IRAQI JOURNAL OF MEDICAL SCIENCES

There is now a huge need to innovate, design and use novel and practicable rapid diagnostic assays (RDA) to combat the grave challenge of emerging life-threatening and multiple drug resistant bacteria (MDR) bacterial pathogens. The conventional methods of diagnosing bacterial pathogens are well enough to give good specificity. However, the sensitivity of assays in terms of short time is still not well settled. The increased population of the world along with availability of global transport means resulted in the emergence of critical health situations that the current time-consuming means of diagnosis cannot cope with the timely management of diseases caused by serious human pathogens.

Background:Glycosylation is an important modification involved during embryonic development. Lectins are specific carbohydrate-binding proteins; they can be employed as specific probes to localize defined monosaccharide and oligosaccharides on cell surface and on cytoplasmic structures, and in extracellular matrix.
Objectives:The lectins (SBA, PNA, WGA, SWGA, UEA-I) binding were used as a sensitive, stable, and easy tool that can provide an extraordinarily sensitive detection for changes glycosylation and carbohydrate expression that may occur during embryogenesis and development of trachea-esophageal region.
Methods:Fertilized chick eggs were incubated at 38 °C, embryos were fixed with Bouin’s solution. Sections were treated with fluoresce ineisothiocyanate (FITC) labeledlectins.
Results:The histochemical study during the 2ndand 3rddays of development revealed variable tempo-spatial variability of lectin bindings to the mesenchymal tissues and other embryonic structures at the trachea-esophageal region.
Conclusions:The lectin bindings could be an indicator for the glycoconjucate changes that play an essential role in developmental phenomenon of trachea-esophageal morphogenesis by marking cellular differentiation, cellular migration, and cellular interactions.
Key words:Trachea, esophagus, chick, embryo, lectin, histochemistry.

Background:Male infertility constitutes about 50% of overall causes of infertility and apoptosis is known to have an essential role in the control of germ cell number in testis. Cigarette smoking is common in males at reproductive age. Studying the influence of smoking on apoptosis in male genital tract and its influence on fertility helps in the management of infertility in smokers.
Objectives:To assess the influence of cigarette smoking on seminal plasma (SP) soluble Fas (sFas) and the correlation between SP sFas and serum sex steroidal hormones and conventional semen parameters in males of infertile couples.
Methods:Seventy male partners of infertile couples (30 smokers and 40 non-smokers) were enrolled in this study. A subject was considered smoker if he had history of smoking of more 10 cigarettes per day for at least one year. Semen analysis was done according to World Health Organization (WHO) 2010. Specific kits were used for the measurement of SP sFas and serum testosterone and estradiol (E2).
Results:In smokers' group, SP sFas was significantly (p <0.05) negatively correlated with age and sperm motility and positively correlated with immotile sperm and round cell number.
Conclusion:Germ cell apoptosis in smoker males of infertile couples is interrelated with sperm motility.
Keywords:Male infertility, Smoking, Apoptosis, Seminal plasma sFas.

Background:The common sign of snake envenomation is hepatotoxicity or liver injury that is dependent on quality and quantity of venom.
Objective:To clarify the effect of intraperitoneal (i.p.) injection of LD50 dose of Naja naja snake venom on the hepatic tissues of albino rats after 3 and 24 hr from envenoming respectively.
Methods:The rats were divided into 3 groups, the first group served as a control group, while the other groups 2 and 3 were treated with the snake venom (0.05 µg/g body weight i.p) and sacrificed by decapitation after 3 and 24 hours of the snake venom injection respectively. The livers were isolated and histological sections were prepared.
Results:Intraperitoneal LD50 for Naja naja snake cobra was determined in rats to be equal to 0.05 µg/g body weight. Histopathological changes in liver tissues after 3 hr from injection were congestion of the central veins, congested liver sinusoids, leucocytes infiltration, cytoplasmic vacuolization and nuclear pyknosis, cellular swelling and necrosis of some cells. While histopathological changes in liver tissues after 24h from injection were the same signs in addition to cellular swelling, necrosis and damage of the injured hepatocytes with acute inflammation cells infiltration.
Conclusion:The injection of LD50 dose of Naja naja snake venomin rats can induce hepatic damage and hepatotixicity in albino rats.
Keywords:Naja naja, snake venom, Rats, Liver, Histopathological changes.

Background:Treatment of acute poisoning due to drug overdose in general depends on the prevention of further absorption of the drug and acceleration of elimination, using specific antidotes. Drugs adsorption is of significant importance in physical pharmacy for the preparation of physical antidotes.
Objective:To investigate the adsorption of glimepiride from aqueous solution on two adsorbents (activated charcoal and Iraqi kaolin).
Method: UV-Spectrophotometric technique was used to obtain the quantitive adsorption data at different conditions of pH and temperature.
Results:The quantities of glimepiride adsorbed on activated charcoal and kaolin were increased with decreasing temperature. Adsorption isotherms of glimepiride on both surfaces were consistent with Freundlich adsorption isotherm. Thermodynamic functions (∆G, ∆H and ∆S) were useful in describing the spontaneity of the adsorption process.
Conclusion:The quantity of the drug that is adsorbed on activated charcoal was higher than that adsorbed on kaolin surface therefore; the activated charcoal is a better antidote.
Keywords:Glimepiride, Adsorption, Activated charcoal, Iraqi kaolin

Background:Pseudomonas aeruginosa has assumed an increasingly prominent role as the etiological agent in a variety of serious infections in hospitalized patients. Pseudomonas aeruginosa strains produce three distinct types of bacteriocins (bactericidal substances). Bacteriocins of P. aerugonosa strains can be classified according to their morpology, or according to functions into pore forming pyocin and DNase activity–pyocins.
Objectives:To type by a molecular method local isolates of Pseudomonas aeruginosa utilizing the genes encoding for the potent bacteriocin (pyocin).
Methods:Fifty bacterial isolates of P. aeruginosa were re-identified by standard bacteriological methods and were subjected to PCR-amplification for the genes responsible for the production of three bacteriocins (pyocin S1, S2, and S3).
Results:Out of the fifty local isolates of P. aeruginosa enrolled in this study there were forty five (45) isolates which showed the presence of the genes encoding for the two mentioned bacteriocins (S1 and S2) corresponding to 95% of the isolates and there were forty five (41) isolates showed the presence of the gene encoding for the pyocin S3 corresponding to 82% of the isolates.
Conclusions:The present work showed a high genotypic relatedness of the studied clinical isolates of P. aeruginosa and it also emphasized the ability of the use of molecular typing of pyocins as more advanced and accurate methods for typing purposes and epidemiological studies.
Key words:Pyocins, Bacteremia, bacteriocins, polymerase chain reaction (PCR), electrophoresis

Background:Mutation within the FLT 3 and NPM 1 genes ranked within the most frequent recurrent known genetic markers in acute myeloid leukemia (AML) and show apparently opposite prognostic significance.
Objective:To detect the frequency of FLT3-ITD and NPM-1 mutations in Iraqi pediatric AML patients using conventional polymerized chain reaction (PCR), and to relate their prevalence with the clinical presentation and the response to induction therapy.
Methods:A prospective study of 30 children presented with AML and 16 children who were age and gender matched served as negative control for the mutation. AML cases were classified according to FAB classification. WBC count, platelet count and hematocrit were measured at diagnosis and after 30 days. Molecular analysis was done on peripheral blood or bone marrow aspirate samples by conventional PCR technology.
Results:FLT 3-ITD mutation was detected in 3/30 (10%) patients, whereas NPM1 mutation was detected in 4/30 (13.33%) patients. Both mutations were detected in older age patients and predominantly in male. No significant correlation between each mutation and various hematological parameters, however WBC count was significantly higher in FLT-ITD unmutated patients. FLT3-ITD mutation was detected in M3 and M3 variant whereas NPM-1 mutation was detected in M2 and M3v. The three patients having FLT-3-ITD mutation (100%) did not achieved complete hematological remission, whereas 3/24 (12.5%) patients without the mutation did not achieve remission. On the other hand 2 out of 4 (50%) patients with NPM-1 mutation had not achieved complete hematological remission and 4/22 (18.18%) patients without mutation did not achieve remission. Finally regarding the interrelation between the two mutations, the two children who had NPM1 mutation and no FLT3-ITD mutation had achieved complete remission on induction therapy whereas the three children who had FLT3-ITD mutation with or without NPM1 mutation did not achieved complete remission.
Conclusion:Prevalence of FLT3-ITD and NPM-1 mutations in Iraqi pediatric AML patients is comparable to that recorded worldwide and both mutations were observed in older age children and mainly in male. FLT3-ITD mutation unlike NPM-1 mutation associate with poor response to induction therapy and the adverse effect of FLT3-ITD mutation overcome the favorable effect of NPM-1 mutation when they exist together.
Keywords:Pediatric AML, Flt3-ITD mutation, NPM1 mutation, PCR

Background:Polycystic ovary syndrome (PCOS) is a common endocrinopathy characterized by oligo-ovulation or anovulation, signs of androgen excess, and multiple small ovarian cysts. PCOS is thought to be one of the leading causes of female subfertility.
Objective:To evaluate and compare the effects of finasteride vs metformin in treatment of PCOS related infertility.
Methods:Seventy seven infertile married women with an age range between 18 and 35 years were studied complaining from infertility due to PCOS. They were divided into group 1 treated with finasteride (5 mg daily concomitantly with an oral contraceptive pill "OCP" continuously for 2 months) and group 2 was treated continuously for 3 months with metformin (500 mg three times daily).
Results:The percentage of patients responded to metformin treatment was 35.89%, whereas 26.32% of patients were responded to the treatment with finasteride-OCP combination. There were no significant difference between metformin and finasteride in regard to the mean number of mature follicles (1.21±0.43 vs 1.2±0.42) and endometrial thickness (7.26±1.1 vs 7.80±2.25 mm) respectively. The pregnancy rate per patient was higher in metformin treated group in comparison to finasteride treated group (60% vs 21.42%); however, this difference was insignificant (P > 0.05).
Conclusion:Finasteride has a good promising effect in the treatment of infertility due to PCOS, as more patients responded to an oral finasteride-OCP combination in comparison to those responded to an oral metformin monotherapy and the difference in the pregnancy rate of the two groups was not significant.
Keywords:Finasteride, Metformin, Polycystic ovary syndrome, Infertility

Background:Pre-operative prediction of difficulties which may occur during laparoscopic cholecystectomy can help in reduction of operative and postoperative complications.
Objectives:To study the value of preoperative ultrasound findings for predicting difficulties encountered during laparoscopic cholecystectomy and to assess the usefulness of these findings to identify patients at high risk of conversion from laparoscopic to open cholecystectomy.
Methods:A prospective study of 200 patients who underwent laparoscopic cholecystectomy for symptomatic cholelithiasis. Pre-operative abdominal ultrasound was done. The diagnosis of gall stones was made and the presence of ancillary findings was recorded. Five ancillary ultrasound findings were assessed. These included; thickened gall bladder wall more than 4mm, presence of pericholecystic fluid, severely contracted gall bladder, empyma, and gall bladder filled with stones. Ultrasound findings were compared with the operative findings.
Results:In 36 patients who had one or more of these findings laparoscopic Cholecystectomy was difficult in 22(61.1%) of them. Thick wall gall bladder > 4mm has the highest sensitivity (69%) and the presence of pericholecystic fluid has the highest specificity (100%) in predicting difficult laparoscopic cholecystectomy and the presence of more than 2 ancillary findings yielded an accuracy rate of (100%). Conversion to open cholecystectomy was needed in 13.9% of these patients. The rates of difficult laparoscopic cholecystectomy and conversion to laparotomy were much lower in those patients who had no ancillary findings (4.3%) and (1.2%) respectively.
Conclusion:Preoperative ultrasound findings are of value for predicting difficulties encountered during laparoscopic cholecystectomy which may require conversion to open cholecystectomy.
Keywords:Laparoscopic surgery, Cholecystectomy, Ancillary ultrasound findings.

Background:Vitiligo is the most frequent depigmentation disorder of the skin. None of the therapeutic alternatives is satisfactory.
Objective:To evaluate the effectiveness of systemic Co-enzyme Q10 in patients with vitiligo.
Methods:Twelve patients received Co-enzyme Q10 75 mg twice daily compared with 12 patients received placebo capsule twice daily orally for 8 weeks in the Department of Dermatology, Al-Kadhimiya Teaching Hospital (November 2011 to march 2012). History of patients was taken and measurement for serum glutathione (S. GSH) (by Elleman methods), malonialdehyde (S. MDA) (by Stocks and Dormandy methods) and VASI score at baseline, 4 and 8 weeks interval.
Results:No significant difference in S. GSH was found between Co-enzyme and placebo group after 4 and 8 weeks. High significant decrease in S. MDA occurred after 4 and 8 weeks with significant decrease in VASI were found after 8 weeks.
Conclusion:Co-enzyme Q10 may have a role in treatment of vitiligo.
Keywords:Co-enzyme Q 10, Vitiligo, Antioxidant.

Background:Hyaluronic acid (HA) is removed by the liver via sinusoidal cell adhesion molecules. This is impeded in fibrosis, leading to a rise in serum HA. As a noninvasive marker of fibrosis, HA may obviate the need for liver biopsy.
Objective:To evaluate HA as a marker of hepatic fibrosis in unselected children undergoing liver biopsy or ultrasound.
Methods:Fifty children aged 2-156 months diagnosed to have different types of chronic liver diseases (CLDs) and thirty healthy children aged 2-156 months were studied as controls were evaluated at the Teaching Hospital and Gastroenterology and Hepatology Center, Medical City, Baghdad, Iraq. The degree of severity of liver infection was assessed by liver biopsy or ultrasound. HA levels were measured using an ELISA.
Results:The mean of HA level was 0.61± 0.32 ng/ml in the control group, 3.05± 1.11 ng/ml in patients with significant fibrosis and 1.18±0.86 ng/ml in patients with chronic liver diseases without significant fibrosis. Significant fibrosis was found in 31 out of 50 children with chronic liver disease, 20 of them were classified (METAVIR score) as cirrhotic liver. Seven out of 18 biopsies value of stage 4. Thirteen out of 32 ultrasounds described as having a coarsely textured liver. The sensitivity and specificity of estimated HA values in the diagnosis of liver cirrhosis were 87.1% and 94.74%, respectively.
Conclusion:HA is a valid noninvasive predictor of histological fibrosis in children with CLD. It complements the thorough investigations of a child with CLD; however, it cannot at present replace histological examination to identify liver fibrosis. Further evaluation of HA is needed to ascertain the use of serial measurements in the targeted patient groups.
Key word:Hyaluronic acid, chronic liver disease, liver fibrosis.

Background:The treatment of chronic prostatitis/chronic pelvic pain syndrome (CP/CPPS) can be a frustrating challenge to physicians and many drugs had been used with variable results.
Objective:To evaluate the safety and the efficacy of adding 5 mg tadalafil for patients with CP/CPPS with the conventional treatment.
Methods:Thirty five patients received tamsulosin 0.4 mg capsule once daily, levofloxacin 500mg tablet once daily and indomethacin rectal suppository 100 mg once daily served as control group. Another 35 patients received the alpha blocker, levofloxacin and NSAID as above with tadalafil 5 mg once daily for 1 month period comprised tadalafil group. The NIH Chronic Prostatitis Symptom Index (NIH-CPSI) assessment was completed by each patient at baseline and 4 weeks after the drug therapy to assess the response to treatment. We consider in our study the chronic prostatitis/CPPS or category IIIa or b according to NIH classification system.
Results:No significant difference in mean age and baseline score in between groups was found. After one month of starting treatment, it had been found that NIH-CPSI/pain, urinary and quality of life domains were significantly changed from (12.8±1.44, 5.9±1.77 and 8.8±1.82) at baseline to (9.6±1.04, 3.55±0.99 and 3.88±1.31) respectively in group A. In group B also there was a significant reduction in the NIH-CPSI among patients in this group; the baseline NIH-CPSI/pain, urinary and quality of life domains were (13.4±1.66, 5.8±1.85 and 9.3±1.92) and changed to (6.28±0.90, 2.65±0.86 and 2.69±1.43) respectively after treatment. The total NIH-CPSI was 27.5±4.78 and changed to 17.03±3.91 after treatmentin group A and 28.5±4.49 changed to11.62±3.59 in group B.
Conclusion:The use of tadalafil in patients of CP/CPPS with conventional treatment for 1 month was safe and has high efficacy in reducing the symptoms for the patients and improving the quality of life.
Keywords:Tadalafil, chronic prostatitis, chronic pelvic pain syndrome

Background:Corticosteroid and antiviral agents are widely used to treat the acute phase of Bell's palsy but their effectiveness is still uncertain.
Objective:This study aimed to compare the theraputic effect of Acyclovir and steroid versus steroid alone, in combanation with physiotherapy, in patients with Bell's palsy.
Methods:This interventional study was conducted in Al-Yarmok Teaching Hospital and Al-Kadhimiya Teaching Hospital, during the period from July 2007 to July 2008. It involved (58) patients, who were divided into two groups: Group A; 28 patients, treated by steroid for 10 days. Group B; 30 patients, treated by steroid and acyclovir for 10 days. Physiotherapy for one month for both groups was followed and reassessment according to House-Brackmann grading system was done after completion of each therapy.
Results:The recovery of patients treated with steroid and Acyclovir was (66.6%), while the patients treated with steroid alone was (46.4%), however, the diffrence was statistically insignificant. After one month physiotherapy the responses were (76.7% and 53.5%) for patients in both groups respectively.
Conclusion:The addition of Acyclovir therapy in Bell's palsy has not found to be benefitial.
Keywords:Bell's palsy, Corticosteroid, Antiviral agents, Physiotherapy.

Background:Pregnancy is considered as a physiological stress, normal static metabolism of a woman is changed into dynamic anabolism, calcium (Ca) is the first most abundant cation in the human body, whereas magnesium (Mg) is the fourth most abundant one, role of calcium and magnesium in enzymatic activity of cell to release energy is well established.
Objective:To assess the relation of serum magnesium and calcium levels in cases of missed abortion.
Methods:Eighty two pregnant women at their 1st and 2nd trimester of pregnancy (before 24 completed weeks of pregnancy), 42 of them with missed abortion compared with 40 normal pregnancies served as a control group. Calcium analysis done using manual colorimetric method while magnesium analysis was done by magnesium calmogite method at the hospital laboratories.
Results:Serum calcium was found to be insignificantly altered while serum magnesium was found to be significantly reduced in cases of missed abortion compared with normal pregnancy. Serum Ca/Mg ratio was found to be significantly elevated in cases of missed abortion compared with normal controls.
Conclusion:Estimation of serum magnesium and Ca/Mg ratio in selected pregnancies can be valuable parameters for predicting missed abortion.
Keywords:Missed abortion, Serum Calcium, Serum Magnesium.

Background:Tamoxifen is a selective estrogen receptor modulator (SERM) that is widely used in the treatment of patients with breast cancer and for chemoprophylaxis in high risk women. Tamoxifen results in a spectrum of endometrial changes due to it's estrogenic effect on the endometrium.
Objectives:To evaluate the extent of endometrial pathologies that might develop in postmenopausal breast cancer patients following treatment with tamoxifen.
Methods:Sixty postmenapausal with breast carcinoma women were involved in this study, Thirty women were receiving 20-40 mg of tamoxifen daily for a period of 6 to 60 months constitutes the study group, and a control group included 30 postmenopausal breast carcinoma patients who were not receiving tamoxifen. Transvaginal sonography was performed for the measurements of the endometrial thickness and the presence of endometrial pathology. All the patients underwent endometrial sampling and the curetting were sent for histopathological examination.
Results:There was statistically significant increase in the frequency of endometrial pathology in those on tamoxifen;there was 11 endometrial pathologies in the case group,while the control group was associated with only 3 pathologies(p=0.015). There was significant difference in endometrial thickness between case group (0.73+0.32 mm) and the control group (0.5+0.16mm) with p value 0.002. Only patients with endometrial thickness of more than 5mm were associated with pathologies, 7 (38.8%) of the endometrial biopsies revealed normal endometrium, whereas, 11(61.1%) had endometrial pathology like hyperplasia, endometrial polyp or carcinoma. The rate of endometrial pathologies considerably increase with increasing duration of treatment.
Conclusion:The long term use of tamoxifen as adjuvant therapy for carcinoma breast is associated with increase frequency of endometrial pathology. Endometrial thickness is increased in such patients and is related to the duration of tamoxifen use.
Key Words:Tamoxifen, Endomatrial pathology, Breast cancer.