IRAQI JOURNAL OF MEDICAL SCIENCES

Background:Although the concept of probiotics was known since the era of Elie Metchnikoff for more than one century ago, the attention of probiotic therapy as effective approach to prevent and treat a wide range of diseases and disordersis increased in the recent years. Probiotic therapy is the treatment of diseases by use live micro-organisms known as probiotics and the aim of this therapy is to increase the numbers of microbiota and enhance their activities until such time that microbiota can be rebalanced. In this review; the definition and properties of probiotics, their types and mechanisms of action, as well as their health beneficial effects and safety have been reported.
Key words: Probiotics, Bacteriotherapy, Safety, LAB, GRAS

Background:Ovarian epithelial cancer is a leading cause of death among gynecological malignancies due mainly to advanced stage at presentation.
Objectives:To investigate the expression of CD44v6 and p53 in borderline tumors and malignant ovarian surface epithelial tumors, correlation with clinic-pathological parameters.
Methods:A cross sectional study included a total of (101) formalin-fixed paraffin-embedded ovarian tissue blocks; of which (19) cases were borderline tumors and (82) cases were overt ovarian carcinomas. Sections from each block were immunohistochemically stained for CD44v6 and p53.
Results:The expression of CD44v6 was higher in ovarian carcinomas (57.3%) than borderline tumors (26.3%) and it was significantly correlated with FIGO stage and histological grade of ovarian carcinomas. p53 was overexpressed significantly in invasive carcinoma compared to borderline tumors, and it was significantly associated with higher grade and FIGO stage of invasive carcinomas.
Conclusions: CD44v6 and p53 expressions were correlated with less differentiated, advanced-stage tumor and these markers may be important molecular markers for poor prognosis.
Key words:Borderline tumor, ovarian carcinoma, p53, CD44v6.

Background:Preeclampsia is characterized by abnormal vascular response to placentation that is associated with increased systemic vascular resistance, enhanced platelet aggregation, activation of the coagulation system, and endothelial cell dysfunction.
Objective:To investigate the serum level of anti angiogenic factor soluble fms-like tyrosine kinase-1 (sFlt-1) in the third trimester of preeclamptic pregnants in relation to the Doppler ultrasonography indices.
Methods:One hundred and five pregnant women at the Pediatric and Maternity Teaching Hospital in Hilla City were studied. All of them were in their third trimester and with singleton pregnancy. All participants were reexamined one month following delivery.
Results:The body mass index, spot urine protein to creatinine ratios and mean pulsatility index, resistance index), systolic and diastolic blood pressures were increased in preeclamptic groups. Post-delivery systolic and diastolic blood pressures increased in the control pregnant group and significant reduction in the both preeclamptic groups compared with the systolic and diastolic blood pressures at third trimester of pregnancy. sFlt-1 levels were increased in severe than mild preeclampsia and control groups. In post-delivery period, the sflt-1 decreases in the control pregnant, mild and severe preeclamptic groups in comparison to the third trimester. In preeclampsia, the sflt-1 is positively correlated with blood pressure, protein: creatinine ratio, body mass index, resistance index, pulstality index, total serum protein, and negatively correlated with neonatal weight and gestational age at delivery.
Conclusion:The changes in anti angiogenic factors sFlt-1 during pregnancy and in post-delivery period stress its role in the pathogenesis of preeclampsia and could be used to predict the disease progression and impact on the outcome of pregnancy.
Keywords: Preeclampsia, sFlt-1, Doppler indices.

Background:Using specific antidotes for the treatment of acute poisoning that is due to drug overdose by drugs adsorption is of significant importance in physical pharmacy for the preparation of physical antidotes.
Objective:The adsorption of folic acid from aqueous solution was investigated on two adsorbents (bentonite and Iraqi kaolin).
Methods:The present study involves studying adsorption of folic acid on Iraqi clays (bentonite and kaolin) from aqueous solution. Adsorption isotherm of folic acid on both surfaces used obeyed Freundlich isotherm. UV- Spectrophotometric technique was used to obtain the quantities of adsorption data at different conditions of temperature.
Results:The quantities adsorbed of the folic acid for bentonite and kaolin was increased at 37oC. Adsorption characteristics were described using Freundlich isotherm. The value of ΔGᵒ showed the spontaneous nature of the folic acid adsorption on both adsorbents.
Conclusion:This result indicated the surface heterogeneity leading to different adsorption forces from site to site and different affinities toward drug molecules.
Thermodynamic parameters have been calculated at different temperatures. The adsorption of folic acid increases with increase in temperature and positive value of ΔHᵒ indicates endothermic nature of the adsorption process. Negative values of free energy at all studied temperatures indicate that the adsorption process is spontaneous and favorable for folic acid. Positive value of entropy suggests increased randomness at the solid/solution interface.
Keyword:Adsorption, folic acid, bentonite, kaolin, thermodynamic parameters.

Background:Trauma is a leading cause of death in children older than one year in the world; with head trauma representing 80% or more of the injuries. Most head injuries in children occurs secondary to motor vehicle accidents, falls, assaults, recreational activities, and child abuse.
Objectives:To evaluate head trauma in pediatrics age group regarding age, sex, presenting symptoms and signs and the line of management; to know the role of CT scan in assessment of pediatrics head trauma, and t determine the extent of pediatric head trauma in Baghdad city.
Methods:Fifty neurosurgical pediatrics cases with head trauma between the age of one year to fourteen years whom presented to the neurosurgical ward in Al-Imamain Al-kadhimain Medical City. Questioner for gender, age, mechanism of injury, presented signs and symptoms, consciousness, CT scan findings, and the line of management.
Results:The study showed that males have the higher incidence with 72%. Head injury due to road traffic accident accounting for 44%. The loss of consciousness was documented in 60% of the cases. All patients subjected to CT scan imaging modality for assessing head injury as the ideal way. The presence of hematoma was seen in 68% of the cases. Associated injuries were seen in 60% of cases. Vomiting as an important symptom in pediatrics head trauma encountered in 52% of the patients. The developments of fits are very important sequel encountered in 16%. The close monitoring and follow up being the most common line of management accounting for 88%.
Conclusion:Pediatrics head trauma is a common problem with males have higher incidence than females. The most common mechanism of injury was road traffic accident. CT scan is a very vital and important diagnostic tool in evaluating patient with head trauma.
Key words:Pediatrics, head trauma.

Background:The choroid plexuses are composed of highly differentiated epithelial cells in with connective tissue and permeable capillaries among them. These cells connected by tight junction to form the blood –CSF-barrier that plays important role in protection of CNS. HNF4α is transcription factor of many drugs transporter proteins and known as nuclear subfamily 2 group alpha encoded by HNF4 alpha gene can be found in the liver, pancreas, intestine, brain and recently in epithelial cell of choroid plexuses.
Objectives:To evaluation the HNF4α intensity and localization of the choroid plexus in the lateral and forth ventricles of the rabbit.
Methods:Choroid plexuses of lateral and forth ventricles of 30 adult male rabbits were studied by morphological and immunohistochemical evaluation of HNF4α in theses ventricles that play role in regulation of drugs transporters and drugs metabolism in B-CSF-B.
Results: Histological method showed little different features by subjective examination between various localizations of the choroid plexuses. The immunohistochemical activity of HNF4α was different between lateral and forth ventricle where the IHC positivity is more in the lateral ventricle (0.067±0.029) than forth ventricle (0.032 ±0.018) and this results is statistically significant.
Conclusion:The choroidal cells of lateral ventricle showed more IHC activity of HNF4α and might indicate targeting of many drug transporters proteins, metabolites and eliminate of toxic compounds from brain tissues.
Key word:Choroid plexuses, HNF4α in lateral ventricle, drug transporter across the blood brain barrier.

Background:Urinary tract infection is a common and serious clinical problem in newborns. Renal scarring, hypertension, and even kidney failure can be prevented by early diagnosis and treatment of urinary tract infection. Jaundice is an important and sometimes the presenting feature of urinary tract infection.
Objectives:To evaluate the frequency and bacterial profile of urinary tract infection in full term and preterm newborns with hyperbilirubinemia in the first two week of life, and the relation with some demographic parameters.
Methods:Seventy two jaundiced neonates were studied. Hematocrit, white blood cell count, reticulocyte count, blood group and Rh, bilirubin (direct and total), Coombs test, and glucose 6-phosphate dehydrogenase level were evaluated. Septic screen and thyroid function test, urinalysis and culture for all patients.
Results:Twenty two (30%) out of 72 complain from urinary tract infection. Majority of them were full term 15 (68%), and Body weight > 2.5 Kg 12 (54%), fifteen delivered by normal vaginal delivery (68%). Breast feeding was recorded in 12 (54%), total serum bilirubin level above 20 mg/dl was found in 19 (86%). Gestational age, Normal Vaginal Delivery, Type of feeding, and total serum bilirubin level more than 20 mg/dl had significant correlation with urinary tract infection in jaundiced neonates, while birth weight was not significant. Commonest isolated bacteria was Escherichia coli in 11 (50%), staphylococcus infection in 2 cases (9.1%) have significant correlation with male gender. Ultrasound result was only positive in one (4.5%) neonate and showed pelvi-calceal obstruction.
Conclusion:Urinary tract infection is common among jaundiced neonates particularly in males. Escherichia coli is the commonest causative bacteria. Gestational age, normal vaginal delivery, type of feeding, and total serum bilirubin level more than 20 mg/dl had significant correlation with urinary tract infection in jaundiced neonates, while birth weight was not significant.
Key word:Neonatal jaundice, hyperbilirubinemia, UTI

Background:Obesity is one of the most frequently found health risks with increasing in its prevalence all over the world. Several measures of obesity like body mass index, waist circumference and percent of body fat had been used in many studies as predictor of pulmonary function tests.
Objectives:To evaluate the effect of anthropometric measurements on pulmonary function tests, and explore the association between body fat percent and pulmonary function tests.
Methods:A total of one hundred subjects were recruited from both sexes (fifty with normal and fifty with high body mass index). Body mass index, waist circumference and percent of body fat were measured for each subject.
Results:This study shows a significant reduction in spirometric parameters (except for FEV1/FVC ratio) in high body mass index groups compared to those with normal body mass index in both sexes, with a significant negative correlation between percent of body fat and waist circumference with spirometric parameters in high body mass index groups had been identified.
Conclusion:Obesity has a restrictive rather than obstructive pattern of lung impairment. Excess body fat and abdominal obesity have anadverse affect on lung function.
Keywords:Pulmonary function test, BMI, WC, BF%

Background:Endoscopic evaluations are commonly included within work up of unexplained anemia.
Objectives:Defining the value of the oesophageogastroduodenscopy as routine investigation in anemic patients in concern with gross pathological findings, as well as determining its importance in state of anemia in relation to age and gender.
Methods:It is a retrospective study reviewed 89 anemic patient reports, at the Oesophageogastroduodenscopy clinic, Al-Imammian Al-Kadhimain Medical City throughout the period between Oct 2011-Jan 2013. The following data had been reported from the patients files and included; gender, age, referral indication (which should be anemia with or without accompanying symptom) and their gross endoscopic pathological findings.
Results:The mean age was 46±17.36 years with range of 13-80 years. Male to female ratio (1:1.23). Majority of patients 50.6 %were referred due to lack of obvious cause to their anemia in absence of gastrointestinal symptoms. The most frequent finding is normal report in 33.7% followed by gastritis in 18%. Almost 82.5% of male patients were reported to have abnormal oesophageogastroduodenscopy in comparison to female patients (53.06%) (p = 0.003). Male patients at or under 45 years is statistically highly significant to undergo screening for the cause of anemia by endoscopy in comparison to same age matched counterpart females (p = 0.015).
Conclusion:It is important to apply practical algorithm in deciding the indication and value of referral anemic patients for oesophageogastroduodenscopy clinic considering young male patients and those with gastrointestinal tract symptoms as priorities after attempting to exclude all other possible causes, otherwise there will be no further yield by endoscopy in addition to exhaustion of resources.
Keywords:Unexplained anemia, oesophageogastroduodenscopy

Background:End stage renal diseases patients have lower seroconversion rates compared with the subjects with intact renal function. Moreover, even after the completion of vaccination schedule anti-hepatitis B titers of responder who kept on dialysis, patients are low and decline logarithmically with time.
Objectives:To determine the response of patients with end stage renal disease undergone hemodialysis to hepatitis B virus vaccination and to identify the factors that could affect this response.
Methods:One hundred patients with an age range from 21 to 75 years complaining of chronic renal failure on regular hemodialysis. Patients negative for hepatitis B antigen and anti-hepatitis C were vaccinated with 40µg of Euvax B intramuscularly in the deltoid muscle by following a schedule of 0, 1 and 2 months. The antibody titer was tested at third month and if titer was <10 or 10-100IU/mL (patients whom regarded as non-responded or poor responded). Then they were given another fourth dose (40µg) of vaccine at sixth month.
Results:The rate of seroconversion to hepatitis B vaccine among individuals with end stage renal disease is 63%. Thirty one (31%) patients were anti hepatitis C virus positive. Eighteen (58%) were responsive to hepatitis B vaccination and 13 (42%) did not response to Hepatitis B vaccination. Advanced age, sex and diabetes mellitus show no effect on response to vaccination. The response to hepatitis B vaccine is significant in patient\'s well control of hemoglbulin, calcium, albumin and long duration on hemodialysis.
Conclusion:Patients on maintenance dialysis typically show a suboptimal immune response to hepatitis B virus vaccine compared with the non-uraemic population.
Keyword: Hemodialysis, chronic renal failure, HBsAg, vaccination.

Background: Adiponectin is an amino acid collagen-like protein that is secreted by adipocytes to acts as a hormone with anti-inflammatory and insulin-sensitizing properties. 1,5 anhydroglucitol, is 1-deoxy form of glucose, is a validated marker of short-term glycemic control. Flaxseed oil is a colorless to yellowish oil obtained from the dried, ripened seeds of the flax plant (Linumusitatissimum, L).
Objectives:To investigate the effects of metformin alone, metformin with flaxseed oil on fasting serum 1,5 anhydroglucitol, adiponectin and insulin resistance.
Methods:Newly diagnosed (≤ 1year) male and female patients with type 2 diabetes mellitus aged 25 to 70 years were enrolled and divided into two groups; group 1 consisted of 32 patients, treated by oral metformim alone over a period of 12 weeks an group 2 consisted of 30 patients treated by oral metformim with flaxseed oil. Fasting serum 1,5 anhydroglucitol, adiponectin, fasting plasma glucose and fasting serum insulin were estimated. All parameters were measured initially, before any intervention, and later on at two steps, the 6th and the 12th week of the study.
Results:After 12 weeks of treatment with metformin alone, metformin with flaxseed oil there was significant improvement in both 1,5 anhydroglucitol (p = 0.010 and 0.013, respectively) and adiponectin (p = 0.041 and 0.037, respectively). For insulin resistance, p value with metformin, metformin with flaxeed oil was 0.105 and 0.110, respectively. Both results showed an apparent improvement only which was statistically insignificant.
Conclusion: Metformin, metformin with flaxseed oil associated with statistically significant improvement in 1,5 anhydroglucitol and adiponectin. Insulin resistance in both treatment groups showed only insignificant apparent improvement. Metformin with flaxseed oil group was more effective in insulin resistance improvement and elevation of adiponectin hormone.
Key words: Adiponectin, 1,5 anhydroglucitol, Homeostasis model assessment for insulin resistance.

Background: Helicobacter pylori persistence may develop atrophic gastritis, gastric ulcer or cancer.
Objectives:To determine the association between the presence of autophagy related gene 16 like 1 and thrionin 300 alanine mutation and H. pylori infection among atrophic gastritis patients.
Methods:Gastric biopsy was taken from eighty patients and tested for urease, and blood samples were taken for serum separation for detection of Anti-H. pylori IgG by ELISA and DNA extraction from whole blood were used for sequence specific primer – polymerase chain reaction for autophagy related gene 16 like 1 and thrionin 300 alanine mutation allelic discrimination.
Results:Among 40 H. pylori positive cases, the carriers of mutated allele were 62.5% compared with 36.25% in H. pylori negative cases (p = < 0.001, OR = 1.72, CI = 1.23-2.42).
Conclusions:Among Iraqi atrophic gastritis, there is an association between H. pylori infection and mutated autophagy related gene 16 like 1 and thrionin 300 alanine mutation allele. Thrionin 300 alanine may confer higher risk for infection with H. pylori.
Key words: Autophagy, H. pylori, atrophic gastritis.

Background: Pneumocystis jirovecii is the causative agent of pneumocystis pneumonia, one of the most frequent and severe opportunistic infections in immunocompromised patients.
Objectives:To determine the possible implication of pneumocystis jirovecii in immunocompromised Iraqi patients with pulmonary infections, and investigate the efficiency of indirect qualitative immunofluorescence diagnosis in compared with conventional stains for the detection of this agent.
Methods:A total of 200 clinical samples from 100 immunocompromised patients (70 bronchoalveolar lavage, 21 sputum samples and 9 pleural fluids). One hundred samples from immunocompetent individuals (50 bronchoalveolar lavage, 30 sputum samples and 20 pleural fluids). Detection of pneumocystosis was done by conventional satins and indirect qualitative immunofluorescence technique.
Results:Fourteen samples gave positive results by indirect immunofluorescence monoclonal antibody test. Twelve out of 100 samples were positive by each Gomori methenamine silver, modified toluidine blue O stains and Diff-Quik stain (modified Giemsa).
Conclusion: Pneumocystis jirovecii is the fundamental opportunistic infection among immunocompromised patients. The indirect qualitative immunofluorescence method gives a promise for use as a primary method for diagnosis of pneumocystis jirovecii pneumonia or as rapid screen to exclude the presence of pneumocystis jirovecii in sputum and bronchoalveolar lavage samples.
Keywords: Pneumocystis jirovecii (carinii), pneumocystis jirovecii pneumonia, immunocompromised, Iraqi patients.

Background:The study focused on acute stage of stroke patients and investigated which parameters of glucose in acute phase of stroke are significant in nondiabetic stroke patients.
Objective:To evaluate hyperglycaemia in acute phase of stroke.
Methods:Cross sectional study was conducted in Al-Imamain Al-Kadhimiyan Medical City in Baghdad city from October 2013 to September 2014. We studied glucose levels and glycosylated haemoglobin in 100 consecutive patients with acute stroke admitted within 24 hours after onset of symptoms.
Results:One hundred consecutive patients (65 men and 35 women ) were included in this study, 76 patients with diagnosis of ischemic stroke and 18 of them with diagnosis of intracerebral haemorrhage and 6 patients with transient ischemic attack Hyperglycemia was found in 44 patient. High glycosylated haemoglobin levels were found in 29 patients, 16 patients of them have history of diabetes. The other 13 with elevated glycosylated haemoglobin levels were considered as prediabetes. The remaining 15 patients had normal glycosylated haemoglobin.
Conclusion:There is significant relationship between idiopathic hyperglycemia and prediabetes with acute stroke.
Keywords:Stroke, diabetes mellitus, hyperglycaemia

Introduction:Gram negative bacillary meningitis is uncommon disease that needs proper diagnosis and urgent treatment to avoid serious complications. Escherichia coli, Klebsiella pneumonia and Pseudomonas aeruginosa are the most frequent gram negative bacilli. Use of third generation cephalosporins has made a significant therapeutic change with significant reduction in mortality. Ceftriaxone should always be the drug of choice until the full sensitivity report is available. Here, we report a case of bacterial meningitis caused by Pseudomonas aeruginosa which is thought to be secondary to previous ear infections. The diagnosis was confirmed by gram stain and culture of the cerebrospinal fluid. The patient was successfully treated with intravenous antibiotic for total of three weeks.
Key words: Pseduomonas aeruginosa, meningitis, ear, infection.