IRAQI JOURNAL OF MEDICAL SCIENCES

Background:Enzyme activity is a subject of continuous research. Comparison of data obtained from various quantitative methods needs standardization of techniques in order to verify the results of histochemical and biochemical assays utilized in the study of tissue enzyme activity.
Objective:Establishment of a biochemical method for the quantification of enzyme activity in α-naphthyl acetate esterases (ANAE) containing solution using hexazotized pararoseaniline (HP) as a coupling agent.
Methods:Wavelength of maximum absorbance (λmax) of coupled HP in solution was analyzed spectrophotometrically based on the simultaneous-coupling method of ANAE demonstration.
Results:λmax of the coupled HP was found to be at 425 nm. The relationship between the optical density of the final reaction product (FRP) and the enzyme concentration was linear with the use of azo dye in solution.
Conclusion:Data obtained from the biochemical assay of ANAE activity was in agreement with those documented by the histochemical methods in use. Thus, characterization of enzyme activity may be standardized when studying tissue sections and tissue homogenates.
Keywords:Esterases, Biochemical assay, Histochemistry, Spectrophotometry

Background:Spleen is a hemopoietic organ which is capable of supporting elements of different systems. Determination of spleen size is important in diagnosing small, normal or enlarged spleens. Songraphy can rapidly and reliably help to determine the size of the spleen.
Objective:The purpose of this study was to analyze the changes in splenic volume with respect to age using anthropometric measurents (body mass index (BMI), body surface area (BSA)) and to find the predicting equation of spleen volume.
Methods:215 Iraqi subjects (103 females with age range (6-74) years and 112 males with age range (7-75) years) without conditions that can affect the spleen or splenic abnormalities were evaluated with ultrasonography. Spleen length, width and thickness were measured and spleen volume was calculated. Spleen size was correlated with age, gender, BMI and BSA.
Results:The mean splenic volume was significantly variable in different age groups.The spleen volume increases starting from childhood to reach a peak in a young adults (20-49) years and then declines in the middle age and elderly subjects (age with greater than 50 years). Splenic volume for males was significantly higher than females. BSA had a stronger linear correlation with splenic volume than BMI. Multiple regression analysis indicated that BSA had significant positive association with spleen volume in subjects younger than 50 years.
Conclusion:Spleen volume was significantly variable among different age groups. Spleen volume affected by BSA especially in subjects younger than 50 years. These results illustrate that the normal value of spleen volume affected by different factors 1) age 2) sex 3) BMI 4) BSA.
Key words:Spleen volume, Ultrasonography, Age, BMI, BSA

Background :Lead is an environmentally persistent toxin that causes pathologies and induced oxidative stress by reactive oxygen species (ROS) causing reduction of antioxidants and a weakening of defense system of the cell.
Objective:To evaluate the occupational lead level and its impact on workers in Batteries Manufacturing Factory / Baghdad.
Method: Blood, hair and urine samples were taken from 45 occupational lead exposed workers in Batteries Manufacturing Factory in Baghdad with age ranged (25-63) years during the period from October 2010 to the end of January 2011. Flame and flameless Atomic Absorption spectrophotometer were used in the measurements of blood lead and hair lead concentrations, HPLC was used in the measurement of vitamin E concentration, and ELISA was used for the determination of 8-Hydroxydeoxyguansin concentration.
Results:The results in this study showed a high concentration of lead in blood and hair for exposed workers in comparison with the normal corresponding values for the control. The results also showed that there was a significant decrease in δ –Aminolevulinic acid dehydratase activity, a low level of vitamin E in the serum and an increase in the level of 8-Hydroxydeoxyguansin in urine of exposed workers.
Conclusion:The correlation between oxidative stress parameters and clinical indices implies that there is a disrupted antioxidant balance which might contribute to lead induced toxicity in erythrocytes.
Keywords:Lead exposure, δ–Aminolevulinic acid dehydratase, 8- Hydroxydeoxyguansin, Antioxidants, Lead battery.

Background Sharp force injuries and fatalities have been reported to be the most common crimes of violence in several countries, predominantly in those where access to firearms is restricted. Death due to sharp force violence is the most common cause of homicidal deaths in Sweden and in many other countries in Europe, Africa and Asia. However incised wounds are less common in homicide.
Objective
Method A medico-legal descriptive study conducted on 18 autopsies during 6 months period. Cases were studied according to their age, sex, scene of incident, number of injuries, presence of other types, suggestive manner of injury and anatomical regions affected. Blood sample was taken for alcohol detection then complete classical autopsy was done.
Results Incised wound cases were about a third of total sharp wound cases. Males were 5 times more frequently involved than females with an age range 36.4±29.1. Indoor and outdoor scene of incidents was almost equal. Most of them were multiple with mixed types of sharp wounds. Suggestive homicidal manner of death was seen. The neck was the most common anatomical region affected. There was no role of alcohol in causation of such injuries.
Conclusion Incised wounds are infrequently encountered in medico-legal autopsy practice. Males seem to be more prone to such injuries with multiple and mixed types in the majority of cases. Homicidal manner was suggested in all cases and neck was the preferable site for the perpetrator.

Background :A large number of traditional investigations and bioassay of hormones have been practiced in the diagnosis and management of infertility for a long time. Measurements of prolactin and thyroid stimulating hormone have been considered important components of the evaluation of women presenting with infertility.
Objectives:To study the effect of prolactin hormone produced from uterine fibroid(s) on thyroid hormones levels and role of these hormones.
Methods:One hundred three women with uterine fibroid were entered to the Obstetrics and Gynecology Department in Al-Kadhimyia Teaching Hospital in Baghdad-Iraq from the 15th of June 2007 to December 30th 2010. Fasting serum prolactin, total T3, total T4, and thyroid stimulating hormone (TSH) were estimated using MiniVIDAS [ELFA (Enzyme Linked Fluorescent Assay)] kits.
Results:Forty five out of 103 (43.69%) women were found with primary infertility and the rest 58 (56.31%) with secondary infertility. Serum thyroid hormones mean ± standard deviations were found normal before and after surgery in both primary and secondary infertile women. Level of serum prolactin was found elevated about 9 folds in primary infertile women and 8 folds in those with secondry infertility before surgery more than their levels after. No significant difference was found between thyroid hormones before and after surgery in both infertile groups, unlike their prolactin which was found highly significant with p value <0.001 in both groups.
Conclusion:It can be concluded that, first, the increase in prolactin level was due to an ectopic production from uterine fibroid(s), and second, there is no effect or role of this prolactin on their thyroid hormones function. Third, their infertility could be due to the presence of prolactin secreting fibroid(s).
Keywords:Infertility, Ectopic prolactin, Thyroid hormones, Uterine fibroids

Background :Lead is one of the most dangerous metals and could be incorporated in various body tissues and thus exposure to it stills a major medical problem in both environmental and occupational setting.
Objectives:To detect the deleterious and toxic effects of the lead acetate on the weight and histological features of mice placenta at different dosages.
Methods:A prospective study including eighty mature pregnant mice were divided into two groups (experimental and control groups). Forty pregnant mice were divided into two major experimental groups (G1and G2) according to the level of the dose. The other forty animals with same age divided at the same way as in the previous experimental groups considered as control groups (C). Injections of lead acetate 0.1, 0.4 mg/kg body weight /day intraperitoneally (G1, G2 respectively) were started at the first day of gestation and continued for (17 or 20 days). When the female in each experimental and control groups reach day 17 of gestation 10 animals of each group were scarified, whereas the other 10 animals were left to be scarified at 20 day post coitum (dpc). Weight of placentas was recorded, in addition, histological study for these placentas were done.
Results:Prenatal lead acetate injection to pregnant mice intraperitoneally for 17 day cause a significant reduction (P<0.05) in placental weight and a highly significant reduction (P<0.01) in placental weight was recorded at 20 dpc experimental groups (G2) but there was no significant decrease in weight of placenta for 17 and 20 dpc in experimental groups (G1) In addition placentas belongs to (G1 and G2) mothers revealed histopathological alterations in the various component of the placenta.
Conclusion:Administration of low dose of lead acetate intraperitoneally to pregnant female mice causes significant decrease in weight of their placenta. Lead acetate also causes adverse effects on the histological features of fetal placenta.
Key words:Lead, Placenta, Placental transport toxicology, Toxic trace elements, Metallothionein, Reproductive toxicology

Background :Acute diarrhea constitutes a major cause of morbidity and mortality, especially among the children.
Objective:To identify and determine the contribution of each of the risk factors associated with diarrhea occurrence in children in the commercial capital of Yemen, city of Aden.
Methods:This outpatient-based case-control and questionnaire study was conducted during the first half of 2010, on random population of a total 304 cases of diarrhea and 517 controls. The explanatory variables were grouped according to the conceptual model, and analyzed by using a hierarchical approach, to provide a more dynamic view of the transmission characteristics of childhood diarrhea. Non-conditional logistic regression was used, and odds ratio and population-attributable fractions were estimated.
Results:Factors related to food handling made a smaller contribution to diarrhea occurrence, compare to much more contribution by environmental contamination (fecal-oral transmission), and contact with one has diarrhea/ high density of housing. However the most determinant for diarrhea occurrence was the contribution of the socioeconomic factors.
Conclusion:The data indicates that factors from all hierarchical levels were implicated in spreading of diarrhea, with relative high role for environmental contamination, and contact / crowding in the transmission. This is compatible with a predominance of the parasitic over the viral, spread by these routes. Diarrhea control strategies must emphasize on policies that improving the socioeconomic circumstances, and reducing the environmental contamination for the prevention of diarrhea.
Keywords:Diarrhea, risk factors, children, Yemen, hierarchical model

To evaluate the depressive features that accompanies Parkinson’s disease and its relation to different parameter of this disease.
This cross sectional study examined 30 patients with idiopathic Parkinson’s disease neurologically and psychiatrically, searching for depression and its association with different features of idiopathic Parkinson’s disease. The American diagnostic and statistical manual (DSM-IV) and the international classification of the disease (ICD10) were used for diagnosis of depression.
53% of Parkinson’s disease patients were found to be depressed and their depression significantly correlated with autonomic system infliction, dysphagia and insomnia. This finding was not correlated with duration or severity of the Parkinson’s disease or the late complications of the disease.
We found depression to be very common among Parkinson’s disease patients; however, no specific type of depression could be identified in those patients. There is significant association between depression and autonomic involvement, insomnia and dysphagia in Parkinson’s disease. Depression in Parkinson’s disease was not found to be related to the age of onset or to the duration of the disease.

Background :Haemorrhages into structure of the posterior fossa pose unique risks due to limited space in this compartment and risk of hydrocephalus from compression of fourth ventricle. Most are neurosurgical emergencies requiring close monitoring and/or immediate evacuation.
Objectives:To analyze therapy results obtained for surgically and conservatively treated patients. As well as to find prognostic parameters that can predict patient’s outcome.
Method: Retrospective study conducted at the Neurosurgical Hospital in Baghdad, and Al-Shaheed Ghazi Al-Hariri for Surgical Specialties Hospital. All the information were collected from hospital records between December 2000 and December 2002 for 20 patients with spontaneous cerebellar hematoma and included Clinical data like the onset of symptoms and signs, durations, progression of clinical condition, past medical history. Records of vital signs and neurological signs. Records of laboratory studies include complete blood picture, blood grouping, blood biochemistry, prothrombin time, partial thromboplastin time, bleeding and clotting time). Records of CT-scan analyzed according to the site, size, and presence of associated pathology. Size of the hematoma estimated by the maximum axial diameter.
Results:Age of patients in this study ranged from 6-76 Years .There was 12(60%) male and 8(40%) female patients with male to female ratio 1.5:1. Mortality in the conservatively treated group is 33%, while it is 54% in the surgically treated group. Hydrocephalus was present in 100% of patients in the surgical group, while it is not present in the conservatively treated patients.
Conclusions:The most important prognostic factors were GCS score on admission, interval between hemorrhage onset and treatment, size and site of hematoma, presence of hydrocephalus, and fourth ventricular extension. Suboccipital craniectomy to evacuate the hematoma is the most effective procedure where surgical treatment is indicated.
Keywords:Cerebellar hematoma, suboccipital craniectomy, ventriculostomy.

Background :Urinary incontinence is a silent epidemic severly affecting the quality of life of women. Urodynamic study is the gold standard investigation for assessing women with urinary incontinence. However it is invasive and unavailable in some hospitals. Ultrasound is safe, noninvasive and available in most units.
Objective:To determine the role of perineal ultrasound for assessing the bladder neck mobility, pubo urethral angle and retrovesical angle during rest and straining in normal women and in those with stress urinary incontinence.
Methods:Twenty patients with urodynamic stress urinary incontinence and twenty age-matched control patients were included in the study. Perineal sonography was carried out in both groups to evaluate the role of this technique in the diagnosis of stress urinary incontinence. By using the posterior edge of the symphysis pubis as a reference point, posterior urethra-vesical angle (PUVA) and the angle between the vertical axis and urethral axis (alpha angle) were measured at rest and on straining. Bladder neck mobility was evaluated only at the cephalocaudal plane by measuring the desensus diameter.
Results:Posterior urethro-vesical angle (PUVA) was found to be significantly different between the study and control groups both at rest and on straining (P < 0.05). The pubo urethral angle (alpha angle) was found to be significantly different between study and control groups only on straining (P < 0.05).Cephalocaudal distance (desensus diameter) of urethra was longer in patients with stress urinary incontinence (P < 0.05).
Conclusion:Perineal sonography has an important role in diagnosing patients with stress urinary incontinence.
Key words:Perineal ultrasound, stress urinary incontinence, bladder neck

Background :Patients with β-thalassemia major (TM) require periodic blood transfusion and iron-chelating therapy for all their life and they frequently show complications like trace elements abnormalities.
Objectives:To evaluate the levels of zinc, copper and magnesium in these patients and to study the relation of these elements with growth state.
Methods:Fifty-four patients with TM, with mean age (15.4 years) and age range (7-31) years, and thirty healthy subjects as controls, their mean age (14.7 years) and age range (8-30 years) were included in this case –control study. Each group divided into children and adult groups. Serum levels of zinc, copper and magnesium of all groups were measured calorimetrically. Serum levels of ferritin were measured depending on ELFA technique, in addition to height and weight of all patients and subjects.
Results:Mean serum levels of ferritin were significantly elevated in TM patients as compared to controls, while mean serum levels of zinc and magnesium of both patients groups were significantly decreased as compared with control subjects. Mean serum levels of both patients groups were significantly elevated compared to control subjects groups.
Conclusion:Patients with TM were suffering from hypozincamia and hypomagnesmia and required additional adjustment, the patients also showed hypercupremia, and there was obvious growth defect in which may be a result of hypozincamia.
Keywords:Thalassemia, zinc, height, short-stature

Background :Platelets play an important role in the development of intravascular thrombosis. Platelet size has been considered to reflect platelet activity. Platelet indices had been studied as an independent predictor of acute ischemic stroke (IS).
Objectives:Assessing the relation of acute IS with different platelet indices.
Methods:Fifty patients were enrolled: 25 of them had first acute IS (mean age 64 years, 12 (48%) were males) [group 1], while the rest 25 patients were those with more than one IS (mean age 68 years, 16 (64%) were males) [group 2] in comparison with the control group (20) subjects (mean age 57 years, 10 (50%) males). Work up included history and clinical examination in addition to brain CT scan and platelet indices which are: mean platelet count (MPC), mean platelet volume (MPV), platelet large cell ratio (P-LCR), and platelet distribution width (PDW) within first 24 hours of patient presentation.
Results:The mean platelet count (MPC) was found to show significant difference between group 2 versus group 1 and control (P=0.012, P=0.023 respectively), while no statistically significant differences were reported with the other indices (MPV, PDW or P-LCR). Linear negative correlation was demonstrated between MPC and MPV, PDW and P-LCR in group 1, such correlation wasn't found in group 2.
Conclusion:Mean platelet count (MPC) differs significantly in cases of multiple stokes in comparison with those having first stroke or the control group; therefore, the significance of this finding needs further studies.
Keywords:Platelet indices, platelet count, mean platelet volume, platelet distribution width, platelet-large cell ratio, ischemic stroke.

Background :Wound Dehiscence is the premature opening of a wound along surgical suture. It is a surgical complication that results from poor wound healing that can increase significantly the risk of morbidity and mortality. Risk factors in general are age, diabetes, obesity, cancers, emergency surgery, pulmonary diseases, malnutrition, weight loss, anemia, chemotherapy and radiotherapy.
Objective:To identify the most important risk factors for wound dehiscence in an attempt to decrease the incidence, morbidity and mortality of wound dehiscence.
Methods:This is a cross sectional study with convenient sample of 66 patients 48 males and 18 females with wound dehiscence after laparotomy in Al-Kindy Teaching Hospital, Baghdad, Iraq from February 2008 to May 2011. The medical records for all patients regarding risk factors responsible for delayed wound healing and burst abdomen of all patients were reviewed. Laparotomy done for all patients under general anesthesia. Retention through and through sutures inserted on both sides of the abdominal wall were used in all cases.
Results:The commonest time for the wound to burst was on the 10th postoperative day. The average duration of hospital staying was 26 days. The most common primary diagnosis of those patients was intestinal obstruction (30.3%), and adhesolysis was the most common operative procedure (18.2%). Emergency laparotomy was the most frequent factor found (92.4%). The mortality rate in patients with wound dehiscence increased with an increment of the number of risk factors, it was 15.6% in Patients who had 2-4 risk factors and reached 100% for patients with 8 risk factors.
Conclusion:The identification of the avoidable factors and their correction could reduce the risk of development postoperative burst abdomen and in turn decrease the mortality and morbidity rate.
Keywords:Wound dehiscence, risk factors, laparotomy

Background :Respiratory distress syndrome (RDS) or hyaline membrane disease (HMD) is an acute lung disease of the newborn caused by surfactant deficiency. It is Seen primarily in neonates younger than 36-38 weeks of gestational age weighing less than 2500 gram.
Objective:To find out the incidence, main risk factors of HMD, note the changes in serum calcium, potassium and sodium and to study the outcome of HMD during the period of the illness.
Methods:A prospective study was performed on one hundred neonate admitted to the neonatal care unit in Al-Kadhimiya Teaching Hospital. Sex, gestational age, weight, mode of delivery, maternal illnesses were studied as risk factors. Serum calcium, Na and K were measured.
Results:The incidence of RDS was 0.75% of total live births, 98(98%) of them were below 2.499 kilograms and less than 37 weeks of gestational age. Risk factors of RDS are male sex accounted for 61% of total cases. Cesarean sections were 28% of the total. Maternal diabetes mellitus represented 25%. Perinatal asphyxia was 22%. Familial predisposition had an incidence of 8% and finally prolonged rupture of membranes stood for 5%. Hypocalcaemia and hypokalemia were common with serum sodium was within the lower normal limits. The time of improvement for most babies (about 40%) was by day 4 of life. Mortality was 30% with the major percentage of death (which was 90%) was between day 1 and day 4.
Conclusion: RDS occurs predominantly in premature babies as a main risk factor with male sex and cesarean sections. In addition to other risk factors such as maternal diabetes mellitus and perinatal asphyxia. Associated changes in serum electrolytes and serum calcium including hypocalcaemia, hypokalemia and lower normal serum sodium are common. The 4th day of life was the time of improvement for most babies while most of them who died did so by the first 4 days of life. Among the admitted babies, about third of them (actually 30%) died because of RDS.
Key words: RDS, Gestational age, Mortality.