IRAQI JOURNAL OF MEDICAL SCIENCES

Background:Fibrin glue is a natural, biocompatible and biodegradable topical tissue adhesive that initiates and duplicates the final stages of coagulation cascade. To prevent early fibrinolysis, antifibrinolytic agent may be added to the components of the glue. Tranexamic acid is a synthetic antifibrinolytic lysine analogue that competitively inhibits the activation of plasminogen to plasmin, hence, delays the fibrinolysis activation.
Objective:To synthesize of the fibrin glue with and without tranexamic acid addition and explore the biomechanical behavior of both formulae with regard to stretching (elasticity) and tension.
Methods:Using thrombin and cryoprecipitate (as a source of fibrinogen) for synthesis of the \"ordinary fibrin glue\". In another preparation; Tranexamic acid was added to both components (thrombin and cryoprecipitate) for synthesis of the \"tranexamic acid added fibrin glue\". Then, by using displacement and force transducers we measure elasticity and tension of the synthesized fibrin glue (both ordinary and tranexamic acid added fibrin glue) at different durations.
Results:Tranexamic acid addition to the fibrin glue causes significantly higher elasticity results at 1 hour, 1 week durations. Significant lower tension results are witnessed at 1 hour duration, while at 1 week duration, comparison of the tension results of both ordinary and tranexamic acid added fibrin glue show no significant difference.
Conclusion:Tranexamic acid addition led to change in biological behavior of the glue presents as increase in its elasticity and decreased tension. This change should be taken into consideration when the applicator needs to use this formula in the management of different areas of human body.
Keywords:Fibrin glue, tranexamic acid, elasticity, tension.

Background:Childhood obesity is a serious public health problem with increasing prevalence worldwide.
Objectives:To estimate the prevalence of obesity and overweight among under 5 years children and to clarify some factors associated with them like socioeconomic status, sedentary behavior, eating habits etc.
Methods:A total of 606 children from those visiting health care center for vaccination or routine care aged 2 months up to < 5 years. The parent (or caretaker) of each child was interviewed using a special questionnaire form provides information about sociodemographic characteristics, inclusion and exclusion criteria, delivery and pregnancy, feeding and nutrition, physical activity, and measurement of weight and height.
Results:The prevalence of overweight was 16.8%; of those at risk of obesity were 18.15 %. No significant association found between obesity, age, gender of the children, occupation of the parents, type and size of the family, obstetrical characteristics, eating habits. A significant association between obesity and residency of the children, educational level of parents, added food given to the child and age started to give this food, and physical activity.
Conclusion:The study shows that the prevalence of overweight and those at risk of obesity are increased in Iraq in the last decade.
Keywords:Overweight, obesity, under 5 years’ children, BMI.

Background:L-carnitine is an important antioxidant present in a high concentration in epididymal fluid. It supplies energy for sperms to acquire their motility in the epididymis.
Objective:To evaluate the effect of L-carnitine on improving some of the seminal fluid parameters in infertile males.
Methods:Ninety-six infertile males were divided into two groups, a group received L-carnitine and the other group received multivitamin. Seminal fluid analysis performed before and after treatment in both groups. Analysis and comparison of the results were carried out between both groups for all patients then for patients with primary and secondary infertility in each group.
Results:The patients received L-carnitine showed no improvement in semen volume but a significant raise in sperm concentration observed in all patients. A highly significant raise of sperm motility was observed especially in patients with primary infertility.
Conclusion:L-carnitine significantly improves sperm concentration and sperm motility especially in patients with primary infertility. It is recommended for oligoasthenozoopermic infertile men.
Key words:Male infertility, antioxidants, L-carnitine, azoospermia.

Background:Refractory epilepsy patients who fail to respond to two antiepileptic drugs used appropriately are likely to have medically refractory seizure disorder and should be investigated for alternative forms of treatments like experimental drug trial, surgical treatment, electrical stimulation and combination of these. Vagal nerve stimulation is an adjunctive treatment for certain types of epilepsy.
Objectives:To evaluate the efficacy of vagal nerve stimulation in refractory epilepsy, as an adjunctive therapy to antiepileptic drugs in Iraqi patients.
Methods:A retrospective study recruiting 34 patients at Neurosciences Hospital in Iraq between Feb. 2008 and Jan. 2011. Diagnosed as refractory epilepsy according to International League Against Epilepsy criteria; the epilepsy state, number of the anti-epileptic drugs, frequency and severity of the attacks (using Chalfont scale) was assessed before and after the vagal nerve stimulation implantation. Programming was done every two weeks depending on clinical assessment.
Results:Severity of the attacks was reduced totally 100% in 26.5% of the patients and 50-99% in 26.5% of patients. The number of attacks per month was decreased by 100% in 26.5% of patients and showed more than 50% improvement in 38% of patients. The number of the drugs used after the implantation decreased by 17.6% (P = 0.007). The most common side effects were hoarseness of voice 55.8% and dysphagia 41% only during the on time of the device.
Conclusion:Vagal nerve stimulation is effective safe and well tolerated in Iraqi patients.
Key words:Vagus nerve stimulation, Refractory epilepsy, Anti-epileptic drugs, Iraqis.

Background:N-RAS mutations are the most commonly detected molecular abnormalities in hematologic malignancies, especially in those of myeloid origin.
Objective:Current study aimed to determine the frequency of N-RAS mutation and its correlation with P21N-RAS protein expression in patients with acute myelogenous leukemia (AML) in Iraq.
Methods:Peripheral blood, bone marrow aspirate and biopsy samples were taken from 58 newly diagnosed AML patients (57 de novo and 1 therapy related AML) and 30 individuals with reactive bone marrow conditions were selected as a control group. Samples screened for N-RAS gene mutations using nested PCR followed by mutation sensitive digestion analysis (MSDA), and immunohistochemical analysis of P21N-RAS protein expression by using anti N-RAS monoclonal antibody.
Results:N-RAS mutations at the time of diagnosis were found in 10/58 (17.24%) and P21N-RAS expression found in 5/58 (8.62%) patients with AML. There was a significant difference (P = 0.001) in P21N-RAS expression between mutant and wild type N-RAS patients with AML. No N-RAS mutations or P21N-RAS expression detected in the control group individuals.
Conclusion:It can be suggested that there is activation of RAS-signaling cascade in AML patients, this is may support their role in molecular pathogenesis of acute leukemia. Also, there was a significant difference between N-RAS gene status and P21N-RAS protein expression in patients with AML.
Keyword:AML, N-RAS Mutation, MSDA, P21N-RAS expression, Digital analysis.

Background:Evaluation of obstructive jaundice is a common clinical problem.
Objective:To compare diagnostic accuracy, sensitivity and specificity of ultrasound and Magnetic Resonance Cholangio-Pancreatography in the diagnosis of intrinsic obstructive biliary disease.
Methods:One hundred and sixty patients with an obstructive jaundice for whom ultrasound (U/S), magnetic resonance imaging (MRI) and Magnetic Resonance Cholangio-Pancreatography (MRCP) were performed. The final diagnosis was confirmed by surgery, tissue biopsy and/or Endoscopic Retrograde Cholangio-Pancreatography (ERCP) in some cases.
Results:Of the 164 patients, 102 (62.2%) were found to have choledocholithiasis, 42 patients (25.6%) with benign stenosis and 20 patients (12.2%) had cholangiocarcinomas. Regarding choledocholithiasis, U/S examination showed a diagnostic accuracy of 80.15% with sensitivity of 71.08% and a specificity of 95.83 %. Conversely, MRCP showed a diagnostic accuracy of 93.89%, sensitivity of 93.97% and a specificity of 93.75 %. Regarding benign stenosis: U/S showed a diagnostic accuracy of 78.62% with a sensitivity of 16.67 % and a specificity of 97.29%. The diagnostic accuracy of MRCP was 93.13%, with a sensitivity of 90% and a specificity of 94.05%. In malignant stenosis: of the 20 patients with cholangiocarcinomas, 6 were localized in the upper third or hilar biliary tract (Klatskin tumor), 4 in the mid third and 10 in the distal third of the common bile duct (CBD). The diagnostic accuracy of US in malignant stenosis was 93.13%, with a sensitivity of 61.12% and a specificity of 98.23%. For MRCP, the diagnostic accuracy in detecting malignant stenosis was 93.89%, with a sensitivity of 72.23% and specificity of 97.34%. In all cases, no difference was noticed when comparing US and MRCP.
Conclusion:Lithiasis was the most common cause of extra-hepatic intrinsic biliary obstructions. U/S is considered the first choice option in the diagnostic imaging of obstructive disease. If laboratory and clinical findings are supported by U/S, ERCP is required for therapeutic purposes, or if necessary surgery is performed. Ultrasound is highly reliable for ruling out benign stenosis, though not for demonstrating their presence. MRCP is required only for staging of malignant stenosis, or if the suspicion posed by clinical and laboratory findings is not confirmed at U/S.
Key words:Ultrasound, MRCP, extra-hepatic intrinsic biliary obstruction.

Background:Diarrhea is the leading cause of morbidity and mortality in children in developing countries, intervention trials showed that using zinc in acute diarrhea decrease morbidity and mortality.
Objective:To evaluate the role of zinc supplement in the recovery of hospitalized children with acute diarrhea.
Method: The study included one hundred patients presented with acute diarrhea (age 3 months -2 years), forty eight of them were males and fifty two were females, sixty of them were infants and forty were above twelve months. Fifty patients were treated with intravenous fluid only and the other fifty patients were treated with zinc in addition to intravenous fluid.
Results:The study showed that the percentage of improvement within the first three days in patients treated with zinc was 80% compared to 44% of control group with P value 0.001. Zn therapy reduce the severity of diarrhea, it is effective in infants but more effective in toddlers, it is similarly effective in both males and females, it is more effective in mixed fed babies than in those on breast or bottle feeding .Using low dose reduce the incidence of vomiting.
Conclusion:Zinc therapy is useful in decreasing the duration and severity of acute diarrhea in children.
Keywords:Zn (zinc), acute diarrhea.

Background:Physicians have a crucial role in health service delivery and therefore their job satisfaction may lead to improved quality in patient care and may cut down costs of care by reducing patient stay in the hospital.
Objectives:To determine the level of job satisfaction among medical doctors who work at Al-Kadhimiya Teaching Hospital in Baghdad, Iraq.
Methods:Cross sectional study was conducted at Al-Kadhimiya Teaching Hospital. The research questionnaires distribution time was from January 9th 2013- March 30th 2013.
Results:Three hundred and twenty seven medical doctors participated in this study. Age mean was (35.8±8 years). Only (12.5%) of the participating medical doctors were satisfied with their job.
Conclusion:The majority of medical doctors were not satisfied with their job at Al Kadhimiya Teaching Hospital.
Key words:Job satisfaction, Teaching hospital, medical doctors.

Background:Adipose tissue secretes variety of adipokines, including leptin, which is involved in endocrine processes regulating reproduction and plays an important role in energy metabolism and fetal development during pregnancy.
Objectives:To investigate the relationship between total serum leptin concentrations and anthropometric parameters including body mass index (BMI) in aborted women at the second trimester.
Methods:A case control study was carried out from November 2011 to April 2012. The patients' group includes 30 aborted women at the second trimester. They were collected from Al-Elweyia, Al-Hakeem and Al-Khadhemiyia Teaching Hospital in Baghdad. Thirty healthy pregnant women (at their second trimester of gestation) were used as control. Patients and control were comparable in age. Blood HbA1c and serum concentrations of total leptin, lipid profile, and glucose were measured in both groups.
Results:Total serum leptin concentration were significantly lower in those with abortion at the second trimester compared with healthy pregnant control (3.5±0.8 pg/ml vs. 24.4±0.7 pg/ml, P = 0.0001) and leptin/BMI ratio vs. control (0.1±0.02 vs. 0.9±0.01 ml, P=0.0001). No correlation was found between leptin level and patient’s age or gestational age in the case group. Highly significant correlation was found between patient’s total serum leptin and their body mass index, HDL-C, total cholesterol/HDL-C ratio and atherogenic index (P < 0.0001).
Conclusion:The significant correlation between patient’s leptin and their BMI in addition to Leptin/BMI ratio even in non obese patient supports our objective that the unexplained abortion at second trimester is due to abnormality in their metabolic hormone action and reflect leptin resistance condition.
Keywords:Second trimester abortion, Leptin, BMI, Gestational age.

Background:Infusion pump is a special pump machine, with two different types, programmable and fixed flow pumps. These pumps used for administration of drugs through lumbar intrathecal route.
Objectives:To evaluate the infusion pump surgery as a new surgical technique in Iraq used for treatment of pain and spasticity and to discuss the limitations and achievements regarding surgical techniques, the cases that to be selected for surgery and general conditions of selected cases pre and post surgery .
Methods:Five patients were collected from Al-Kadhimiya Teaching Hospital complaining of either spastic lower limb due to dorsal spinal tumor, radiculopathy due to bullet injury not relieved by other techniques, or generalized pain due to tumors with different locations and liver metastases. Surgery done for all patients using (Isomed/Medtronic) fixed flow infusion pump.
Results:Four patients have pain relief with different percentage when using morphine and one patient with spasticity showed mild improvement after baclofen pump injection.
Conclusion:Infusion pump surgery is a new technique in Iraq, which is effective in the management of intractable pain and spasticity not relieved by medications.
Keyword:Morphine, baclofen pumps, spasticity, isomed.

Background:The glycogen content of individual muscle fibers varies according to their types as well as in response to workload changes. The effects of tenotomy on this glycogen content in skeletal muscles of the rat leg have long been studied, however, such effects on the contralateral limb was not detailed in most of these studies.
Objective:To investigate the effect of tenotomy of the Achilles tendon on the glycogen content of gastrocnemius and soleus muscles fibers in both the tenotomized and contralateral limbs.
Methods:Thirty adult male rats (Rattus rattus norvegicus albinus) divided into non-tenotomized (control) and tenotomized (experimental) groups. The Achilles tendon of the right hind limb was incised and left to heal for 2 weeks. Animals then were sacrificed and cross sections of the right and left gastrocnemius and soleus muscles were examined spectrophotometrically for the mean optical density of PAS stain.
Results:A significant decrease in the glycogen content of the tenotomized and contralateral limbs of gastrocnemius muscle compared with the control group. Similar significant decrease was found for soleus muscle in tenotomized but not the contralateral limb of the experimental group compared with the control group.
Conclusions:The disuse atrophy in the tenotomized limb causes decrease in the glycogen content of gastrocnemius and soleus muscle fibers. However, the change in glycogen content seems to affect the fast gastrocnemius rather than the slow soleus musclein the contralateral limb probably because the mechanical load on gastrocnemius during muscle contraction following tenotomy is higher than that exerted on soleus muscle.
Key words:Skeletal muscle, Gastrocnemius, Soleus, Glycogen, Spectrophotometry.

Background:Peptic ulcer is diagnosed at endoscopy where there is a mucosal break of 5mm or larger covered with fibrin. Mucosal breaks smaller than 5 mm are called erosions that do not penetrate the muscularis mucosa whereas an ulcer extends through the muscularis mucosa in the sub-mucosa.
Objective:To determine the clinical picture, epidemiological aspectof peptic ulcer in children from birth to sixteen years of age and determine the relationship of the clinico-epidemiological aspect of the disease and the socio-demographic features.
Methods:Fifty-three patients with an age ranged from birth to 16 years presented with gastrointestinal tract complaint and diagnosed to have peptic ulcer by endoscopic findings. The data was collected by viewing the case sheet of every child included in the study using special questionnaire to obtain socio-demographic information.
Results:The mean age was (10.73±5.2) and the majority of the patients (54.72%) were in the age range (11-16) years old, with a male to female ratio of 2.5:1. Duodenal ulcer (66.04%) is more common than gastric ulcer (33.96%). There is significant association between age groups and type of peptic ulcer. Negative family history was found in (71.7%) of patients. Hematemesis is the most common clinical feature present in (69.81%).
Conclusions:It is important to investigate children with recurrent abdominal pain, nocturnal pain and positive family history of the disease. Further studies for longer duration are required to follow up complications and healing or chronicity to the adult life.
Key words:Peptic ulcer, children, clinico-epidemiological view.

Background:Hemodialysis patients experience frequent and various cutaneous manifestations. Chronic renal failure (CRF) is a clinical state, which results in declining of kidney functions.
Objective:To evaluate the frequency and nature of cutaneous lesions associated with CRF patients on hemodialysis.
Methods:Fifty patients with chronic renal failure on hemodialysis in Al-Kadhimiya Teaching Hospital, Dialysis Center from the period of February 2012- May 2012 were conducted in this case series study.
Results:All patients included in this study had at least one cutaneous manifestation related to chronic renal failure. The most frequent findings were pruritus (100%), pallor (100%), xerosis (100%), hyperpigmentation (74%), petechae (40%), ecchymosis (30%) and wrinkles (30%). Nail changes were half and half nail (76%), koilonychias (48%) and splinter hemorrhage (28%). Oral changes were xerostomia (88%) and ulceration (52%). Other manifestation like hair changes (42%) was seen.
Conclusion:Chronic renal failure is associated with various cutaneous manifestations caused by hemodialysis or the disease itself. The most frequent findings; pruritus, pallor and xerosis. The early diagnosis of cutaneous changes may decrease the morbidity and eventually lead to the improvement of life quality in these patients.
Keywords:Chronic renal failure, hemodialysis, cutaneous manifestations.

Background:The observation of ketonuria and its severity in post- term pregnancies can be considered as one of the most important biochemical markers, which can help the obstetrician to predict the adverse outcome of post-term pregnancy with some sort of precision.
Objective:To assess the effect of maternal ketonuria on fetal wellbeing in pregnant woman with post-term pregnancy, estimate the frequency of amniotic fluid volume changes in different degrees of ketonuria and to estimate the frequency of non-stress test abnormalities according to the severity of ketonuria.
Methods:Two hundred and fifty post-term pregnant women divided into pregnant woman with ketonuria of different severity (27) and pregnant woman without ketonuria (223). Ketone bodies were tested in urine. Fetal testing had been done for all of them in terms of non stress test and amniotic fluid volume assessment in term of amnioticfluid index.
Results:Ketonuria was found in 10.8% of post-term pregnant woman and 62.9% of them had moderate to severe ketonuria. Oligohydramnios had been observed in 62.9% and 22.4% of pregnant woman with ketonuria and those without ketonuria, respectively. 4(80%) with severe ketonuria had oligohydramnios. Abnormal non-stress test was observed in 85.1% and 45.7% of those pregnant women with and those without ketonuria, respectively. There is a significant statisticalassociation between the presence of ketonuria and the result of fetal testing.
Conclusion:Ketonuriawas significantly associated with oligohydramnios and abnormal results of non-stress test. Higher frequency of oligohydramnios and abnormal results of non-stress test among those with severe ketonuria.
Keywords:Post-term, ketonuria, oligohydramnios, non-stress test

Intracranial colloid cysts are non-neoplastic epithelium-lined cysts of the central nervous system that almost always arise from the anterior third ventricle roof (immediately posterior to the foramen of Monro). These epithelium-lined, mucin-containg cysts can be found in asymptomatic patients; however, depending on their location, size, and degree of cerebrospinal fluid obstruction, patients may present with a variety of neurological symptoms. These symptoms can range from headaches to sudden death on rare occasions when there is acute hydrocephalus.
This study describes a colloid cyst located between the two lateral ventricles at the level of foramen of Monro obstructing the cerebrospinal fluid (CSF) flow leading subsequently to sudden death and discovered incidentally during autopsy. The study was done in the Medico-legal institute in Baghdad from 1st of November 2012 to 1st of May 2013.
Key words:Sudden Death, Colloid Cyst, Autopsy, Intracranium.