IRAQI JOURNAL OF MEDICAL SCIENCES

Background: Urinary tract infection (UTI) caused by bacteria that can also live in the digestive tract, in vagina, or around the urethra most often these bacteria, enter the urethra and travel to the bladder and kidneys and prostate (in men).
Objective: To determine the most common gram negative aerobic bacteria caused UTI in both sex and different ages, and to study the antibiotic susceptibility in order to determine the most effective antibiotics that can cure UTI.
Methods Prospective study of 311 samples of urine has been collected from out patients complaining signs and symptoms of UTI. Isolation and Identification of causative bacteria was concluded, antibiotic susceptibility test has been done, and statistical analysis chi square had done.
Results 125 urine samples obtained from 25 male and 100 female show growths of Gram negative aerobic bacilli. No bacterial growth was defined in the rest of urine samples. Single bacterium was identified in 120 samples, while 5 samples identified as a mixed infection with two kinds of bacteria. In 55 (44%) of cases, Echerishia Coli was isolated; in 41 (32.8%) Klebsiella Pneumoniae; in 17 (13.6%) Proteus mirabilis plus P. Vulgaris; and 12 (9.6%) Pseudomonas aeruginosa. The percentage of resistance for E. Coli varies from 73% to 86%, to Ceftzidime, Ceftriaxone, and Trimethoprim Sulfamethaxozol; for K. pneumoniae it ranges from 71% to 100% for Amoxicillin, Pipracillin, Trimethoprim Sulfamethaxozole, and Colistin; for P. mirabilis plus P. vulgaris ranging from 66% to 100% for Cetazidime, Trimethoprim Sulfamethaxozol, and Cefotaxime; and for P. aeruginose ranges from 66% to 100% for Cefazidime, Colistin, Nafcillin, Gentamycin, Trimethoprim Sulfamethaxozol.
Conclusion: E. Coli caused UTI in female higher than men in the community, and the gram negative rods had multi antibiotic resistant.
Keyword UTI, Enterobacteriacae, Antibiotic susceptibility

Background Semen samples are prepared for assisted reproduction by selecting a population of highly motile, morphologically normal sperm and removing the seminal plasma, leukocytes and bacteria. Culture media provide the spermatozoa with needs that maintain optimal function of spermatozoa to give rise excellent results during semen preparation.
Objective The aim of this study was to investigate the effect of alcoholic extraction of turmeric (AET) on sperm parameters during in vitro sperm activation (ISA) for asthenozoospermic (AZ) and oligoasthenozoospermic (OAZ) patients.
Methods Seventy four infertile patients were included, and classified into two groups according to their sperm parameters. Semen sample was divided into 3 aliquots. One mL of Earl's medium either alone (control group) or supplied with one concentration of AET (5 µg/mL or 10 µg/mL) was over layered the pellet, and the three tubes were incubated at 37 oC for 30 min in air incubator. Sperm concentration, motility, grades activity, progressive motility, normal morphology and agglutination were assessed pre- and post-activation in vitro.
Results Results revealed an enhancement of most sperm parameters for control and both treated groups post-activation as compared to pre-activation. Post-ISA, sperm parameters for both treated groups were better than the control group. However, best results for improvement of sperm parameters were assessed within treated group (5 µg/mL of AET).
Conclusions The lower concentration of alcoholic turmeric extraction enhanced human sperm parameters during ISA without any harmful effects on sperm physiology. The results are also useful as a guide for further standardization of turmeric extracts used for pharmaceutical purposes in the techniques of assisted reproduction.
Key words Male infertility, Sperm activation, Turmeric.

Background Abdominal wall is the site of opposing physical forces that may eventually result in the appearance of the hernias. The external abdominal hernias are the most common forms, the inguinal hernia being the commonly encountered type [75% of the abdominal hernia]. Many factors are responsible for the formation of the inguinal hernia but, what makes a few people more susceptible to this situation is still clearly not proved. Few of the previous studies have concluded that the low lying pubic tubercle is associated with the development of the inguinal hernia.
Objectives This study was designed to investigate the distance between the anterior superior iliac spines and the perpendicular distance of the pubic tubercle from the interspinal line.
Methods 50 males with inguinal hernia compared with the control group comprising of 60 adult healthy males.
Results This study revealed that both parameters (interspinal SS distance and the pubic tubercle height ST) in the study group were significantly greater than that in the control group. The distance from mid inguinal point to the superficial inguinal ring was also measured in both the study and control groups and the results show that the distance is shorter in the individuals with the inguinal hernia. Identification of the structural characteristics of inguinal region enables the surgeon to perform the surgical technique appropriately.
Conclusion The low pubic tubercle group of cases has more tendencies for herniation. The unusual origin of internal oblique muscle in group II with low lying tubercle is far away, from the external half of the inguinal ligament, leaving the internal ring unprotected during abdominal muscle contraction, which is another causation of hernia development.
Key words Inguinal hernia, pubic tubercle, inguinal canal, anterior superior iliac spine

Background Studies have shown that the cerebellum develops within the dorsal metencephalon creating a rhombencephalicdemilune (RD) which represents the formation site of the cerebellum granular cells progenitors. These studies used different histological techniques but all have provided qualitative information regarding the biosynthesis and cell mitosis at the RD.
Objective Quantifying the proliferative activity of the cellsat the RD during the embryonic period.
Methods Six age groups from day 16 to day 21 albino rat embryos Rattusrattusnorvegicus were investigated with Ag-NOR staining technique to quantify cell proliferation.
Results There wasa statistically significant difference (p<0.01) between cellular activity at different age groups with a surge during embryonic day 18.
Conclusions Correlation with other studies revealed that Ag-NOR staining technique, which reflects protein biosynthesis and nuclear mitotic activity, provided a valuable quantitative measure of cellular proliferation in the developing rat cerebellum.
Keywords Rhombencephalicdemilune, Rat, Developing Cerebellum, Ag-NOR, Quantitative, Histochemistry

Background Dirofilaria immitis has been increasingly recognized worldwide as inadvertent human pathogens. The epidemiological survey usual hosts of theses nematodes are domestic and wild carnivores. The disease is regarded as one of the most dangerous threat for the dog health. The adult worms take up residence in the heart, lungs and surrounding blood vessels.
Objective This study attempts to shed the light on relationship between glomerular lesions and heart filarial (Dirofilaria immitis) infection.
Methods Dirofilaria immitis was isolated from 98 dogs out of 457 dogs that were autopsied for the time between April 2008 and May 2010, in Al-Hindya area, Karbala province. Parameters concerning parasitological and pathological changes are used in this study to determine the significance of the results.
Results Grossly many adult heartworms were found in the right ventricle of infected hearts and the cross section revealed body cavity, thick cuticle with coelomyarian and polymyarin muscle type, accompanied by infiltration of inflammatory cells mainly eosinophils and lymphocytes between muscle fibers. The microscopical changes in the kidney were necrotic and sloughing of epithelial cells, cystic dilation of collecting tubules of medulla containing hyaline casts, with glomeruli showing membranous nephropathy.
Conclusions This is the first histological report of canine filariasis in Iraq particularly in Karbala province. It is important to keep in mind that pathologic changes in heartworm disease may be well advanced before the appearance of clinical signs of the disease. In heartworm disease the circulatory system is not the only system affected. The renal, hepatic & pulmonary systems can be secondarily affected. In our work the observations support the previous hypotheses of immature and possibly adult worms, contribute to the glomerulonephropathy.
Key wards Canine heartworm, interstitial nephritis, membranous nephropathy.

Background The perinatal morbidity and mortality increase significantly as pregnancy progresses beyond term. The ketone production as a result of dehydration becomes significant in the latter portion of pregnancy.
Objective To determine whether ketonuria, a commonly assessed urinary marker of maternal starvation and dehydration, is associated with abnormal fetal test results in the setting of postterm pregnancy.
Methods During a one-year period (March 2007-March 2008), a total of 180 visits of 100 patients of postterm pregnancies ( 41 weeks’ gestation) occurred at Baghdad Teaching Hospital. Maternal assessment included vital signs and urinalysis. The presence and degree of maternal ketonuria was correlated against abnormal results of fetal heart rate tests, non stress tests, amniotic fluid index measurements (the biophysical profile scores) performed on the same day.
Results There were 180 evaluations suitable for inclusion in the study. Clinically detectable ketonuria occurred in 13.9% of the patients studied. Patients with clinically detectable ketonuria were at increased risk relative to patients without ketonuria for abnormal outcomes during postterm testing, including the presence of oligohydramnios (28% vs. 9.7%; p <0.018), non reactive non stress tests (12% vs. 2.6%; p <0.03), and variable, late fetal heart rate decelerations (20% vs. 8.3%; p <0.05).
Conclusions Maternal ketonuria among patients with postterm pregnancy was associated with a >2 fold increase in the occurrence of oligohydramnios, a 3-fold increases in non reactive non stress tests, and a significant increase in fetal heart rate decelerations.
Key words maternal ketonuria; biophysical fetal test; postterm pregnancy

Background The pubovaginal sling (PVS) is a safe and durable surgical procedure for stress urinary incontinence (SUI) of all types. Among numerous modifications of the procedure is using synthetic sling material to decrease surgical morbidity and increase long-term success.
Objective To present the results of pubovaginal sling with a polypropylene mesh in women with SUI.
Methods We studied 12 consecutive patients who underwent PVS procedure using polypropylene mesh for SUI between January 2008 and April 2009. Stress urinary incontinence was demonstrated by positive cough test, filling cystometry. Urethral hyper mobility was demonstrated with straining cotton swab (≥ 30◦), with different grades of vaginal wall prolapse. Urodynamic study was not performed. All these patients were treated with pubovaginal sling (PVS) with a low-cost polypropylene mesh confectioned by the surgeon. The sling was placed at the level of the proximal half of the urethra and tied with adequate tension, but not obstructing the bladder outlet. Postoperatively, the patients were evaluated at 6-month with a symptom questionnaire, physical examination, and postvoid residual volume determination. Demographic criteria, complications during surgery and post operative period, and subjective cure rate at three months were assessed.
Results Twelve patients with mean age of 55.5 years and median parity of 4 years underwent bladder neck sling surgery using polypropylene mesh. Body weight range was 45-68 kg. No intraoperative or major postoperative complications were reported. Mean duration of surgery was 65.5 minutes (60-120 minutes). Concomitant procedures were performed, including cystocele repair (n= 10) rectocele repair (n=11). Mean duration of hospital stay was 2 days (1-5 days). Ten patients had complete cure of SUI, one patient had significant decrease in the severity of stress urinary incontinence. One patient had persistent SUI.
Conclusions The construction of a pubovaginal sling using a low-cost polypropylene mesh is a safe and effective technique for the relief of SUI. It should be considered an alternative, especially in patients with weak rectus fascia.
Key words stress urinary incontinence; pubovaginal slings; polypropylene

Background: Human chorionic gonadotropin (HCG) is a glycoprotein hormone, which consists of two polypeptide subunits (alpha and beta), produced by syncytial trophoblast cells of the placenta during pregnancy. Ectopic HCG production occurs in many tumors including breast tumor.
Objectives: The objective of the study is to investigate the expression of β–HCG in breast tumor and its correlation with pathological prognostic factors (age, tumor type, site, size, histological grade, lymphocytic infiltration, vascular invasion and lymph node involvement).
Methods: A total of 44 breast tumors were selected, consisting of eight benign lesions (Fibrocystic disease in four cases and fibroadenoma in the rest) and 36 malignant breast tumors (invasive ductal carcinoma (21 cases) all of not-otherwise-specified type (NOS), in situ ductal carcinoma (6 cases), invasive lobular carcinoma (6 cases) and in situ lobular carcinoma (3 cases).
Results: β-HCG expression was found in 6 of 36 malignant breast tumors (16.7%). None of the benign breast lesions showed β-HCG expression. High expression of β-HCG is seen more frequently in infiltrative ductal carcinoma with higher-grade tumor and in old age group (≥50 years).
Conclusion: It was concluded that high expression of b-HCG is seen more frequently in infiltrative ductal carcinoma with higher grade. There was a high b-HCG expression in tumors more than or equal to 5-cm diameter.
Key words: Breast tumors, b-HCG

Background Hepatitis C virus (HCV) infection is a serious public health problem throughout the world. Chronic haemodialysis patients are at higher risk for acquiring hepatitis C virus (HCV) infection.
Objective To assess the rate of seroconversion of hepatitis C virus (HCV) infection every month for one year duration, to evaluate the possible associated risk factors and the relationship of hepatitis C virus infection with blood transfusion and duration of hemodialysis.
Methods Fifty seven patients, 37 males (65%) and 20 females (35%), who were on regular haemodialysis in Al-Kadhimiya Teaching Hospital was studied during the period between January 2009 and December 2009. Patients were analyzed monthly with anti –HCV antibodies using a commercial enzyme-linked immuno-sorbant assay BioKit (bioelisa HCV 4.0) and serum Alanin aminotransferase measurements.
Results Twenty three patients (40.3%) were HCV positive of whom, 13 were males (56.5%) and 10 were females (43.5%). History of blood transfusion, number of blood transfusion and duration of haemodialysis, had significant correlation in acquiring HCV infection.
Conclusion Seroconversion of HCV infection was of high rate incidence (40.3%). Duration of HD, history of blood transfusion and number of blood transfusion(s) are factors affect the rate of seroconversion of HCV infection in patients on regular HD. The higher rate of seroconversion of HCV infection needs further research to identify the causes and to establish a well organized prophylactic program by using more sophisticated and accurate investigation.
Key words Hepatitis C virus infection, Hemodialysis, Chronic renal failure

Background So many women think that the use of intrauterine devices in a scarred uterus carries high complications like increased uterine bleeding and pain and these side-effects may result in early removal of the device.
Objective The study was conducted to show the difference in the side effects of Copper intrauterine device (CuT380A) in women after vaginal deliveries and those with previous scar of cesarean section.
Methods The study group consisted of 411women who were using CuT380A device for contraception which has been fitted for more than 3months (240 of them had vaginal deliveries and 171 had one or more cesarean section scar). Complications of the CuT380A device were compared in both groups in regard to heavy vaginal bleeding (menorrhagia), painful menstrual cycles (dysmenorrhea), cycle irregularity, other types of pain (pelvic pain and backache) and infection. Both groups were further studied and complications were compared according to the duration of intrauterine device insertion.
Results The most common side-effects related to CuT380A were bleeding and pain. Menorrhagia was recorded in 35.42% and 29.24% while dysmenorrhea in 27.08% and 34.50% women of the non-scarred and scarred uterus groups respectively. These side effects were not statistically different between the two groups and they decreased significantly with time; menorrhagia decreased from 40.54% to 27.17% (P-value=0.035) and from 36.27% to 18.84% (P-value=0.014) while dysmenorrhea decreased from 31.76% to 19.57% (P-value=0.039) and from 41.18% to 24.64% (P-value=0.026) in non-scarred and scarred uterus groups.
Conclusion The study revealed that the side-effects of CuT380A device did not differ between non-scarred and scarred uterus and that menorrhagia and dysmenorrhea significantly decreased with time.
Key words CuT380A, non-scarred uterus, scarred uterus.

Background The trace heavy metals such as Cobalt, Zinc, Copper and Nickel play important roles in bacteria; they regulate a wide array of metabolic function as coenzyme or cofactors. However, some metals like arsenic, mercury and cadmium, are not essential for growth and extremely toxic. Understanding of metal resistance in Staphylococci in association with antibiotics resistance has progressed rapidly in the last years with well-established cadmium, mercury, antimony and arsenic resistance system encoded by plasmids.
Objective To evaluate antibiotic and heavy metal resistance in Staphylococcus aureus isolates.
Methods Thirty S. aureus isolates were collected from different clinical specimens. The minimum inhibitory concentration of thirty S. aureus isolates was determined for four types of antibiotics, which were tetracycline, gentamicin, cefotaxime and penicillin-G. Resistance of S. aureus isolates to heavy metals ions (Cobalt, Zinc, Mercury and Cadmium) were tested. Ethidium bromide was used as a curing agent with freshly growing S. aureus to study resistance features link with antibiotic and heavy metal resistance.
Results The minimum inhibitory concentration of thirty S. aureus 83.3% of the isolates were resisting tetracycline 80% of the isolates were resisting gentamicin 93.3% of the isolates were resisting cefotaxime, and 80% of the isolates were resisting penicillin-G. While, 93.3% of isolates found to be resistant for Cobalt ions, 86.6% resisted Zinc ions, 86.6% resisted Mercury ions. While, 83.3% of isolates resisted Cadmium ions. Using Ethidium bromide as a curing agent showed two groups of cured colonies.
Conclusions There is strong relationship between multiple antibiotic resistances and multiple heavy metal resistance In addition; there may be two to three types of plasmids depending on results obtained from curing experiment.
Key wards Heavy metals, S aureus, antibiotics, resistance.

Background Urinary tract infection (UTI) is usually associated with multiplication of microorganisms in urinary tract followed by adhesion of these organisms to the uroepithelial cells which is considered as the first step for colonization and infection. Adhesion of Candida on the epithelium of the urinary tract stands as the first step in the pathogenesis of Candidiasis. The adhesion process is under the impact of many factors.
Objective This study was designed to determine the susceptibility of uroepithelial cells obtained from patients with different urinary tract diseases, for adherence with Candida albicans in vitro.
Methods
Forty eight urine samples collected from women attending Medical City Hospital-Baghdad suffering from urinary tract diseases and proved to have Candida growth. Ten urine samples were collected from apparently healthy age matched females and used as a control. The uroepithelial cells of each sample have been collected and incubated with Candida albicans cells and the percentage of uroepithelial cells with an adhered Candida cells (% EC). The mean number of Candida/epithelial cells (C/E) was estimated before and after adherence assay.
Results Klebsiella infection showed the highest percentage of uroepithelial cells with Candida (%EC), next in frequency was samples with high number of uroepithelial cells, then, Streptococcus pyogenes, Escherichia coli, pus cells, and finally samples with high number of RBCs. This study indicates that receptivity of Candida adhesion to the uroepithelial cells of urinary tract have different affinity depending on the type of modulating factor surrounding these uroepithelial cells.
Conclusion
From the obtained data it can be concluded that urine findings including bacterial growth might modulate epithelial cell surface and increase their receptivity for Candida adherence.
Key word Adherence, Candida albicans, uroepithelial cells.

Background Microvessel density is one of the variables that are thought to affect the natural history of prostatic carcinoma in as much as its degree influences tumor progression including the ability of invasion and metastasis.
Objectives To assess microvessel density of prostatic adenocarcinoma, and determine its relationship to serum levels of prostatic specific antigen, and carcinoma grade, as determined by Gleason's score.
Methods Thirty patients with prostatic adenocarcinoma were studied. Parameters assessed are patients’ age, serum levels of prostatic specific antigen, and the grade of the carcinomas according to (Gleason’s scoring system). The values of the serum levels of prostatic specific antigen and the Gleason score were divided into 3 subgroups for statistical purposes. The degree of angiogenesis was evaluated by assessing microvessel density in sections stained immunohistochemically with CD34.
Results The microvessel density ranged from 10 to 35 (average 20.24 ± 5.95). Statistically significant correlation was found between the mean of microvessel density and serum prostatic specific antigen when the cutoff point of was 11 ng/ml, and with Gleason score when the cutoff point was 7.
Conclusion Microvessel density determination can predict the potential biologic behavior of prostatic adenocarcinoma in individual cases. The incorporation of the serum levels of prostatic specific antigen levels and Gleason scores with the former makes such predictions more practical.
Key words Prostatic adenocarcinoma, microvessel density, serum prostate specific antigen, Gleason score.

Background Dentin hypersensitivity may be defined as pain arising from exposed dentin. The relationship between dentin hypersensitivity and the patency and Microleakage through dentinal tubules has been established in vitro. Currently the most accepted mechanism of nerve activation associated with dentin hypersensitivity appears to be hydrodynamic in nature.
Objectives: The concept of tubule occlusion as a method of dentin desensitization is a logical conclusion of the hydrodynamic theory.
Methods Forty two human maxillary anterior teeth were selected, the crowns were cut away at the CEJ, the root canals prepared, cleaned and filled then the coronal access closed with zinc phosphate cement. The specimens were randomly divided into four groups, two of them experimental A and B and two controls C (positive) and D (negative). All the specimens were coated with sticky wax except the ring that had cementum removed while the negative control specimens were entirely coated with sticky wax. All the specimens were stored in human saliva which was changed daily for 21 days with daily brushing of specimens of group A with a Sensodyne tooth paste (that with active ingredient Strontium chloride). At the end of the 21 days, the specimens were immersed in pelikan ink for three days then the sticky wax was removed, after that the teeth were cleared to make them transparent to provide a three dimensional assessment of dye penetration. The teeth were subjected to linear dye penetration measurement and scanning electron microscope analysis to investigate whether Sensodyne with Strontium chloride occlude dentinal tubule orifices.
Results Strontium chloride, the active ingredient of Sensodyne tooth paste has a tubule occluding property which may indicate a therapeutic potential in vivo. Also scanning electron microscopic analysis revealed presence of deposits in and around the tubular orifices.
Conclusion Sensodyne with strontium chloride proved effective (in vitro) in occluding the orifices of patent dentinal tubules.
Keywords Dentin hypersensitivity, Dentinal tubules occlusion, Sensodyne with strontium chloride.

In 1907, Siegfried Oberndorfer (1876–1944), a German pathologist at the University of Munich, coined the term karzinoide, or "carcinoma-like," to describe the unique feature of behaving like a benign tumor despite resembling a carcinoma microscopically. Carcinoid tumours are characteristically low grade malignant tumors with neuroendocrine differentiation that have been described in several locations, including the gastrointestinal, respiratory, hepatobiliary, and genitourinary systems. Carcinoid tumors most commonly occur in the gastrointestinal tract (74%) and bronchial system (25%). less than 1% of cases these tumors have been reported in the genitourinary system.
In this report we describe a 55-year-old house wife female who presented with vague gastrointestinal complaints for long period then she developed intestinal obstruction due to small bowel carcinoid. The clinical findings are used to illustrate pathophysiology, classification, management of carcinoid tumours through review of literatures.

Keywords: carcinoids tumours, neuroendocrine tumours, small bowel obstruction.

The hydatid cyst is endemic in our country, but bone lesions are less common. The disease often takes the appearance of abscess or malignant lesion. We report a case of a 31-year-old woman with a hydatid cyst of the rib complicated with cutaneous fistula. The surgery allowed both diagnosis and treatment.

Keywords: hydatid cyst, rib, fistula.