary heart disease, previously thought to be markers of the heart condition, could also, indicate a condition of glucose abnormality, such as overt type 2 diabetes.
Key words hypercholestermia, type 2 diabetes, antioxidants, oxidative stress, GGT.

Background Staphylococcus aureus isolates distributed into 3 groups according to their sources, 10 isolates from each source. Each of the 30 isolates produced phage lysate. Based on our results, it has been found that these phages obtained from all isolates can be classified into 3 groups (A, B and C).
Objective To produce local phage groups from locally isolated Staphylococcus aureus strains to be used for epidemiological purposes.
Methods A total of 60 specimens were obtained from three different source locations, surgical theaters (instrument, walls, floor and masks), nurses and inpatients, were enrolled in a study based at Al-Sulimanyiah Teaching Hospital from December 2008 to November 2009. Each specimen was subjected to well known established microbiological. Methods for isolation and identification of Staphylcoccus aureus. All isolates were tested for the presence of phage employing heat method and detected by spotting method, also based on resistance or sensitivity of each isolates to give phage lysates by application of the cross-lysis technique.
Result Staphylococcus aureus isolates distributed into 3 groups according to their sources, 10 isolates from each source. Phages were induced from thirty Staphylococcus aureus isolate. Based on results obtained of the isolates, it has been found that these phages obtained from all isolates can be classified into 3 groups. Group (A) revealed that 1 and 6 phage lysates originally from isolates 1 and 6 were able to lyse all isolates in group 1 except 1 and 6 isolates and those in other groups which were unlysed. A strain was phage typeable (at least one phage produced 20 or more plaques of lysis). Isolates 15 and 16 produced phage lysates 15 and 16 in group (B) which were able to lyse all isolates in group 2 except 15 and 16 isolates and the remaining isolates in other groups which were unlysed. phage lysates 23 and 26 in group (C) which were induced from isolates 23 and 26 were able to lyse all isolates in group 3 except isolates 23 and 26 and the remaining isolates in other groups which were unlysed also.
Conclusions It is detected that 3 local phage groups from Staphylococcus aureus are presented to be used for epidemiological purposes in case of Stapylococcus aureus epidemic.
Key words Staphylococcus aureus, phages, epidemiology.

Background Cholecystectomy is one of the most commonly performed operative procedures, on the other hand, the wide acceptance of laparoscopic cholecystectomy for sure led to the increased rate of cholecystectomies. The data assessing relationship between cholecystectomy and colo-rectal carcinoma is limited; therefore the relationship of whether prior cholecystectomy modifies the natural history of colo-rectal carcinoma is worth assessing in Al-Khdymia Teaching Hospital.
Objective To estimate the risk of colo-rectal carcinoma in cholecystectomized patients and to assess the feasibility of screening in these patients.
Methods Retrospective evaluation of a total of 123 patients with approved colo-rectal carcinoma over a period of eleven years in a wide district drainage referral Hospital (Al-K
adhimiya Teaching Hospital) in Baghdad-Iraq.
Result The total number of patients included is 123 from June 1999 to June 2010. The whole group approved to have a colo-rectal carcinoma. The age range is from 17-90 years, the females constitute 55 patients of the total and the rest 68 patients were males. The results were not significant regarding the gender of cholecystectomized patients and the risk of colo-rectal carcinoma. While on the other hand there were slightly increased statistically significant relative risk of colo-rectal carcinoma specially involving the proximal colon in cholecystectomized patients.
Conclusions There is an increased risk of incidence of colo-rectal carcinoma in cholecystectomized patients regardless the gender of the patient, and the risk is higher for the proximal colon than the distal colon.
Key words
cholelithiasis, cholecystectomy, colo-rectal carcinoma, screening of cholecystectomized patients

Background Heart rate variability (HRV) and heart rate turbulence (HRT) illustrate regulation of the heart by autonomic nervous system (ANS). The autonomic nervous system plays an important role not only in physiological situations, but also in various pathological settings such as diabetic neuropathy Diabetic autonomic neuropathy is a serious and common complication of diabetes.
Objective To determine the association between HRT, HRV and diabetes control monitored by concentrations of HbA1c.
Methods In 52 patients with diabetes mellitus type II of either sex attending Cardiac Care Unit (CCU) in Al-Kadhimya Hospital, 24-hour Holter ECG monitoring was performed to evaluate time domain HRV parameters (SDNN, SDNNI, SDANN, rMSSD, pNN50) and HRT parameters (TO and TS). HBA1c was measured in all patients. Regression analysis was performed to evaluate the association between tested parameters.
Results Significant correlation has been observed between TO and SDNN, SDNNI and SDANN. TS correlated significantly with SDNN, SDNNI, SDANN, rMSSD, pNN50. We noted no correlation between HbA1c and HRV or HRT parameters.
Conclusion We concluded that HRV time domain parameters correlate with HRT in patients with diabetes mellitus. Diabetes control estimated on basis of HbA1c value did not show correlation with HRV and HRT.
Key words Heart rate turbulence HRT, Heart rate variability HRV, Diabetic Autonomic Neuropathy. HbA1c.

Background Adequate control of cardiovascular disease risk factors and health habits are important for preventing ischemic heart disease, but it has been reported that many patients remain uncontrolled despite regular care.
Objective To identify some of the risk factors of ischemic heart diseases among patients admitted to coronary care unit (CCU).
Methods A hospital based case-control study was conducted in AL-Hussain Hospital in Karballa, from January 2007 to October 2007. The study included 300 cases of ischemic heart disease admitted to coronary care unit (CCU) of the hospital during the study period, and 300 age & sex matched controls, who attended the outpatient clinic of the same hospital. All the participants were interviewed with a special questionnaire form. In addition the weight and height were measured for both cases and controls to determine their body mass index (BMI).
Result 73 (24.3%) of the cases were in the age group (60-69) years. The females accounts for two third of cases, 199 (66.3%) in comparison to males 101 (33.7%).
The study showed a statistical significant association between the following risk factors and admission to CCU: smoking, alcohol consumption, obesity, hypertension, diabetes, and positive family history of various cardiovascular diseases among first degree relatives of the cases.
Conclusions The admission to CCU was more common in the age group (60-69) years and the females were more likely than males need for CCU admission, patients with the following risk factors were in more need to CCU admission than others: smoking, elevated body mass index (BMI), hypertension, diabetes and positive family history of various cardiovascular diseases among first degree relatives of the cases.
Key words risk factors, CCU admission

Background Transitional cell carcinomas (TCC) of the bladder are a major health problem and can be a leading cause of death. There are several proteolytic enzymes which are responsible for the degradation of the extra cellular components and have an essential role in tumor invasion and metastasis. MMP-2 and MMP-9 are the most important class of these enzymes.
Objective To assess the In situ hybridization expression of MMP-2 and MMP-9 in TCC of the bladder.
Methods Fifty formalin fixed, paraffin embedded of TCC of the bladder tissue blocks from Specialized Surgical Hospital in Baghdad, were included in this study. In addition ten apparently normal bladder autopsies were collected from the Forensic Medicine Institute Archives used as control group. Tissue blocks were sectioned on charged slides to be used for In situ hybridization, for the detection of MMP-2 and MMP-9.
Results The expression of MMP-2 and MMP-9 in TCC of the bladder tissues in the present study was 64 % for both and strong relationship between expression of MMP-2 and MMP-9 and TCC of the bladder was detected.
Conclusion MMP-2 and MMP-9 play an important role in progression of transitional cell carcinoma of the bladder.
Key words Bladder cancer, Matrix Metalloproteinases, invasion, metastasis, carcinogenesis.

Background The leukocyte integrin that plays a major role in neutrophil activities is CD11b. In addition to mediating neutrophil adherence to endothelial cells, CD11b binds to the complement component iC3b and directs phagocytosis and intracellular lysis of microorganisms.
Objective To determine whether neutrophil activation, through the increased surface expression of the cell surface markers CD11a, CD11b, CD11c have a correlation with the values of complement components C3 and C4 in pregnant women with pre-eclampsia.
Methods This study was conducted at the AlKadhemiya Teaching Hospital. Patients were 60 pregnant women in labour subdivided into three groups:
Group A: 20 pregnant women with severe pre-eclampsia.
Group B: 20 pregnant women with mild-moderate pre-eclampsia.
Group C: 20 normotensive pregnant women (control group).
We performed the following laboratory measurements for all groups: total white blood cell WBC count, cell surface expression of CD11a, CD11b, CD11c by direct immunofluorescent technique, and serum complement C3 and C4 levels by radioimmunodiffusion method (RID).
Results There was a significant difference in neutrophil activation as detected by the cell surface expression of CD11a, CD11b, CD11c being higher in the pre-eclamptic group than the control group. The incidence of neutrophil activation was significantly higher among patients in group A compared to the other groups. There was a significant difference in the serum level of C3 and C4 in the pre-eclamptic group being higher in group A and B than group C.
Conclusions No correlation was found between the markers of neutrophil activation (CD11a, CD11b, CD11c) and the serum levels of (C3, C4) in the pre-eclamptic group. The incidence of adverse maternal and neonatal outcome is significantly higher among patients in group A compared to the other two groups.
Key words Preeclampsia, complement serum level, CD11a, CD11b, CD11C, neutrophil.

Background Little to our knowledge has been attempting to show the effect of pentoxifylline (PTX) on ovulation or oogenesis. In a few studies of man with asthenospermia oral treatment with PTX produced significant increase in sperm concentration and motility.
Objective Study the effect of PTX on ovulation and oogenesis in albino mice.
Methods Sixty albino mice randomly divided into 6 equal groups: Group 1 received tap water and considered as a control group. Group 2 treated with 16 mg of PTX/Kg/BW/daily for 2 weeks. Group 3, 4, 5, and 6 treated with same dose for 4, 6, 8, 10 weeks respectively. Post-mortem examination done according to the time of treatment and the reproductive systems were excised and processed for light microscopic examination.
Result PTX administration causes an increase in the diameter of the ovary and in the total number of ovarian follicles and their diameters especially Graafian and secondary follicles. In addition, highly significant increase in the numbers of corpus lutea especially in those groups treated for longer time was noticed. Moreover, an increase in the thickness of uterine and oviduct epithelial lining due to hyperplasia and an increase in the diameter of endometrial glands and oviducts was demonstrated.
Conclusions We concluded that administration of PTX has a significant effect on the female genital organs especially if given in small doses for 10 weeks. This will definitely influence reproduction and litter size manifested after mating with untreated males.
Key words Pentoxifylline, ovary, uterus, fallopian tube

Background β-thalassemia is found in Mediterranean, Saudia Arabia, Jordan, Egypt and Yemen. Survey in Iraq showed that β-thalassemia trait is carried by 4.5-5% of the population.
Objective To determine factors that is associated with thalassemia in Mosul district.
Methods 105 thalassemia blood transfusion dependent children with the age of 2.5–18 years attending Ibn Al-Atheer Teaching Hospital in Mosul city during 2005 were included in this study, 45 healthy subjects served as control. Blood groups, Hb, and PCV were evaluated. SI, TIBC, and TS levels were also determined.
Results The occurrence of homozygous β-thalassemia is significantly higher in the offspring of first cousin marriages."O" blood group represents a highest percentage (42.8%) among the thalassemic patients. Hb, PCV and TIBC were below the control measurements. Whereas SI and TS were above that of the controls.
Conclusions Consanguinity seems to be increasing the size of the disease due to the limited health education of the parents about the disease.
Key words Thalassemia, Hb, PCV, SI, TIBC, TS

Background Majority of patients with bladder cancer present with superficial tumor, which is of three types: papillary carcinoma confined to the bladder epithelium, tumor invading but confined to the lamina propria, and carcinoma in situ (cis). Transurethral resection represents the effective management of superficial tumors but with high recurrence rate (75%) that can be minimized to 50% by using cytotoxic drug or immunotherapy.
Objective To compare two method lines of treatment in respect to long - term versus short - term therapy of Mitomycin C (MMC)Intravesical instillation after transurethral resection of superficial transitional carcinoma of urinary bladder to detect the duration of disease free interval, recurrence rate and adverse effects.
Methods A prospective, randomized, two parallel and compared lines of treatment study involved 50 patients who were evaluated after transurethral resection of superficial bladder cancer with median follow-up of 30 months. They were informed about the study and their approval to participate in the study was taken. Group A (25 patients) received intravesical MMC 30 mg weekly for 6 weeks, while group B (25 patients) continue to receive further 12 monthly instillations. Statistical analysis was performed by using Kaplan - Meier methods and chi square test.
Results After follow-up of 30 months, 28% of patients who received short course of intravesical MMC were disease free in comparison to those with long – term treatment in group B which shows significantly higher rate of disease free (56%). Regarding the adverse effects, no significant differences in incidence were noted between two groups.
Conclusion The data from the present study confirm both efficacy and safety of using intensive, prolong regimen of intravesical MMC instillation for superficial bladder cancer.
Key words Mitomycin C, superficial transitional carcinoma, and transurethral resection.

Background Cytokines are responsible for the modulation of immunological and inflammatory processes and play a significant role in the pathogenesis of acute coronary syndrome patients (ACS).
Objective This study aims to investigate the serum levels of IL-1α and IL-6 in ACS patients.
Methods The study covered 140 subjects. It comprised a total of 101 patients with ACS patients [62 with acute myocardial infarction (AMI) and 39 with unstable angina (UA)], compared with 39 healthy individuals with no history of cardiac disease. Serum IL-1α and IL-6 analysis was performed by ELISA.
Results The present results revealed that there were significant elevation in mean serum levels of IL-1α and IL-6 in patients with ACS ( AMI and UA) as compared to healthy control (P<0.001). Moreover, the levels of these cytokines were significantly higher in AMI patients when compared to UA patients (P<0.001).
Conclusion These finding suggest that IL-1α and IL-6 play an important role in pathogenesis of ACS.
Keywords
Acute coronary syndrome, IL-1α and IL-6.

Back ground: P. aeruginosa is one of the most common causes of infection in burns and wounds and it is the major cause of death in burn patients. This organism is frequently feared because it causes severe hospital-acquired infections, especially in immunocompromised hosts, and is often antibiotic resistant; complicating the choice of therapy. Thus, there is continuous need for enhancing the antibacterial efficacy of antibiotics against P aeroginosa.
Objective This study was conducted to determine the MIC of antibiotics used in combination for resistant isolates of Pseudomonas aeruginosa and measure the effect of EDTA in increasing the inhibition effect of these antibiotics.
Methods: P. aeruginosa was identified microscopically and biochemically. The swab samples from burns and wounds were collected from patients of AL-YarmooK, Baghdad and Al-Kadhimiya Teaching Hospitals. Minimum inhibitory concentration (MIC) was used to evaluate antibiotics effectiveness, while fractional inhibitory concentration (FIC) was used to evaluate the effect of antibiotics combination on pathogenic bacteria (P.aeruginosa). Disk diffusion assay were used to determine the inhibition zone of antibiotic disk (with and without EDTA) against P. aeruginosa.
Results Ten isolates were selected according to their pattern of resistance as those showing multi-drug resistance and tested to specify their minimum inhibitory concentration for (amikacin, gentamicin, ceftazidime, and ciprofloxacin). Amikacin had the lowest MIC compared with others. Among combinations, the combination of ß-lactam antibiotics with amikacin was found to be the most effective combination. Results showed that EDTA increases the effect of antibiotic against P. aeruginosa isolates especially when it was combined with aminoglycoside antibiotics.
Conclusion Amikacin is the most effective agent against Pseudomonas aeruginosa especially when combined with ceftazidime, more over; EDTA increases the activity of antibiotic against pseudomonas aeruginosa especially when combined with aminoglycoside antibiotics.
Keywords P aeruginosa, minimum inhibitory concentration (MIC), Fractional inhibitory concentration (FIC), Ethylenediaminetetraactic acid (EDTA).