IRAQI JOURNAL OF MEDICAL SCIENCES

Background:Several clinical and laboratory observations are consistent with the hypothesis that hypokalemia might be a risk factor for the development of ischemic stroke in humans.
Objectives:To evaluate the level of serum potassium in ischemic stroke patients and its relation to non-stroke patients and those with hypertension.
Methods:Serum potassium was estimated from one hundred newly discovered first-life ischemic event of acute ischemic stroke patients and one hundred control patients with an attempt to evaluate the its level in ischemic stroke and the relation to hypertension. Normal value of serum potassium in both sexes was considered as 3.5-.5.5 mmol/L.
Results:Mean serum potassium level of stroke patients was significantly lower than that of control group (3.89±0.67 versus 4.19±0.56, p=0.0001). Hypokalemia was found in 23 (23%) patients with stroke compared to 7 (7%) of the control group. The Mean serum potassium in hypertensive patients was significantly lower than those without hypertension (3.91 ±0.65 versus 4.2 ±0.54). The mean serum potassium for hypertensive stroke patients was significantly lower than non-hypertensive stroke patients (3.79±0.78 versus 4.26±0.72), while there was no significant difference among the control hypertensive and non-hypertensive subjects (4.05±0.57 versus 4.43±.40).
Conclusions:Serum potassium should be taken in consideration as low levels are significantly associated with ischemic stroke with hypertension.
Keywords:Serum Potassium, ischemic stroke

Background:Rhinosinusitis is the inflammation of nasal and paranasal sinus mucosa and is associated with mucosal alteration ranging from inflammatory thickening to gross nasal polyp formation. Concha bullosa is the term used for an aerated middle turbinate or a cell found within the middle turbinate. These structures appear as a widened area of the middle turbinate, and they may obstruct the ostio meatal complex. In the absence of a history of sinusitis, the incidental finding of widened middle turbinate during endoscopy or concha bullosa on computed tomography (CT) does not mandate further investigation.
Objectives:To determine the symptoms described at presentation, radiological findings, endoscopy and to compare endoscopy and computed tomography scan findings of the nose and paranasal sinuses in patients with chronic rhinosinusitis before endoscopic sinus surgery.
Methods:Forty three patients with chronic rhinosinusitis were studied. Physical history, ear, nose and throat examinations plus endoscopic examinations of nose and paranasal sinuses were performed. Computed tomography scan of the sinuses and ostiomeatal complex were done for all patients.
Results:The patients aged 17 to 53 years (32.44 ± 9.83 years), and male to female ratio was 1.15:1. Headache is the commonest symptom (69.76%). The duration of symptom was 1-5 years in 44.18% of patients. Septal deviation was the most common finding 46.51% by endoscopic examination. Mucosal thickening present in all patients (100%) by CT-scan. Between endoscopic and CT scan findings There is a significant statistical difference for enlarged ethmoid bulla but not for septal deviation, abnormal uncinate proces and hypertrophy of inferior turbinate.
Conclusion:Endoscopy and CT-scan of the nose and paranasal sinuses are mandatory before endoscopic sinus surgery of nose and paranasal sinuses in patients with chronic rhinosinusitis.
Keywords:Chronic sinusitis, endoscope, CT-scan

Background:The process of normal human childbirth is categorized in three stages of labor: the shortening and dilation of the cervix, descent and birth of the infant, and delivery of the placenta. Oxytocin is the most commonly used agent for induction, and is used to induce uterine contractions.
Objective:To estimate the efficacy of oral misoprostol for labor induction.
Methods:This randomized, controlled trial study was comparing intravenous oxytocin to a 25-microgram dose of oral misoprostol every 3-4 hours. A woman who had cervical dilation of 0-2 cm then undergoes labor induction. Our outcome was recorded.
Results:we found when we used misoprostol the time duration was significantly less specially in primigravida and when os closed, the side effect approximately same as oxytocin.
Conclusion:Oral misoprostol is an effective agent for inductionof labor.
Keywords:Induction of labor, misoprostol, oxytocin

Background:Some people used herbal extracts as a treatment for diabetes mellitus worldwide. Such treatment of considerable benefit especially during the early stages of the illness. Many phytoconstituents responsible for anti diabetic effects have been isolated from hypoglycemic plants; one of which is Foeniculum vulgare.
Objective:To investigate the effects of alcoholic extract of Foeniculum vulgare on some biochemical parameters in liver and kidneys of alloxan-induced diabetic mice, in order to use this herb as natural products to the management of diabetes mellitus.
Methods:Twenty four female mice (18 diabetic mice and 6 control) were divided into 4 groups, each contain 6 mice (I = control, II = alloxan-treated miceI, III and IV = extract treated mice). Oral administration of Foeniculum vulgare extract given for 30 days to group III and IV in doses of 1.2 mg/kg BW) and 2.2 mg/kg BW, respectively. The serum glucose, insulin, lipid profile, glutamate oxaloacetate transaminase, glutamate pyruvate transaminase, alkalinposphatase, creatinine, urea and calcium, were measured in fasting state.
Results:As compared with group II, serum glucose was significantly reduced and serum insulin significantly elevated in groups III and IV following oral administration of extract for 21 days. Following 30 days, significant reduction in the total cholesterol, triglycerides, low density lipoprotein- cholesterol, glutamate oxaloacetate transaminase, glutamate pyruvate transaminase, alkaline phosphatase, very low density lipoprotein- cholesterol, and creatnin, whereas high density-cholesterol and calcium were significantly increased.
Conclusion:Foeniculum vulgare extract have good hypoglycemic, antihyperlipidemic in Alloxan- induced diabetic mice, in addition to the improvement in the glutamate oxaloacetate transaminase, glutamate pyruvate transaminase, alkaline phosphatase, creatinin, urea and calcium.
Keywords:Diabetes militates, Antihyperlipidemia, Hypoglycemic effect, alloxan, medical plants, Foeniculum Vulgare.

Background:Pneumocystis carinii is one of the rare fungi which cause pneumonia in immunocompromised patients. It is important to detect the fungus from the clinical specimens of suspected patients by laboratory tests.
Objective:To identify Pneumocystis carinii from immunocompetent and immunocompromised patients with lower respiratory tract infections.
Methods:This study included 300 patients suffering from lower respiratory tract infections of both immunocompetent (150) and immunocompromised (150) patients attending the Teaching Hospital in Mosul/Iraq. The clinical specimens collected were samples of sputum (247), and bronchial wash (80). The identification of Pneumocystis staining methods.
Result: The organism was detected from 8 immunocompromised patients with pneumonia. Seven out of the 8 patients had carcinoma.
Conclusion:Pneumocystis carinii is an opportunistic fungus which is an important pathogen in immunocompromised patients.
Key words:Pneumocystis carinii (jiroveci), pneumocystis pneumonia, respiratory tract infection.

Background:Bacteriophages, or phages, are virus-like agents that infect bacteria. Lytic phages can be used as biological antimicrobials and can kill bacteria.
Objective:To formulate therapeutic phage cocktails able to overcome multiple-drug resistant Escherichia coli in Iraq.
Methods:Escherichia coli were isolated from Iraqi hospitals and were characterized in terms of site of isolation, patient's age, sex, and disease. Antibiotics sensitivity test was used to evaluate antibiotics effectiveness. Accordingly, isolated bacteria were grouped in terms of resistance to antibiotics, infection type, and infection site. Wild phages specific to Escherichia coli were isolated from different areas. The isolated phages were optimized and their biokinetics were measured.
Results:A total of 10 samples of Escherichia coli, 7 samples of them revealed specific phages. The formulated phage cocktail to Escherichia coli was shown to remarkably minimize the bacterial resistance to individual phages.
Conclusion:Bacteriophage cocktails are useful to tackle the problem of MDR bacteria.
Keywords:Multi-drug resistance, bacteriophage, phage therapy, Escherichia coli.

Background:5-fluorouracil (5-FU) is a potent chemotherapeutic drug widely used in the treatment of cancer and acts by blocking DNA synthesis. N-acetylcysteine (NAC) is a pharmaceutical drug and nutritional supplement represents the rapidly absorbed form of the amino acid L-cysteine and acts as antioxidant.
Objective:The current study aims to investigate the protective role of N-acetylcysteine administration against 5-FU induced pulmonary toxicity in albino rats.
Methods:The study was conducted on 18 healthy adult female and male Wistar albino rats which were randomly selected and equally distributed into three groups of 6 rats for each. Group I served as a control group. Group II received 5-FU (20 mg in 2ml normal saline per kg body weight) by intraperitoneal injection for 7 consecutive days. Group III received intraperitoneal injections of N-acetylcysteine (200 mg/kg) 24 hour prior to each intraperitoneal injections of 5-FU for 7 consecutive days. The specimens of lung tissue of the three groups were extracted and prepared for light microscopic examination. The tissue sections were stained with Harris Hematoxylin and Eosin (H&E) stain and with Masson's trichrome stain.
Results:Structural changes were observed in Group II (5-FU recipient group compared to Group I (control group)including emphysematous dilatation of the alveoli, proliferation of BALT (bronchus associated lymphatic tissue), thickening of alveolar walls with mononuclear inflammatory cells infiltration, in addition to congestion and hemorrhage of pulmonary interstitium. Pretreatment with N-acetylcysteine effectively reduces the changes induced by 5-FUon the lung and reverts the abnormal pulmonary structure to become nearer to the norms.
Conclusion:Treatment with N-acetylcysteine prior to 5-fluorouracil effectively attenuated 5-FU induced pulmonary damage and reverted the abnormal structural changes to near normal. Thus NAC has a protective potential in ameliorating 5-fluorouracil induced pulmonary toxicity.
Key words:5-Fluorouracil, N-acetylcysteine, rats, lung, emphysema.

Background:Over the past 20 years, percutaneous drainage of intra-abdominal collections has evolved from revolutionary to routine, replacing open surgical abscess drainage in all but the most difficult or inaccessible cases.
Objective:To evaluate the practical safety and efficacy of image-guided perctaneous drainage for different intra-abdominal collection.
Method: Patients with intra-abdominal collections underwent percutaneous drainage under ultrasound guide were studied prospectively in Al-Imamian Al-Kadhymian Medical City over the period of 20 month from February 2011 to September 2012. The procedure done under local anesthesia and aseptic technique under ultrasound or CT scan guidance.
Results:There were 50 patients (32 females and 18 males), Age ranging 12-58 years. Forty seven patients had a previous operative procedure and three patients had no such history. The post-operative collections in majority of patients 34 (72%) were single while in 13 patients (28%) were multiple. The type of content was as following: pus in 32 patients (64%), bile in 13 patients (26%), infected pancreatic/gastric secretions in 3 patients (6%) and infected urine in 2 patients (4%)., Percutaneous drainage was successful in 42 cases (84%), while 8 cases (16%) needed further surgical intervention to cure the collection. No major complications were recorded only minor complications like minor bleeding and wound infections. Mortality was in one case and it is not directly related to percutaneous drainage procedure rather to underlying problem and sepsis after second exploration.
Conclusion:Guided percutaneous drainage is a safe and effective procedure for treating an intra-abdominal collections and it can be the first line treatment in severely ill patients.
Key Words:Guided percutaneous drainage, abdominal collections.

Background:Epilepsy is a common chronic neurological disorder characterized by recurrent unprovoked seizures.
Objective:To investigate the possible antiepileptic effect of both atorvastatin and L-carnitine on seizure induced by pilocarpine.
Methods:Fifty male albino mice weighing between 30-35 gm were equally allocated into five groups (each group contained 10 mice) and were given one of the following; control group; distal water group (0.1 ml), diazepam group (1mg/kg), atorvastatin group (5 mg/kg) and L-carnitine group (300 mg/kg). All animals (except normal group) were injected with Pilocarpine hydrochloride (350 mg/kg) to induce generalized tonic-clonic seizures 30 minutes after the tested drugs had been administrated. The mean onset of seizure were determined as well as the mean serum concentration of electrolytes, glutathione (GSH) and malondialdehyde (MDA) were measured after seizure had been induced.
Results:Pilocarpine induced seizure at approximately 7 minutes after injection, while both atorvastatin and L-carnitine produced highly significant increase in mean onset of seizure 14 ± 0.471 and 14.5 ± 0.909 respectively as compared to that of D.W. group, also both drugs produced highly significant changes in mean serum concentration of electrolytes, GSH and MDA.
Conclusion:Atorvastatin and L-carnitine had antiepileptic effects against seizures induced by pilocarpine when used at applied doses.
Key words:Epileptic seizure, Atorvastatin and L-carnitine.

Background:Different immunophenotypic markers were found to be related to the prognosis of acute myeloid leukemia. Among them are CD34, CD123 and myeloperoxidase.
Objective:To evaluate the relationship between the expression of CD34, CD123 and myeloperoxidase markers by flow cytometry; and the initial response to induction therapy in acute myeloid leukemia patients.
Method: A cohort of forty one patients with newly diagnosed de novo acute myeloid leukemia were prospectively tested for the expression of CD34, CD123 and myeloperoxidase using multicolor flow cytometry and re-evaluated for the response to a 7+3 induction therapy regimen.
Results:It was found that 64.29% of CD123- patients achieved complete remission while 70.37% of CD123+ patients not (P = 0.035). For CD34, 55.56% of CD34- patients achieved complete remission while 63.64% of CD34+ cases not. The induction failure in CD34+M3 cases was 100% (P = 0.045). Regarding myeloperoxidase, 61.54% of patients who had >20% myeloperoxidase expression achieved complete remission while 70.37% (myeloperoxidase expression in <20% of cells) failed to achieve complete remission (P = 0.05).
Conclusion:Expression of CD34 and CD123 and weak expression of myeloperoxidase (<20% of blast cells) are associated with poor response to induction therapy in acute myeloid leukemia patients.
Keywords:Flow cytometry, CD34, CD123, myeloperoxidase, acute myeloid leukemia

Background:Congenital esophageal atresia and tracheoesophageal fistula are well-known congenital anomalies which affect 1 in 2400 – 4500 live births. The survival rate has dramatically improved in the last decades due to the advances in the neonatal intensive care, anesthetic management, ventilatory support and the surgical techniques.
Objective:To evaluate the surgical outcomes and postoperative complications in patient with esophageal atresia and tracheoesophageal fistula who were admitted to our hospital.
Methods:A retrospective study of 65 cases of esophageal atresia with distal tracheoesophageal fistula was studied over a period of 5 years from January 2008 to January 2013. Patients demographic, frequency of associated anomalies, postoperative complications and surgical outcomes were studied.
Results:There were 38 male and 27 female with frequency of forty-seven (72%) infants were full term and 18 (28%) were preterm. Survival rate was (66%) for newborn who underwent surgery within the first 24 hours which was higher than those newborn with age above two days. Congenital heart disease was the commonest associated congenital anomalies and accounted for 28% of all our patients. Our patients developed many complications including respiratory tract infection (26%) and anastomatic leak (20%) as the most common complications.
Conclusion:The survival rate of the patients with EA/TEF is influenced mainly by associated life -threatening congenital anomalies, prematurity of newborn and the age at the time of surgical repair.
Keywords:Esophageal atresia, tracheoesophageal fistula, congenital anomalies.

Background:Hypotension is one of the complications of hemodialysis treatment. It increases morbidity and mortality and can compromise the dialysis efficacy. Cooling the dialysate below 36.5°C is an important factor that contributes to hemodynamic stability in patients during hemodialysis.
Objective:To assess the effect of dialysate temperature on hemodynamic stability during hemodialysis sessions, post dialysis fatigue and the adequacy of dialysis.
Methods:A total of 40 patients were assessed during six dialysis sessions; in three sessions, the dialysate temperature was (37 °C) and in three other sessions, the dialysate temperature was (35 °C). Specific scale questionnaires were used in each dialysis session, to evaluate the symptoms during the dialysis procedure as well as post-dialysis fatigue, and respective scores were noted. Blood pressure, heart rate, temperature were recorded. Also dialysis efficacy using Kt/v, urea reduction ratio were measured.
Results:The results showed that usage of low dialysate temperature was associated with the following : higher post dialysis systolic blood pressure (P < 0.05) and lower post dialysis heart rate (P < 0.05), better intra-dialysis symptoms score and post-dialysis fatigue scores (P < 0.05 and P < 0.05, respectively), shorter post-dialysis fatigue period (P < 0.05) as well as Similar urea removal and Kt/V .
Conclusion:Cool dialysis is an important factor in hemodynamic stability during hemodialysis. Also it improves symptoms during and after hemodialysis. Cool dialysis has no effect on adequacy of dialysis.
Key words:Hemodialysis, Cool dialysate, Hypotension, Hemodynamic

Background:Epilepsy is one of the oldest known neurological conditions characterized by recurrent seizures.
Objective:To explore the possible antiepileptic effect of both Verapamil and Olanzapine in pilocarpine epileptic model in mice.
Methods:Fifty healthy male albino mice weighing between 30-35 gm were equally allocated into five groups (10 mice in each group) and were distributed into: normal group (without drug); distilled water group (0.1 ml); diazepam group (1mg/kg); verapamil group (20 mg/kg) and olanzapine group (10 mg/kg). All animals (except normal group) were injected with pilocarpine hydrochloride (350 mg/kg) to induce generalized tonic-clonic seizure 30 minutes after the tested drugs had been administrated. The mean onset of seizure were determined as well as the mean serum concentration of electrolytes, glutathione and malondialdehyde were measured after seizure had been induced.
Results:Pilocarpine-induced seizure at approximately 7 minutes after injection. While both verapamil and olanzapine produced highly significant increase in mean onset of seizure 16±1.549 and 13.1±1.566 respectively as compared to D.W. group, also both drugs produced highly significant changes in mean serum concentration of electrolytes, glutathione and malondialdehyde.
Conclusion:Verapamil and olanzapine had anticonvulsant activity when used at applied doses in the pilocarpine model of seizures in mice.
Key words:Epilepsy, seizure, verapamil and olanzapine.

Hydatid disease is one of the commonest zoonotic diseases. It is caused by the larval cyst of Echinococcusgranulosus and result in the most severe form of cetodiases in man. The hydatid disease is endemic in some Mediterranean countries, the Middle East, the South America, and South Africa and Oceania. The combination of imaging and serology usually enables diagnosis. We report a case of single and giant hydatid cyst in an unusual site (retroperitoneal region) which is very rare and also in a five-year old child which is unlikely to happen at such age with this big size.
Keywords: Hydatid disease, retoperitoneal region.