IRAQI JOURNAL OF MEDICAL SCIENCES

Background Classical semen analysis gives an approximate evaluation of the functional competence of spermatozoa, but not the quality of sperm DNA. With the advent of assisted reproductive technologies (ART), the concern over using damaged DNA has become apparent.
Objective To clarify the role of DNA integrity and maturity of ejaculated spermatozoa in male infertility.
Methods A randomly selected group of 50 nonazoospermic infertile patients with a history of infertility of at least 1 year duration were included in this study. Whereas control group consisted of semen samples obtained from healthy volunteers of proven fertility (n = 27). Two main assays were studied in ejaculated spermatozoa: The green Acridine Orange (AO) fluorescence test that measures DNA integrity and the terminal deoxynucleotidyl transferase-mediated deoxyuridine triphosphate-nick end labeling (TUNEL)- based ApopTag® technology that assesses DNA fragmentation as a late apoptotic marker. Results were compared with the standard sperm characteristics (concentration, motility and morphology) between infertile patients as well as some patients' subgroups against control donors.
Results Significant low levels of green AO fluorescent spermatozoa were observed in all patients and patient's subgroups with asthenoteratozoospermia and oligoasthenoteratozoospermia (P = 0.00001). High percentages of TUNEL-positive spermatozoa were significantly noticed, against control donors, in all patients as well as asthenoteratozoospermic and oligoasthenoteratozoo-spermic infertile patients. Interestingly, normozoospermic patients had a significantly low percentage of green AO fluorescent spermatozoa and high levels of TUNEL-positive spermatozoa versus control donors (P = 0.0005, P = 0.0069, respectively).
Conclusion From this study, it can be concluded that male infertility is associated with high rates of DNA damage in the spermatozoa, and that sperm DNA damage analysis could reveal a buried deformity of sperm nuclear DNA in infertile men classified as idiopathic, having apparently normal standard sperm parameters.
Keywords DNA denaturation, DNA fragmentation, acridine orange, TUNEL.

Background Understanding the practice of birth spacing and factors which influence women’s interbirth interval (IBI) is critical for countries like Iraq with high fertility levels.
Objectives This study aimed at measuring the duration of the interval between births and determining some of the factors favored optimal spacing intervals of Iraqi women.
Methods A cross-sectional study was conducted among ever married and having at least 2 live births 472 women during March 2008 in Al-Kadhimyia Teaching hospital. Data were obtained by interview questionnaire, included birth intervals, demographics, and fertility variables. Actual birth interval was measured and data were analyzed using a logistic regression model.
Results The mean birth interval was 31.16 ± 21.56 ranged 9–228 months, and 65.6% of interbirth intervals were of less than 36 months. The multivariate regression revealed that older woman, a woman’s husband higher education and having male children were the significant predictors of longer interbirth interval.
Conclusions Relatively short interbirth interval found in the present study may help national health program conveying the message of optimum birth interval, with expanding education and employment opportunities for women can act as a motive for child spacing.
Key words Pregnancy spacing interval, contributing factors, Iraqi women.

Background Endometriosis is a chronic and recurrent disease characterized by the presence and proliferation of functional endometrial glands and stroma outside the uterine cavity. GnRH analogues are currently one of the most widely used medical therapies for endometriosis.
Objective This study assesses the role of zoladex (goserelin acetate depot) for patients with recurrent endometriosis after surgical treatment.
Methods A descriptive follow up study of 20 women with recurrent endometriosis after surgery were arranged to receive Goserelin acetate (Zoladex) one month depot administered subcutaneously monthly for a period of six months followed by one year follow up in Al-Karama Teaching Hospital -Wasit Governorate/ Iraq from May 2008 until May 2010.
Results Ninety percent of patients showed symptomatic improvement, ultrasound improvement achieved in 80%, recurrence rate of 20% within one year after stopping treatment and none of the patients required surgical interference during the period of the study.
Conclusions Our results support the beneficial role of Goserelin acetate (3.6 mg) month depot administered subcutaneously in the treatment of recurrent endometriosis after surgery.
Keywords Endometriosis, GnRH analogues, Goserelin acetate

Background Skeletal muscle fibers contain about 2% of its weight is glycogen, this glycogen used to keep the muscle functioning if it fails to receive sufficient oxygen. PAS stain is useful in detecting cytoplasmic accumulation of glycogen. Glycogen had been studied in skeletal muscles under various state of muscle activities and nutritional states but glycogen quantification with aging is not clearly defined till now.
Objectives Quantification of the mean glycogen concentration in skeletal muscles fibers stained with PAS stain in various age groups by microspectrophotometry.
Methods The tibialis anterior muscle of 20 Albino male rats (rattus rattus norvegious) of neonate, 3, 6, 9, 12, and 18- months were selected. Paraffin blocks were performed, sectioned and stained with PAS stain.
Analysis of the PAS stained sections by microspectrophotometry at 510 nm wave length. For the test group, mean absorbance, standard deviation, maximum, minimum, and mode values were estimated and compared with the control groups.
Results A significant difference in PAS absorbtion between test and control groups, and among different age groups, being increased with age.
Conclusion The variation in PAS absorbtion with aging indicates that the glycogen content in skeletal muscle increase with aging, this could be due to the influence of age on skeletal muscle glucose transport and glycogen metabolism.
Key words Skeletal muscle, PAS, Glycogen, Microspectrophotometry

Background Enuresis, which is frequently diagnosed amongst school age children, is an important psychosocial problem for both parents and children.
Objective In the present study we aimed to determine the prevalence and associated risk factors of enuresis in sample of Iraqi children and to identify common methods for its management.
Methods Across sectional epidemiological study was performed among primary school age children living in Tikrit and Beji cities during the period from the October 2008 to the June 2009. A self-administered questionnaire was prepared for this study and distributed to the parents of 1.150 school age children whom aged 6-12 years.
Results Of the 1.150 questionnaires distributed, 1000 (87%) were completed. The overall prevalence of nocturnal and diurnal enuresis were 22% (n = 220) and 1.9% (n =25) respectively. Although male gender, low age, history of enuresis among parents, low educational level of the parents, deep sleep, increased number of siblings, increased numbers of people sleeping in the child's room, history of enuresis among siblings, poor school performance and history of recurrent urinary tract infections (UTI) were significantly associated with enuresis, but not with the severe enuresis. The percentage of children with enuresis seen by physician for treatment was 17.2%. The most preferred treatment option for enuresis was medications (59.5%), whereas alarm treatment was the least preferred (2.4%).
Conclusion The results with enuresis prevalence and associated risk factors were comparable to other epidemiological studies from various countries, but it is higher in our country. Furthermore we demonstrated that families in the Tikrit do not pay sufficient attention to enuresis and most of enuretic children do not receive professional treatment.
Key Words Enuresis, family characteristics, prevalence

Background Certain infectious agents have been identified more frequently in cultures from women who have had a spontaneous pregnancy loss; these include Ureaplasma urealyticum, Mycoplasma hominis, and Chlamydia.
Objective The aim of the study was to evaluate the frequency of Chlamydia trachomatis infection among women who experienced recurrent spontaneous abortion.
Methods A total of 119 women, age ranged from 23.9−28.5 years were enrolled in the current study and were classified into: Group A- Recurrent spontaneous abortion (RSA): n= 62 women, with a mean age of (28.5±0.68); Group B- non- recurrent spontaneous abortion (non-RSA): n= 34 women, with a mean age of (26.4±0.85) and group C- Control (successful pregnancy): n= 23 women, with a mean age of (23.9±0.88). From each patient and control blood and urine samples were collected. Urinalysis test strips including Leukocytes esterase in urine was done, and estimation of IgM levels against Chlamydia trachomatis in sera of patients was done using ELISA method.
Results Based on ELISA screening assay, results showed a significant difference in the level of circulating C.trachomatis specific IgM antibody between group A and group C (p< 0.05) as well as between group B and group C (p< 0.01). Also highly significant positive correlation (r=0.401, p<0.001) between C.trachomatis acute infection and urine level of leukocyte esterase.
Conclusion C.trachomatis infection is an important causative agent of miscarriages in women. C.trachomatis infection diagnostic procedures should be considered in screening tests during pregnancy.
Key words Chlamydia trachomatis, RSA, ELISA, Leukocytes esterase

Background Blepharoptosis has a significant impact on patient functional status and may cause poor visual development in childhood and correction of congenital ptosis is one of the difficult challenges the ophthalmologist faces. Several surgical techniques were used for correction. The selection of one technique over another depends on several factors including the experience and comfort level of the surgeon with various techniques, the severity of ptosis and the degree of levator function.
Objective To Evaluate Whitnall sling procedure for moderate to severe congenital blepharoptosis with fair to poor levator function as a good choice to those whom frontalis sling procedure was there only option.
Methods Twenty five patients with different types of congenital blepharoptosis of moderate to severe degree and poor to fair levator function were received in Al-Wasity Hospital for Reconstructive Surgery and treated with Whitnall sling procedure. The results were evaluated according to the following criteria; Good: where the ptotic lid lies within 1 mm of normal lid position (1 mm below superior limbus) in primary gaze position. Moderate: postoperative lid position drooped more than 1 mm of normal lid position but maintained above the pupil. Poor: post operative lid position drooped to obscure the visual axis in primary gaze position.
Results 20 cases (80%) were having good results, 5 cases had moderate results (20%). There were no poor results. There was no need for additional tarsectomy in our cases.
Conclusion Whitnall sling procedure is a good choice for cases lying in the overlap zone between it and the frontalis sling procedure whenever the surgical indications and procedure of choice were concerned.
Keywords blepharoptosis, congenital lid ptosis, whitnal sling

Background Depression is the most common psychopathological condition among patients with chronic renal disease yet it is still under recognized and underestimated. Depression adversely affects the already disturbed quality of life of patients with chronic renal disease.
Objectives To determine the rate of depression in a sample of chronic renal failure patients attending haemodialysis unit in teaching hospital in Baghdad and examine the sociodemographic variables of such patients.
Methods This is a cross-sectional study done at Al-Kadhimiya Teaching Hospital, during a period of 2 months from 4th of January 2009 to 4th of March 2009. The total of 50 random cases with chronic renal failure coming for haemodialysis were interviewed by semi structured schedule for psychiatric diagnosis. Results were reviewed by simple descriptive and inferential statistical measures.
Results The rate of depression in this sample of patients with chronic renal failure was 40%.There was no statistically significant relation between any of the demographic variables and depression.
Conclusion The rate of depression in this study is high. Results were compared with other studies in light of circumstances of this study.
Key words Depression, chronic renal failure, haemodialysis

Background The signs and symptoms of acute appendicitis vary according to the site of the appendix; and absence of tenderness in the right iliac fossa dose not exclude appendicitis like in postileal, subhepatic and pelvic appendix. Even Alvarado scale zero is not excluding the diagnosis of acute appendicitis.
Objective To study the incidence of delayed appendectomy and its relation to the anatomical variation of the appendix and its morbidity.
Methods A prospective study for patients whom underwent appendectomy for acute appendicitis during the period from-June 2009 to June-2010. The appendix of all the patients was submitted to histopathological examination and was proved to be acutely inflamed. The patients were divided into two groups according to the time interval from the onset of the first symptom to the time of appendectomy. In group A, this interval was more than 72 hours; while in group B it was less than 72 hours.
Results Group A includes 35 patients; while group B include 201 patients. The anatomical site of the appendix in group A was very significant in delayed decision of appendectomy in postileal appendix (P=0.0001), subhepatic appendix (P=0.0004), and significant in retrocecal appendix (P=0.017); but it is not significant in pelvic appendix (P=0.88), paracecal appendix (P=0.83) and preileal appendix (P=0.95). Patients in group A had longer hospital stay due to complications 35 (100%) generalized peritonitis and 3 (8.57%) patients were died due to septic shock which is significant (P= Conclusion The classical visceral-somatic sequence of pain is not mandatory for diagnosis of appendicitis. In postileal and subhepatic appendicitis there is neither pain nor tenderness in the right iliac fossa (due to its anatomical position); and when the decision of appendectomy is delayed, there were generalized peritonitis and patients died due to septic shock.
Key words Appendectomy decision, Anatomical variation, Appendix

Background Hirschsprung's disease or the congenital intestinal aganglionosis is the result of arrested fetal development of the myentric nervous system, but the precise pathogenic mechanisms involved are unknown. The successful treatment of infants and children with Hirschsprung's disease depends on prompt diagnosis and early treatment.
Objective To compare the complications of Swenson's and Soave's pull-through procedures for the management of Hirschsprung's disease.
Methods This study was conducted by patient's relative interview in Central Teaching Hospital of Pediatrics in Baghdad for the period from June 2006 to June 2010 .All the patients were under (10) years old who were admitted and underwent surgical interference and followed up under the study group. This study included 40 infants and children with Hirschsprung's disease underwent either Swenson's or Soave's pull-through procedures. On average, the post operative follow-up period was six months after the last stage of operation (closure of colostomy).
Results The patients consisted of 32 males (80%) and eight females (20%), a ratio of 4:1. Their age ranged from 1 day to 10 years. History of failure to pass meconium was the commonest presentation and was found in (87.5%). Twenty-five patients (62.5%) underwent a Swenson's pull-through and fifteen patients (37.5%) underwent Soave's pull-through. The incidence of the complications following Swenson's procedure was 24% while after Soave's procedure was 20%. Wound infection and adhesive intestinal obstruction were the commonest complications after Swenson's pull-through and occurred in (12%) while anastomatic stricture was the commonest complication after Soave's procedure and occurred in (20%).
Conclusion The rate of complications was higher following Swenson's pull-through in comparison to Soave's pull- through procedure.
Keywords Hirschsprung's disease, Swenson's pull-through, Soave's pull through, complications.

Background Polyvinyl chloride (PVC) is used in production and manufacturing of many essential tools for example plastic pipes, fabric, cables, decorative products etc.). Its production is impossible without the use of vinyl chloride monomer (VCM), which can cause liver damage in long-term.
Objective To assess the effects of mild to moderate long term exposure to VCM on liver and to assess the importance of liver enzyme measurements as screening tools.
Methods In this study, measurement of serum levels of liver enzymes of 64 exposed workers and 61 control workers was carried out starting from the first of October 2010 till the end of January 2011. All of the studied cases were worked in a poly vinyl chloride (PVC) production unit in three polyvinyl chloride factories and considered as target population for detection of any possible industrial vinyl chloride associated liver enzymes changes. The controls were randomly selected from office personnel of the same factories. Biochemical paramedics and a questionnaire method were used for analysis and in both groups.
Results Both groups have a similar age structure. Statistical difference was noted between the alanine aminotransferase (ALT) and gamma-glutamyl transferase (GGT) mean values for both the exposed and non-exposed groups. The mean values for alpha-2-globulin and gamma-globulin in both exposed and non exposed groups of serum electrophoresis were statistically significant. The relative risk for the exposed workers was higher than that one for all other variables. It was the highest and most significant for gamma-globulin abnormal values associated among the exposed group followed by the relative risk of alpha-2- globulin.
Conclusion Liver function tests with serum protein electrophoresis are useful to detect hepatic damage among workers exposed to polyvinylchloride.
Key words Liver Enzymes, Workers, Protein Electrophoresis, Vinyl Chloride

Background Parkinson's disease (PD) is the second most common degenerative neurologic disorder after Alzheimer’s disease. Pain is one of the major clinical symptoms of Parkinson's disease, occurring in 50-83% of patients. Pathways mediating pain are complex and include basal ganglia and thalamocortical-basalganglia circuits.
Objective To quantitatively assess pain perception in Parkinson disease patients, by determining pain threshold in patients with and without pain through using electrical stimulation.
Methods A cross sectional observational study recruiting 18 patients with a clinical diagnosis of Parkinson disease and healthy controls from the neurologic unit in Al-Kadhimiya Teaching Hospital in Baghdad; between May 2010 to Jan 2011. There were 13 men and 5 women with a mean age of (66.5 ± 10.2 years). The control group includes 18 healthy subjects, [12 males/ 8 females] with a mean age of 56.6±6.74 years. Quantitative sensory testing was carried at the neurophysiology laboratory in Al-Kadhimiya hospital; using bipolar stimulating electrodes on the forearm, index finger, mid leg, and big toe.
Results Fourteen Out of 18 patients (77.7%) reported pain, while 4 (22.3%) had no pain. There was a highly significant statistical difference in electrical perception between the affected and unaffected side, and between Parkinson disease patients and the controls. There was no statistically significant difference between males and females [p =0.8248], and between patients with and those without pain [p =0.3279]. And between upper and lower limbs on the affected side [p =0.1412], and body side involvement whether right or left in both the patients and controls.
Conclusion Chronic pain is present in 77.7% of Parkinson disease. Patients with Parkinson disease had lower pain threshold compared to controls. The affected side had lower pain threshold. The left or right body side and gender had no effect on pain threshold.
Key worlds Parkinson disease, Pain

Background Myoepithelial cells play an important role in the interpretation of breast fine needle aspiration cytology, since these cells are believed to be a component of the benign process in the breast lesion. Myoepithelial cells distinction may be difficult occasionally, so their demonstration by immunocytochemistry method through myoepithelial cell marker like smooth muscle actin is a useful diagnostic tool to differentiate between benign and invasive malignant lesions.
Objective To study the role of smooth muscle actin as immunocytochemical marker in the demonstration of myoepithelial cell as an aid in the diagnosis of benign breast lesions in fine needle aspiration cytolog of breast.
Methods Forty five cases of fine needle aspiration cytology of palpable female breast lesions were selected. 25 out of these 45 cases comprised 20 invasive breast carcinoma and 5 fibrocystic diseases with atypia stained with smooth muscle actin by immunocytochemistry method directly and 20 cases comprised of 10 fibroadenoma and 10 fibrocystic disease stained with smooth muscle actin after destaining from H&E stain. All of these cases had a confirmatory histological diagnosis.
Results Smooth muscle actin staining consistently highlighted the myoepithelial cells in smears of all histologically proven benign lesions such as fibroadenomas and fibrocystic changes. In contrast, invasive breast cancers demonstrated absence of staining with smooth muscle actin that seen in benign breast lesions.
Conclusion Application of smooth muscle actin immunostaining in breast fine-needle aspirates is feasible and practical. The use of destained H&E smears provides an effective means to directly examine any atypical cluster of cells for the presence of MEC differentiation. The demonstration of presence or absence of MEC differentiation in atypical cases can provide sufficient evidence to decrease error in diagnosis (false positive) of breast fine-needle aspirates.
Keywords Smooth muscle actin, fine needle aspiration cytology, breast lesions

Background Chronic suppurative otitis media is a common disease affecting young age group, it is typically a persistent disease, often capable of causing severe destruction and irreversible sequelae and clinically manifest with deafness and discharge.
Objectives To evaluate the degree of sensorineural hearing loss component in patients with chronic suppurative otitis media with and without pathological sequelae, which necessitate early detection as it increase in severity with time.
Methods A prospective study of 140 patients with unilateral chronic suppurative otitis media was evaluated otologically and audiologically for bone conduction hearing loss in the diseased ear throughout one year. The patients mean age was 26.5±0.5 years ranging from 10-45 years and the mean duration of the illness were 6.9±2.5 years ranging from 1-30 years.
Results Eighty-eight and a half percent of the patients with unilateral chronic suppurative otitis media had some loss of cochlear function.
Conclusion Most patients had a difference of less than 10 db in bone conduction between diseased and uninvolved ears. The range difference between diseased and uninvolved ears was wider at the higher frequencies, related mainly to the duration of the disease and its pathological sequelae such as cholesteatoma and or granulation tissue.
Key word Sensorineural, otitis media, round window, cholesteatoma

Abstract Spleen rupture is a rare life threatening emergency that mostly occurs in pathologically enlarged spleens. Causes may include infections, congenital cyst, metabolic, degenerative and malignancy (leukemia). Several possible mechanisms have been proposed for spleen rupture in patients with hematological disorders. Most commonly, malignant cells of lymphoproliferative or myeloproliferative origin infiltrate the spleen directly. Their sheer volume exceeds the capacity of the relatively non-distensible splenic capsule, causing splenic rupture and splenic hemorrhage.
In this report we present a 34 years old male patient presented with an acute abdomen after 3 days from sustaining blunt hit over the abdomen. After immediate resuscitation, exploratory laporotomy had done that revealed old altered blood in the peritoneal cavity and large spleen with non-bleeding laceration in addition to hepatomegaly and dilated mesenteric veins. Evacuation of the clotted blood was done with splenectomy.
Key word Massive splenomegaly, chronic myeloid leukemia, spleen rupture