IRAQI JOURNAL OF MEDICAL SCIENCES

Background:Nocturnal enuresis is one of common clinical problems in pediatric population that frequently diagnosed among school age children.
Objectives:To determine the prevalence of nocturnal enuresis, to detect the socio-demographic factors that may correlates with nocturnal enuresis and to assess the emotional and behavioral disorder in children with enuresis.
Methods:A cross sectional study was performed among children (5-15 years old) visited the general pediatric out patient in Al-Imamain Al-Kadhimain Medical City in the capital Baghdad during the period from the first of December 2013 to the first of April 2014, a special questionnaire was prepared for this study with assessment of Parents' Rutter Behavioral Questionnaire.
Results:Out of 623 children studied the overall prevalence of nocturnal enuresis was 29.5% (n=184). Male gender (60.3% of enuretic children), young age (37% of enuretic children at age 5-6 years old), positive family history of nocturnal enuresis (founded in 71.7% of enuretic children), large family size and increased number of household children (half of enuretic children living in extended family and household children more than four), these were significantly associated with the prevalence of nocturnal enuresis. Among the enuretic children, about half of them (45.1%) had moderate school performance, 50.5% had positive history of recurrent urinary tract infection and 63% had behavioral disturbances, so these factors were significantly associated with the prevalence of nocturnal enuresis.
Conclusion:Nocturnal enuresis is a common problem among school children, with four-fold risk among children with disturbed behavior. Most of the families do not have adequate attention about enuresis and most of the enuretic children don’t receive professional treatment.
Key words:Nocturnal enuresis, prevalence, behavioral disturbance, and Rutter Behavioral Questionnaire.

Background:Hydatidosis is a chronic cyst forming helminthic disease of human, domestic and wild animals. The immune responses play a pivotal role in limiting cystic larval development.
Objective:To investigate the immunopathological effects of Fasciola hepatica antigens (FHAgs) and hydatid cyst fluid antigens (HCFAgs) on the immune response against hydatidosis in mice.
Methods:One hundred mice were divided into 5 groups; the 1st three were immunized subcutaneously with 0.2 ml of HCFAgs, FHAgs and mixed antigen (MAg = HCFAgs+FHAgs), respectively. The last two regarded as control groups. On day 27 post immunization, the skin test was done for the 1st four groups. On day 30, half the animals of each group were scarified to perform E-rosette test, agar gel diffusion (AGD), and ELISA test. The rest of the mice with the 5th group were challenged with 2000 viable protoscolex / mouse. After 3 months, they were scarified for gross and histopathological examination.
Results:The immunized group with MAg was hypersensitive prior to challenge the skin test, while E-rosette test indicated the highest ratio of active lymphocytes before and after challenge in comparison with other groups. The AGD test showed severe reaction between the sera of mice immunized with MAg against the FHAgs against HCFAg and between sera of immunized group with FHAgs against HCFAg and vice versa. The highest level of antibodies was recorded in the immunized group with MAg. Histopathological examination for the internal organs of immunized groups revealed granulomatous lesions, reduction in the number of cysts with lymphocytic hyperplasia and presence of degenerative protoscolices. Control infected group revealed growth of cysts in the internal organs, with degenerative and necrotic lesions.
Conclusion:The 3 types of Ags stimulate humoral and cellular immunity was proved by immune-histopathological investigations. The MAg was highly immunogenic in comparison with each Ag alone. This antigenic activity may be due to the presence of synergistic interactions and cross-reactivity between the 2 parasites and this can be used as protective value against hydatidosis in the intermediate hosts.
Keywords:Parasitic infections, immunological cross reaction, isolation parasitic antigens, Fasciola hepatica antigens, Hydatid fluid antigens.

Background:Flow cytometric study found that lymphoblasts of B acute lymphoblastic leukemia exhibited multiple aberrant antigens by which they can be distinguished from hematogones. These antigens are CD34 and CD123.
Objective:To determine the immunophenotypic pattern of CD34 and CD123 expression in hematogone of reactive bone marrow and in neoplastic lymphoblast in B-acute lymphoblastic leukemia (ALL) patients and to evaluate the impact of that pattern in the residual disease detection after chemotherapy.
Methods:This is a case control study to determine the expression of CD34 and CD123 in 30 patients newly diagnosed with B-ALL. Re-assessment was done for 20 patients of them after 4-6 weeks of chemotherapy; in addition to 10 patients with reactive bone marrow to assess hematogones.
Results:In (93.4%) of the newly diagnosed B-ALL cases, leukemic blasts expressed both CD34 and CD123, Conversely, in (6.6%) cases, neither antigen was expressed. In hematogones; the immature hematogones (dim CD45, CD34 +) did not express CD123 while the mature hematogones (moderate CD45+, CD34-) expressed CD123. The strategy of concordant and discordant patterns of CD34/CD123 expression on B-ALL blasts and hematogones respectively in post chemotherapy patients remain stable.
Conclusion:The distinct pattern of CD34 and CD123 expression on hematogones (discordant) and B-ALL blasts (concordant) is useful in correctly classifying immature B cells as residual leukemic blasts or hematogones in the bone marrow of patients treated for B-ALL.
Keywords:B-Acute Lymphoblastic leukemia, Flow cytometry, Immunophenotypic aberrancy, Hematogones, CD34 and CD123.

Background:Although quinolone resistance results mostly from chromosomal mutations in Enterobacteriaceae, it may also be mediated by plasmid-encoded qnr determinants. Shigella harboring the novel qnr plasmid-mediated mechanism of quinolone resistance has been described worldwide.
Objective:To understand the distribution of serogroup of Shigella spp, as well as antimicrobial susceptibility and to investigate the plasmid mediated quinolone-resistant qnr genes in clinical isolates of Shigella spp. resistant to quinolone.
Methods:Fifty nine clinical isolates of Shigella spp. were collected from two hospitals in Baghdad. Antimicrobial susceptibility tests were performed using disk diffusion test and minimum inhibitory concentration. The isolates were screened for the plasmid-mediated qnr genes of qnrA, qnrB, and qnrS by Multiplex polymerase chain reaction.
Results:The isolation rate of Shigella spp. was 14% and observed to be high among children < 10 years and low in teenagers and adults. The highest percentage was Sh. flexneri (54.2%) followed by Sh. sonnei (37.3%) then Sh. dysenteriae (8.5%), while no Sh. boydii was found in this study. Antimicrobial susceptibility tests revealed that 54.23% and 49.2% of both Sh. flexneri and Sh. sonnei were resistant to nalidixic acid and ciprofloxacin, respectively, while Sh. dysenteriae isolates were fully susceptible to these antibiotics. The minimum inhibitory concentration value of resistant isolates of Sh. flexneri and Sh. sonnei ranged between 2-64 μg/ml and 32-512 μg/ml for ciprofloxacin and nalidixic acid, respectively. Multiplex polymerase chain reaction amplification of plasmid-borne qnrA, qnrB, qnrS genes revealed that the overall percentage of qnr-genes were (52.9%) distributed as (29.4%) qnrA, (20.6%) qnrS and (2.94%) qnrB detected alone or in combination. The genes were identified in (44.1%, 15/34) of quinolone resistance Shigella isolates.
Conclusion:To our knowledge, this is the first report detected fluoroquinolone resistance due to the qnr gene among Shigella isolates in Iraq which is indicated that plasmid-mediated quinolone resistance has emerged in Iraqi pediatric patients.
Keywords:Drug resistance, Shigella spp., Plasmid; Quinolone, qnr

Background:Several immunological defects can be found in patients with β-thalassaemia, among them is disturbance in the production of some cytokines.
Objectives:To evaluate the levels of interleukin-12 and 13 and its relation with Hb, packed cell volume, serum ferritin and between them in β-thalassemic major patients with or without viral hepatitis.
Methods:A case control study was conducted on 48 patients with β-thalassemia major divided into two groups; Group I comprised 24 infected with viral hepatitis C and group II comprised 24 patients with no infection; in addition twenty healthy age- and sex-matched subjects were studied as control group. Five ml of venous blood sample were collected; two ml put in EDTA tube for complete blood count and 3 ml in plain tube for biochemical lab investigations; 300 µm from the left-over serum was taken and divided into two tubes; one for estimation of interleukin-12 level and the other for estimation of interleukin-13 using ELISA Reader device.
Results:All thalassemic patients with or without viral hepatitis had low level of interleukin-12 and had high level of interleukin-13. Interleukin-12 was much lower in those infected with hepatitis C virus than those with no infection and the reverse with interleukin-13.
Conclusion:β-thalassemia major patients had decreased level of interleukin-12 and increased level of interleukin-13 which was more prominent in hepatitis positive thalassemic patients. Inverse correlation was noticed between interleukin-12 and 13 levels in thalassemic patients.
Key words:IL-12, IL-13, β-thalassemia major, viral hepatitis.

Background:Deep Brain stimulation is well accepted now as amethod for treating refractory parkinsons disease.
Objective:To describe deep brain stimulation in Iraq, emphasize the technically demanding procedure and to discuss the results on the patients after six years of follow up.
Methods:A clinical prospective study of 8 patients with Parkinson’s disease underwent deep brain stimulation surgery in the Neurosciences Hospital. We performed 18 multiple stages operations from October 2007 to June 2008. The procedure begins with proper selection of patients, pre operative radiological studies, planning for targeting the subthalamic nucleus, the operation stage and the programming stage, which usually starts one-week post operatively.
Results:One patient developed subarachnoid hemorrhage, another one have miss targeting and required retargeting surgery. A part from these complications all the patients had satisfactory outcome in controlling their symptoms during the six years follow up period.
Conclusion:Deep brain stimulation is indicated for the treatment of refractory Parkinson disease. However it needs a well skilled personnel working as a team. The future of deep brain stimulation is remarkable as the list of indications is continually increasing to include other disease modalities.
Key words:Parkinson's disease, deep brain stimulation, functional neurosurgery.

Background:Spinal muscular atrophies are a group of degenerative diseases primarily affecting the anterior horn cells of the spinal cord and motor cells of cranial nerve nuclei. Even if the clinical picture is mainly dominated by the diffuse muscular atrophy, in some cases, patients may show associated, atypical clinical features. There have been a few reported cases of spinal muscular atrophy with central nervous system involvement; in particular, the association with progressive myoclonic epilepsy has been rarely described.
Objectives:To clarify the impact of this degenerative disease on central nervous system and specifically on cerebral activity by using electroencephalographic exam.
Methods:Thirty two patients with spinal muscular atrophy and 20 control subjects were included in this study. Their ages were between two months and one year. Brain CT and MRI, electroencephalography was done for all of them and cerebral activity was precisely assessed with emphasis on normal brain waves frequency and distribution.
Results:The frequency of brain waves recorded from patients with spinal muscular atrophy who show abnormal electroencephalography were 1.49±0.4 and it is significantly lower than that of control subjects (4.11±1.1). The mean frequency of brain waves recorded from patients with spinal muscular atrophy with normal electroencephalography were 4.13±1.2 which is higher than the mean frequency of brain waves recorded form patients with abnormal electroencephalography (1.49± 0.4).
Conclusion:Central nervous system could be affected in patients with spinal muscular atrophy specifically cerebral activity, which might show diffuse slowing in brain waves as revealed in this study.
Keywords:Spinal muscular atrophy, cerebral activity, electroencephalography

Background:Pilonidal sinus is one of the most common sinuses seen in general surgical practice and usually seen in the natal cleft. Postoperative wound complications have always been the main cause of concern followed by the risk of recurrence in the surgical treatment of the pilonidal sinus disease. Various techniques evolved so far mainly aimed at solving these problems. This clinical study conducted to discuss the results of elliptical rotational flap in chronic pilonidal sinus.
Objective:To assess the outcome of patients operated by rotational flap procedure in chronic pilonidal disease in term of healing time, complications and recurrence rate.
Methods:The study was conducted in two different places from December 2007 till April 2011. Eighty two patients with chronic pilonidal sinus were treated by rotation flap. The setting was in two different places, at Nizwa General Hospital, Sultanate of Oman and from Al-Imamain Al-Kadhemain Medical City, Baghdad. Evaluation of operative and post-operative results, complications and recurrence in addition to demographic data.
Results:Out of 82 Patients included in study, 2 cases (2.4%) failed to heal due to partial necrosis of the flap and underwent redo surgery, while 80 patients (97.4%) were cured completely and no further surgery was needed. Eighteen patients (22%) went home in the end of same day and the rest (78%) discharged in second day. Forty six Patients (56%) had dry dressing till suture removed after 8 days, while 20 Patients (24.4%) continued to discharge serosangunious fluid and spent more than 10 days to heal. Eight Patients (9.8%) developed seroma needed further time to becomes dry and the last 6 Patients (7.3%) developed wound infection and treated by proper antibiotics and surgical drainage in some case.
Conclusion:Flap procedures may be promising especially in complex and recurrent pilonidal diseases as it is simple to be done and carry low recurrence rate and relatively shorter hospital stay in comparison to other surgical procedure
Keywords:Chronic pilonidal sinus, elliptical rotation flap.

Background:Ipsilateral concomitant fractures of the femoral neck and femoral shaft are unusual (incidence 5-6%), and pose a difficult treatment problem. This injury usually resulting from high energy trauma, road traffic accident and fall from height. Many treatment methods have been invented and adopted, controversy exists about the optimal methods of treatment for such fracture.
Objectives:To assess the short-term results of ipsilateral fracture neck and shaft femur treated by modified traditional ante-grade intra-medullary nailing.
Methods:Fourteen patients with ipsilateral concomitant fracture neck and shaft femur treated by modified traditional ante-grade interlocking nailing. The surgery includes fixation of both neck and shaft fracture by interlocking nail (traditional type) and multiple long lag screws inserted via the nail itself toward the head and anterior or posterior to nail. Those patients followed for maximum 48 weeks to assess the risk of infection, knee stiffness, delayed union, mal-union, and non-union.
Results:One patient had superficial infection treated by oral antibiotics and improved (7.1%). Two patients had knee stiffness of mild degree (the range is 0-120) improved by physiotherapy (14.3%). Two patients had Trendelenburg’s gait (14.3%). One patient had non-union of femoral shaft (14.3%). One patient had mal-alignment of femoral neck (7.1%). One patient had mal-alignment of femoral shaft (7.1%). One patient had delayed union (failure to progress by 6 month as judged by serial radiographs) of femoral shaft (7.1%). Two patients need open reduction because of soft tissue interposed (14.3%). We lost follow up of 2 patients (14.3%).
Conclusion:Modified method for fixation of ipsilateral neck and shaft fracture with traditional interlocking nails and multiple long lag screws still can be adopted especially in the absence of cephalo-medullary nails with good results regarding early results. Still the cephalo-medullary nails may be better and required other studies.
Key words:Interlocking nailing, ipsilateral fracture neck and shaft femur.

Background:BK polyomavirus is one of the common post-transplant viral infections, affecting ∼15% of renal transplantation recipients (RTR), leading to graft loss in more than half of cases.
Objectives:Study the rate of detection of BK virus (BKV) in RTRs in Pap-stained urine cytology specimens.
Methods:A single center study, urine samples were collected from 99 RTR patients, with 15 Living Donors (LD) and 15 patients with chronic kidney disease (CKD) were taken as controls. And urine cytology smears were Pap stained for detection of decoy cells (DCs).
Results:Out of the 99 RTRs, 27 (27.3%) patients were decoy positive, 8 out of these 27 patients had uncommon DCs, and 5 out of these 27 cytology positive patients (18.5%) had biopsy proven BKV nephropathy (BKVN).
Conclusion:This study suggests that the finding of BKVN in 18.5% of the DC positive patients stresses the importance of screening for BK polyomavirus with Pap-stained urinary cytology in RTR.
Key wards:BK polyomavirus, renal transplantation, decoy cells

Background:Nevi of Ota is usually present at birth. It may be congenital but is not hereditary.
Objective:To determine the efficacy and side effect profile of Q-switched Nd:YAG and KTP Laser on fourteen patients with nevus of Ota.
Methods:Fourteen patients were treated with Q-switched ND: YAG (1064 nm) and KTP (532 nm) laser for a period of 21 months. Six-month follow-up was done after the last session. Response to the treatment was graded on quartile grading scale.
Results:Near total improvement was observed (grade IV) in 36% patients, marked improvement (grade III) in 28.5%, moderate improvement (grade II) in 28.5%, and minimal improvement (grade I) in 7% of the patients. Regarding complication (not permanent), no textural change or scaring. When Nd:YAG laser was only used to treat nevi of Ota for three sessions the response was less than 10% improvement in the lesion. When KTP used in combination with Nd-YAG alternatively there was an increasing improvement in most cases up to more than (70%).
Conclusion:Concurrent use of the Q-switched 532 in combination with the (1064 nm) Nd:YAG is more effective in pigment clearance than the Q-switch (1064 nm) alone for nevus of Ota.
Keywords:Nevus of Ota, Q-switched Nd:YAG (neodymium-doped yttrium aluminum garnet).

Background:Violence against female is an important and serious public health and medico-legal problem. It carries important risk factor related to ill health of female and its consequences on physical, social, mental and reproductive health of women.
Objectives:To determine the type of fatal and non-fatal intentional injuries involving women, girls and young female kids and method used for such injuries and to reveal the magnitude of domestic violence of both physical and sexual types.
Methods:A cross-sectional study was carried out within 6 months period on 82 medico-legal female cases with intentional violence. All females (living and postmortem cases) were studied. Information was collected from the same victim or her relative (in non-living cases) through an interview, police reports and their medical reports. Digital photography was done for some interesting cases while radiological survey followed by complete autopsy for all non-living cases.
Results:The study showed that 57.3% were living subjects while 42.7% were postmortem victims. Regarding the living cases, their mean age was 20.61±9.37 years. Illiteracy constitutes 57.4% of them. All of them were referred as cases of violence directed to the genital area (sexual assault) but 72.3% were with no tear to the hymen. In post-mortem victims, the mean age was 28.6±12.84years. Housewives constituted 85.7% of them and 45.7% were having primary school level of education only. Burn was the main type of injury constituting 71.4%. In 65.71% were affected by sexual assault and in 69% of victims there were old hymen tears. In 80% death was due to suicide.
Conclusion:Violence was more common among living female and highest in the third decade of life. Majority were either with low level of education or having primary school level of education. All of the living females were sexually assaulted while burn was the main type of injury among the postmortem group.
Key words:Violence, Hymen, women, female.

Background:Awareness about diabetic eye complications and regular eye examinations plays an important role in avoiding blindness.
Objective:To assess the level of awareness and knowledge regarding diabetic ocular diseases among diabetic patients attending Aden Diabetic Center at Al-Gamhoria Teaching Hospital in Aden.
Method:This is a cross sectional study including a sample of 182 diabetic patients attending this center during the period from January – March 2013. To achieve the objectives of the study, a closed-ended questionnaire including different variables related to diabetic patients\' awareness supplied to each patient. The authors filled in the questionnaire during interviews with the patients.
Result: The results showed that 109 patients were females and 73 were males with a mean age 53 years and half of the patients were illiterates. Of the total 182 respondents, 157 (86.3%) had variable awareness and knowledge of ocular complications of diabetes mellitus. From those 157 respondents, 124 (79%) had awareness of blindness as an ocular diabetic complication. Awareness of diabetic complications affecting other organs was 93.6%. Awareness regarding the importance of controlling issues caused by diabetes mellitus and its impact on preventing eye complications as well as other body organs was 73.9%. About 36.8% of respondents never visited eye specialists. Medical staff together with the media was the main source of information about eye diseases.
Conclusion:The majority of patients was aware of diabetes mellitus complications and had knowledge of cataract, glaucoma, and retinopathy as the most known ocular complications.
Key words:Awareness, eyes, diabetes mellitus, complications.

Background:Breast cancer is the most common type of malignancy among females worldwide. Breast cancer is the second most commonly diagnosed cancer in women under 35 years with the most common hitological type being infiltrative ductal carcinoma.
Objective:To determine the incidence of breast cancer in excised breast biopsy specimen in Al-Hussain Teaching Hospital in Kerbala governorate as well as determining the most prevalent histopathological type, pathological stage and grade at time of diagnosis.
Methods:It was a statistical study in which a total of 200 excised biopsy and mastectomy specimens where enrolled in the study, biopsy processing and slide preparation from paraffin blocks was processed in the pathology laboratory in Al-Hussain teaching hospital in Kerbala from January 2011 – January 2012.
Results:Out of 200 cases who were initially enrolled in the study, 140 (70%) were benign, and 60 (30%) were malignant. The highest incidence of breast cancer was found among 40-49 years age and ductal carcinoma is the most common histological type.
Conclusions:Breast cancer accounts for about 30% from all excused biopsy materials in Al-Hussain Teaching Hospital in Kerbala. This study highlights some of the features of breast cancer seen in this region; younger age, intermediate stage at presentation, and higher incidence in housewives. In contrast to data from the West, where more than half of breast cancer patients are above 50 years of age and higher incidence among high socioeconomic group.
Key words:Breast cancer, lesions, histopathology, incidence, percent.