IRAQI JOURNAL OF MEDICAL SCIENCES

Background:Epileptic discharges generally initiated at specific locations and spread after time in preferred directions along specific pathways, this spread will simultaneously change the dynamics of system in which it spread and cause epileptic destabilization of neuronal circuits.
Objectives:To study the relationship between single focal epileptic discharge or multiple focal epileptic discharges and the duration of their disease.
Methods:Ninety six epileptic patients with partial epilepsy and mean age of 12.5±7.5 years were studied, no one of patients receive antiepileptic drugs or were on irregular treatment. They had been divided according to duration of illness into two groups; those with more than one year illness and those with less than one year illness. Electroencephalography recording were obtained via 10-20 system using bipolar and referential montage with a thirty minutes record for each patient, accordingly. Patients were divided into those with single focal epileptic discharge (unifocal) & those with multifocal (multiple focal) epileptic discharge.
Results:A significant difference in mean duration of illness between patients with unifocal and multifocal epileptic discharge were found. Those with multifocal epileptic discharge show higher mean duration of illness (17.8±9.05) months as compared to those with unifocal epileptic discharge (9.1±6) months. Significant positive linear correlation was found (P = 0.01), and the duration of illness increased more in patients with multifocal epileptic discharge.
Conclusion:We found that longer duration of exposure to epileptic discharge could lead to generation of new foci not exist previously and that may possibly be due to kindling phenomena and triggering more spread of epileptic discharge.
Key words:Epileptic discharge, Kindling phenomena, electroencephalography.

Background:In Basra, Southern Iraq, an increased prevalence of congenital cardiovascular defects was reported. Although genetic and environmental factors predispose to these defects, little information is available concerning the non-inherited modifiable factors that may cause these defects.
Objectives:To determine the environmental risk factors for congenital cardiovascular defects in infants and children.
Methods:A total of 109 patients with congenital cardiovascular defects and 252 infants and children without congenital cardiovascular defects were studied. Their age ranged from 1 day-14 years. History included residence, family history of congenital heart diseases, maternal factors, employment, maternal exposure to drugs and radiation during pregnancy, and maternal illnesses and potential paternal risk factors.
Results:A significant association between maternal age (less than 20 years or more than 34 years) (odd ratio, OR 4.65), influenza (OR 4.25), maternal phenobarbital intake (OR 1.54) was demonstrated with congenital cardiovascular defects. On the other hand, lower birth order (OR 0.412), absence of maternal exposure to air pollution like carbon monoxide, nitrogen dioxide, ozone, sulfur dioxide, and particulate matter (OR 0.852), and maternal stressful events (OR 0.822) were associated with a reduced risk for congenital cardiovascular defects.
Conclusions:Birth order, maternal age, maternal exposure to air pollutions, maternal stressful events, influenza and phenobarbital therapy are independent risk factors for congenital cardiovascular defects.
Keywords:Congenital cardiovascular defect, children, Basra

Background:β-thalassemia major is an inherited disease resulting from decrease or total lack of β globin chains. Patients with this disease need repeated blood transfusion for survival. This may cause oxidative stress and tissue injury due to iron overload and depletion of antioxidant enzymes.
Objective:Evaluation the role of vitamin E, L- carnitine and melatonin supplementation in management of β-thalassemia major patients.
Methods:Forty five patients with β-thalassemia major were allocated to three groups A, B and C treated with vitamin E, L-carnitine and melatonin respectively. Serum malondialdehyde, serum reduced glutathione, serum ferritin, Hb, PCV, MCV, MCH, and MCHC levels and RBCs count were measured before and after treatment.
Results:A significant decrease was observed in serum malondialdehyde and ferritin level after therapy in all treated groups; whereas, no significant (P > 0.05) changes in glutathione level after treatment in all groups. Hb level and RBC count increased significantly in group A (vitamin E), whereas, PCV, MCV, MCH and MCHC levels did not change significantly in all treated groups.
Conclusion:Vitamin E, L- carnitine and melatonin have beneficial effects of in reducing lipid peroxidation and iron overload in patients with β-thalassemia major. These antioxidants may increase the life span of RBCs, which manifested by significant increase in Hb level in vitamin E treated group and significant decrease in serum ferritin level in all treated groups.
Keywords:Beta-thalassemia, malondialdehyde, glutathione, ferritin, hematological parameters, vitamin E, L- carnitine, melatonin.

Background:Ericsson method used to determine whether enriched sperm samples would result in offspring of a desired gender. It is used in approximately 50 centers in the United States and in many centers worldwide when scientists and andrologist discovered that sperm samples with high concentrations of either X or Y bearing sperm could be obtained.
Objective:To examine the effect of Ericsson method on gender selection following intra-uterine insemination for infertile couples.
Methods:One hundred infertile couples were included in this study. A programmed ovulation induction for women was done. Luteinizing hormone and estradiol hormone level were measured. Ultrasonography was used to detect the number and diameter of follicles and endometrial thickness at menstruation cycle 1 day before human chorionic gonadotropin injection. Semen analysis was done for all husbands and density gradient technique with 7% and 17% albumin concentration was performed for sperm selection in vitro. Intra-uterine insemination was accomplished and pregnancy test was done 14 days following insemination to detect the level of human chorionic gonadotropin in blood. The gender of fetus was recorded 4 months following pregnancy by ultrasonography.
Results:Twenty two (22%) out of one hundred women become pregnant. According to gender, live birth babies distributed into thirteen male babies (76.64%) and only four female babies (23.36%). One pregnant woman delivered twins following intra-uterine insemination.
Conclusion:It is concluded that Ericson method is a simple and effective technique for gender selection when infertile couples seek to have a baby by intra-uterine insemination.
Key Words:Gender selection, Infertile couples, Intra-uterine insemination, Ericsson method.

Background:Shortening the onset time of sensory block is a practical goal to improve the quality of epidural anesthesia. The addition of Neostigmine to a local anesthetic solution is one of the ways used during epidural anesthesia to perform this goal.
Objective:To examine the onset time of sensory block and intensity of motor block during epidural lidocaine anesthesia with and without Neostigmine addition to the epidural solution and to compare haemodynamic changes and any associated side effects.
Methods:We made two groups of twenty patients, each of both the sexes ranging from 20-80 years age group of American Society of Anaesthesia (ASA) Grade I & II, selected for abdominal surgery; group I (epidural administration of 17 ml of 2% Lidocaine plus 1 ml of normal saline); group II (epidural administration of 17 mL of 2% Lidocaine plus 500 µg Neostigmine in 1 ml of normal saline). The sensory block was assessed by pinprick method; the motor block was assessed by using Bromage scale. The hemodynamic changes, post epidural shivering, and side effects of epidural Neostigmine were also recorded.
Results:The onset time of sensory block up to T10 dermatome was significantly more rapid in the group II (8.95±2.44 minutes) than that of the group I (25±4.32 minutes). The upper level of sensory block was also significantly higher in group II, regarding intense motor block it was significantly in group II (13.11± 5.52 minutes) while in group I it was 30.2± 6.4 minutes; this represents the stage of just being able to flex knee but full flexion of foot (Bromage Scale). Post epidural arterial blood pressures and heart rates were not statistically different between both groups. No significant difference was also noticed considering associated side effect (nausea, vomiting, hypotention and shivering).
Conclusions:Addition of Neostigmine 500µg to 2% Lidocaine shortened the onset of sensory block with rapid cephaled spread with more potent motor block without increasing side effect.
Key Words:Epidural, Neostigmine, Lidocaine, Onset of sensory block and Motor block.

Background:Despite the well-accepted success of laparoscopic cholecystectomy (LC) in the elective treatment of symptomatic gallstone, the safety and the efficacy of this technique has been subjected to some debate in the setting of acute cholecystitis (AC).
Objective:To evaluate our institution’s experience with early LC and to evaluate the safety and effectiveness of LC in the treatment of AC.
Methods:Eighty nine patients were diagnosed as having AC based on the clinical, laboratory and ultrasound findings; 80 patients were divided randomly into two equal groups.
Group 1 included 40 patients who had early LC for AC within one week from onset of the symptoms and group 2 included 40 patients who had late LC around 6 weeks from onset of symptoms as interval LC after conservative treatment.
Results:No significant difference in the conversion rate (in early group 8 patients (20%) versus delayed group 6 patients (15%). Complication rate was insignificant (in early group 4 patients (10%) versus delayed group 3 patients (7.5%). The delayed group had a significantly shorter operative time (early group = 128±53.5 min versus delayed group = 107±50.1 min) and significantly shorter postoperative stay (early = 2.4±3.2 days versus delay = 1.4±1.4 days). The early group had a significantly shorter total hospital stay (early = 5.5±3.1 days versus delay = 8.5±4.5 days). The male gender had a significant higher conversion rate in both groups.
Conclusion:Early LC can be performed safely in most patients with AC and it is considered as effective treatment, allows significantly shorter total hospital stay with no significant differences in conversion rate or complications compared with delayed LC, in the hands of a safe and well trained surgeon.
Keywords:Early laparoscopic cholecystectomy, acute cholecystitis.

Background:Spasticity is one of the most frequently observed phenomena after a lesion of the upper motor neuron system. Treatment of spasticity should not be aimed at its complete removal but rather at improving function, easing care or alleviating pain.
Objective:To evaluate the effectiveness of oral antispasticity drugs, transcutaneous electrical nerve stimulation and physical therapy alone on the management of spinal cord injury spasticity by using the H-reflex.
Methods:Fifty nine patients with traumatic spinal cord injury suffering from spasticity divided into 5 groups (positive controls, group I who were subjected to a regular physical therapy program, group II who were taking the oral anti-spasticity drug (Baclofen) and were performing the same previous physical therapy program, group III who were subjected to transcutaneous electrical nerve stimulation therapy and performed the same previous physical therapy program, group IV who were taking the oral anti-spasticity drug (Tizanidine) and were subjected to the same previous physical therapy program and 31 normal volunteers were studied. Electrophysiologic study of H-reflex including H latency, H duration, H-reflex conduction velocity and H max/M max ratio.
Results:Highly significant difference was noticed between the pre- and post-treatment assessments in group I and III in H max/M max ratio.
Conclusion:Spasticity can be effectively treated but a multidisciplinary approach is required since it is unusual for a single intervention, such as oral medication or physiotherapy alone, to be the only modality needed.
Keywords:H-reflex, Spasticity, Spinal cord injury.

Background:Polycystic ovary syndrome is associated with adiposity and metabolic changes predisposing to insulin resistance and diabetes mellitus. Ghrelin is an appetite-stimulating hormone, which acts through its receptor on the hypothalamus to regulate energy balance and thus plays a major role in the etiology of metabolic diseases.
Objective:To investigate the relation between ghrelin hormone and insulin resistance in patients with polycystic ovary syndrome.
Methods:Thirty nine women with polycystic ovary syndrome and 30 healthy controls were examined. Fasting ghrelin, insulin, glucose, lipid profile concentrations were determined. Insulin resistance indexes were calculated (HOMA-IR and QUICKI-IR indexes).
Results:Serum ghrelin concentration was significantly lower in polycystic ovary syndrome patients than control subjects (235 ± 17.36 pg/ml Vs 489.7 ± 53.4 pg/ml). Insulin resistance and BMI were significantly higher in polycystic ovary syndrome than control group.
Conclusion:Ghrelin hormone may be used as a new additional marker in the diagnosis of polycystic ovary syndrome. Hyperinsulinaemia and hyperleptinemia are associated features in polycystic ovary syndrome.
Keywords:Ghrelin, Obesity, Polycystic ovarian syndrome (PCOS), Body mass index (BMI), Insulin resistance

Background:Melatonin known as "the light of night" secreted from the pineal gland and implicated in a number of cyclical bodily performance and circadian rhythmic activities in humans. The kidney is the main organ regulating water-electrolyte homeostasis in the body adjusted to a daily rhythm.
Objective:To study the effect of rising periods of continuous darkness onthe urinary space of adult male rat’s kidney.
Methods:Eight groups of adult Wister albino rats, each of 4 rats were kept in absolute 24 hours darkness for successively rising 4 periods. Group II, III, IV and V were situated in continuous darkness for two, four, six and eight weeks in succession. Group Ia, Group Ib, Group Ic and Group Id were the control groups for group II, III, IV and V, respectively. All rats were dissected under general anesthesia at the end of experiment and the right kidney was removed, weighed and arranged for morphometric as well as anatomical and histological studies.
Result: No imperative structural effects were noticed with the short and medium periods, but with long periods significant effects were noticed, which were in ratio to the length of darkness.
Conclusion:The continuous darkness has structural influence on the glomerular urinary space in the kidney of adult male rats according to the length of exposure.
Key words:Darkness, melatonin, kidney and urinary space.

Background:Splenectomy has been associated with several long-term complications; pulmonary arterial hypertension has gained special attention. It seems that the absence of a spleen, rather than underlying condition for which the splenectomy was performed, is the primary cause of this condition.
Objectives:Assessing the risk factors for development of pulmonary hypertension in different indications of splenectomy
Method: Fifty postsplenectomy patients were included and transthoracic echocardiographic study looking for right ventricle size; ejection fraction and pulmonary artery pressure were performed for each patient in addition to complete blood count.
Results:The patients' mean age was 32.5±1.8 years. The mean duration after splenectomy was 5.2±0.34 years with a range of 1-10 years. Hemoglobinopathies in different types formed 54% (27/50) of these indications, while non hematological indications were reported in 7 cases (14%). Pulmonary arterial hypertension was reported in 22% of patients with mean pressure 30.10±1.18 mmHg. It is positively correlated with right ventricular size. The highest risk of pulmonary arterial hypertension was reported with splenectomy due to hemolytic diseases in comparison with other indication despite persistence of similar risk in non hemolytic indication but of no statistical significance. The more severe degree of anemia has negative correlation with pulmonary arterial hypertension as well as high WBC count unlike thrombocytosis.
Conclusion:Whatever the underlying indications of splenectomy, the risk of pulmonary hypertension exists, which may not related only to thrombocytosis but also for anemia and leucocytosis and it needs long duration follow up to be diagnosed.
Key words:Splenectomy, pulmonary hypertension.

Background:Dyslipidemia is a modifiable cardiovascular disease risk factor that remains largely uncontrolled in patients with type 2 diabetes mellitus. Administration of melatonin may improve tissue responses to insulin and increase the efficacy of drugs which act through this pathway like Sulfonylurea.
Objective:To investigate the effectiveness of Atorvastatin and melatonin that possess antioxidant and/or hypolipidemic effects on the changes that occur in patients with type 2 diabetes mellitus due to uncontrolled glycemic status.
Methods:Forty one diabetic patients (26 female and 15 male) with an age 35-60 years and disease duration of 5-10 years were studied. Patients allocated to 3 groups, first group was treated with Placebo (starch 50mg; n=13), second group was treated with (Atorvastatin 20mg/day; n=14), while third group was treated with (Melatonin 10mg/day; n=14), in addition to the already given oral hypoglycemic agent (glibenclamide) and dietary control for 12 weeks. Biochemical parameter (baseline, 6 and 12 weeks later) including and lipid profile tests were done.
Results:Atorvastatin and melatonin administration significantly increases fasting serum glucose and glycated hemoglobin levels, with significant decrease in cholesterol, triglycerides, and low density lipoprotein. However, the effects on these parameters were variable between the studied groups.
Conclusion:The administration of Atorvastatin may induce hyperglycemia despite of its hypolipidemic effect, while melatonin could improve both glycemic control and lipid profile in patients with type 2 diabetes mellitus.
Key words:Atorvastatin; melatonin; glycemic control; type 2 diabetes mellitus.

Background:Finasteride is a selective 5- reductase enzyme inhibitor that blocks the conversion of testosterone to dihydrotestosterone, down regulates prostatic angiogenesis and blood flow and promotes apoptosis of prostatic cells. It significantly decreases suburethral prostatic microvessel density in patients with benign prostatic hyperplasia, which may explain its efficacy for decreasing benign prostatic hyperplasia -associated bleeding. Transurtheral resection of the prostate is considered the gold standard operation for symptomatic benign prostatic hyperplasia. It is characterized by immediate treatment success with long-lasting improvement of symptoms.
Objective:To study the effect of finasteride on bleeding during transurethral resection of the prostate.
Methods:Thirty eight patients with benign prostatic hyperplasia underwent transurethral resection of the prostate. Patients were randomly assigned into two groups, the finasteride group (18 patients) and the control group (20 patients). The intra-operative bleeding was measured.
Results:Statistically less significant bleeding during transurethral resection of the prostate in patients who were placed on 10 mg finasteride for 6 weeks prior to the surgery.
Conclusion:Finasteride given daily for 6 weeks prior to transurethral resection of the prostate reduces time of surgery, bleeding, and irrigation fluid requirements.
Keywords:Hematuria, Finasteride, Benign prostatic hyperalgesia.

Background:Several studies have demonstrated the role of hematological parameters like hemoglobin (Hb), white blood cells (WBC) count and platelet count in the assessment of patients with coronary artery disease; some studies suggest an additional role of platelet indices in the prognosis of patients with coronary artery disease.
Objective:To assess complete blood count and platelet indices in patients with coronary artery disease.
Methods:Blood sample of 42 newly diagnosed ischemic heart disease patients including 20 patients with myocardial infarction (MI) and 22 patients with unstable angina were studied. The control group included 15 individuals with no history of heart disease and a normal electrocardiogram. Clinical and laboratory information regarding age, sex, packed cell volume, WBC count, platelets count, platelet distribution width and platelet volume were obtained.
Results:The frequency of diabetes and smoking was higher in patients with coronary heart disease in comparison to the control group (P < 0.05), while the frequency of hypertension was not significntly different. Significant difference in WBC count and Hb level of patients with coronary heart disease (P < 0.05), while no significant difference in the platelet count, platelet distribution width and mean platelet volume was found. In patients with unstable angina there was a significant difference in the Hb level (P < 0.05) while no significant difference in WBC count, platelet count, platelet distribution width and mean platelet volume was observed. In patients with myocardial infarction, there was a significant difference in the Hb level and the WBC count (P < 0.05), whereas no significant difference in platelet count, platelet distribution width and mean platelet volume was found.
Conclusion:Hemoglobin level was significantly lower in patients with coronary artery disease while the mean level of WBC count was significantly higher than that of the control group. There was no significant difference in platelet count and platelet indices between those two groups. In patients with unstable angina the WBC count was not statistically different from that of the control group.
Key words:Coronary artery disease, Hb, WBC, PDW, MPV.

Background:The Lower pole anatomy (apart from other factors: stone size, shock wave energy) is an important determinant of success after extracorporeal shockwave lithotripsy.
Objectives:In this study, we aimed to determine if there is a significant relationship between lower pole ratio (infundibular length: infundibular width) on preoperative excretory urograms and stone fragment clearances after shockwave lithotripsy.
Methods:A total of 60 patients with isolated lower pole stones were prospectively included in the study. Anatomical factors, such as infundibular length and width were measured and the lower pole ratio was calculated on pretreatment excretory urogram. Stone fragment clearance was assessed on periodic follow up visits (1-8weeks) with a plain abdominal X-ray for kidney, ureter and bladder.
Results:The overall eight-week stone-free rate was 56.66%. Mean stone size ± SD was 11.383 ± 5 mm, mean infundibular length was 11.95 ± 6.52 mm, mean infundibular width was 4.25 ± 1.66 mm and mean lower pole ratio was 3.2 ± 2.4. Stone free status after shockwave lithotripsy was significantly related to infundibular length and width as well as to lower pole ratio. Infundibular length less than 25 mm, width greater than 4 mm and lower pole ratio less than 3.5 were noted to have an improved eight week stone-free rate.
Conclusion:Lower pole anatomy is an important predetermining factor for lower pole stone clearance after shockwave lithotripsy. The present study suggests that a lower pole ratio of less than 3.5, which considers both infundibular length and width, is a promising and easily applicable predictor for stone-free status.
Key words:Lower pole ratio, extracorporeal shockwave lithotripsy, stone clearance.