IRAQI JOURNAL OF MEDICAL SCIENCES

It is believed that good ethical values flow out from one source, and follow a clear path that extends to every part of the world. These values honor the dignity of man as a human being honored by God almighty, and maintain man’s essential rights, including life, freedom, preservation of property, health and sufficiency, throughout man’s life.
The Glorious Qura'n and Holy Shari`ah had contribute actively in regulation these ethical aspects in medicine. Although, these principles have been adopted in practice since the early days of Islamic culture and cited by many Muslims scientists. Nowadays, physicians are under prepared to deal with the new progress in medical technology like organ transplants, genetic engineering, and respirators that keep a person alive, only as a vegetable, for several years.
Keywords: Ethics, Medical Ethics, Relgion, Islam, The Glorious Qura'n, Holy Shari`ah

Background:Cervical cancer is the fourth most common cancer affecting women worldwide. Immunohistochemical expression of several biomarkers; including those regulating apoptosis and angiogenesis; may help to distinguish reactive conditions from precancerous and cancerous lesions of the uterine cervix.
Objective:To assess the IHC expressions of p53, bcl2 and CD34 in cervical intraepithelial neoplasias and carcinomas.
Methods:A cross sectional study included a total of 127 formalin-fixed paraffin-embedded cervical tissue blocks; of which 22 cases were chronic cervicitis, 24 cases were low grade squamous intraepithelial lesion (LSIL), 28 cases were high grade squamous intraepithelial lesion (HSIL) and 53) cases were invasive cervical carcinomas. Sections from each block were immunohistochemically stained for p53, bcl2 and CD34.
Results: p53 was not expressed in chronic cervicitis, with significant increase in its expression from LSIL through HSIL to carcinomas had been identified. A significantly higher IHC expression of p53 was observed in adenocarcinomas and adenosquamous carcinomas compared to squamous cell carcinomas. Bcl2 was expressed in all cases with non-significant differences. Regarding CD34 IHC expression; there was a significant increase in microvessel density (MVD) from chronic cervicitis through LSIL and HSIL to carcinomas. A significantly higher MVD was detected in adenosquamous carcinomas and adenocarcinomas, in poorly differentiated carcinomas and was significantly increasing with stage.
Conclusions: p53 plays an important role in the progression of the severity of intraepithelial cervical lesions. MVD can be utilized as ancillary marker for the risk of malignant transformation of cervical intraepithelial lesion.
Key words: LSIL, HSIL cervical carcinoma, p53, bcl2, CD34, MVD

Background: Preeclampsia is a major problem in obstetric practice; it is considered one of the largest causes of maternal and perinatal morbidity and mortality, and one of the most important causes of intrauterine growth restriction and low birth weight.
Objectives:To evaluate the intraplacental villous microvascular density and vascular surface area in pregnancy induced hypertension in term placentae, and its effect on newborn body weight.
Methods:A sample of 50 placentae divided into 25 normal term placentae (Control group) and 25 term placentae of pregnancy induced hypertension (preelampsia) considered as the (Test group). Fresh placental tissues were taken from the peripheral placental area, processed to paraffin blocks, stained with CD-34 (clone QBEnd-10) (DAKOCYTOMATION), assessment of the vascular density, and vascular area with image j software.
Results:Significant increase in vascular density, with a significant reduction in vascular area seen in placentae of preeclampsia compared to control group at p ≤ 0.05, in addition fibrosis with vascular degeneration and stenosis were evident in terminal villi, lead to avascular terminal villi in preeclampsia compared to control group. Significant reduction in newborn body weight in preeclampsia compared to control at p ≤ 0.05.
Conclusions:These results suggested that placenta adapt its structure to maintain its function, this adaptation reflected as an increase in vascular density that consequently occur as uteroplacental perfusion reduces due to maternal vasospasm, and the placenta becomes ischemic as gestation progresses due to hypoxia that affect terminal villi vasculature. Fibrin deposition, vascular degeneration, thickened vessels wall, and stenosis those together reduce the vascular area; these changes accordingly were reflected on newborn body weight in preeclampsia.
Key words: Preeclampsia, vascular density, vascular area, placenta.

Background:Ketamine as an analgesic drug is widely used to provide sedation for minor procedures. It was reported that the use of this drug causes deletion of large numbers of neurons from the developing brain.
Objectives:To investigate the effect of prenatal ketamine exposure on the newborn rat frontal cortex using immunohistochemical TUNEL test.
Methods:Seventy two pregnant rats were divided into three groups: I, II, and III (24 rat for each group), and exposed to ketamine at the 7th day, 11th day, and 18th day, of gestational age. Each group was subdivided into control subgroup A injected intraperitoneally with normal saline, and the subgroups B, C and D injected with intraperitoneal ketamine with 5 mg/kg, 10 mg/kg, and 20 mg/kg, respectively. Paraffin block sections of newborn rat frontal cortices were investigated by TUNEL test.
Results:Counting of fluorescent cells showed progressive increase in mean values with increased dose of ketamine injection and advancing age of prenatal exposure to ketamine. Significant variability was demonstrated between the control subgroup A and the other subgroups, and between the subgroups of each group, whereas, non-significant variability was observed between the counted mean differences values obtained for subgroup B in all groups (I, II, and III) compared to that of the control subgroup A.
Conclusion:Prenatal exposure to ketamine in a dose of 5mg/kg was a relatively non-toxic in all studied groups compared to the control subgroup. Apoptosis in frontal cortical tissue was involved in the mechanism of neuronal death caused by ketamine exposure during pregnancy.
Keywords:Frontal, cortex, prenatal, ketamine, neurotoxicity, immnuohistochemistry.

Background:Burn is a major health problem, life threatening with a high mortality and morbidity; Chitosan and its formulations are used as a topical dressing in wounds and burns management due to its nontoxic, hemostatic, healing stimulant, antimicrobial, biocompatible and biodegradable properties as well as its vehicle use to deliver biopharmaceuticals, antimicrobials and growth factors into tissue.
Objective:To evaluate the effects of chitosan-dextrin combination on induced burn in rabbits.
Method: Forty domestic male rabbits, weighing 1250-1750 kg were divided into five groups, each of eight animals: AH group: apparently healthy rabbits, BWT group: left with no treatment, AR group: treated with Aqua Rosea, AG-S group: treated with silver sulfadiazine cream and CH-D group: treated with chitosan – dextrin combination; all animals (except AH group) wereinduced burn and treatedtopically on burned area once daily for 28days. Tissue levels ofvascular endothelial cell growth factor (VEGF), tumor necrosis factor alpha (TNF-α) and skin histological examination.
Results: Histopathological evaluation showed enhances inflammatory response, vascularization, granulation tissue formation, and collage deposition due to the appropriate regulation of TNF-α and VEGF.
Conclusion:Topical use of chitosan – dextrin combinationshowed effective and enhance wound healing activities.
Key words:Thermal injury, burn, chitosan, dextrin.

Background:Multiple sclerosis is an autoimmune disease, its etiology until know is unknown. Many studies suggested that the environmental risk factors one of them is chlamydia Pneumoniae may play a role in the initiation of the disease.
Objectives:To investigate the relationship between previously Chlamydia Pneumoniae infection and multiple sclerosis disease initiation
Methods:Sixty patients with multiple sclerosis (30 newly and 30 previously diagnosed), their ages ranged from 13 to 58 years were enrolled in the present study. They attended seeking for treatment or for the diagnoses of multiple sclerosis in outpatient clinic at the Medical City, Baghdad Teaching Hospital, Baghdad in the period from December 2014 till March 2015. In addition, thirty healthy volunteers their gender and ages were matched with patients group were participated as a control. We measured the anti chlamydia Pneumoniae IgG by ELISA technique.
Results:The chlamydia Pneumoniae positivity in the multiple sclerosis patients was considerably higher than the control group but the variation was not significant (p > 0.05) and there was no difference between the previously and newly diagnosed multiple sclerosis patients.
Conclusion:There is no statistically significant relationship between previously chlamydia Pneumoniae infection and MS disease.
Keywords:Multiple sclerosis, chlamydia Pneumoniae

Background: Anticonvulsants drugs are a diverse group of pharmacological agents used in the treatment of epileptic seizures are known to inhibit or activate cytochrome p-450 enzymes that play a crucial rule in the metabolic process.
Objective:To investigate any possible differences in the effect of antiepileptic drugs; enzyme inducer (carbamazepine) and enzyme inhibitor (lamotrigine) on lipid profile in normal and diabetic rabbits depending on its effect on cytochrome p-450 enzymes.
Methods:Fifty four healthy domestic rabbits of both sexes weighing 0.5-2.5 kg were studied. They were divided into group A (standard) received tolamatrigine and carbamazepine without induction of diabetes and group B (received the same regimen) with induction of diabetes. Lipid profile was tested in the two groups.
Results: Carbamazepine-treated group showed a significant increase in the lipid profile at day 20 of treatment compared to day 5 in comparison with induced and non-induced control groups and control group in normal and diabetic rabbits. Lamotrigine showed less effect on lipid profile; and in non-diabetic treated groups it showed a non-significant change in lipids level as compared to the control group.
Conclusions:Anti-epileptics drugs that possess an enzyme inducing effect as carbamezpin tend to induce high lipids profile in comparison to lamotigine.
Keyword: Lamotrigine, carbamazepine, anticonvulsants, glucose, lipid.

Background: Leptin may serve as the critical link between the body’s adipose tissue and the hypothalamo-pituitary axis, thus it is considered a possible link between nutrition and reproduction.
Objective:To evaluate leptin in the serum and follicular fluid and its effect on fertilization rate and pregnancy outcome in infertile female patients undergo intra-cytoplasmic sperm injection cycle.
Methods:Seventy four infertile women who agreed to participate in the study were selected randomly from those attending the Fertility Centre in Al-Sader Teaching Hospital, Holly Najaf. Hormonal analysis was done for serum and follicular fluid leptin hormone at the day of ovum pickup.
Result: Serum and follicular fluid leptin hormone levels were increased above its normal cutoff level according to the kit used. There was a relationship between the fertilization rate and leptin in serum and follicular fluid. Fertilization rate was significantly (p = 0.049) different depending on the serum leptin level while it has nothing to do with follicular fluid leptin hormone. On the other hand, follicular fluid leptin significantly (p = 0.04) affect pregnancy outcome.
Conclusion: Leptin provides possible impact on oocyte and/or embryo quality leading to impaired endometrial bed preparation that may be involved in pregnancy failure.
Keywords: Leptin, ferilization rate, pregnancy outcome.

Background:Elevated high-density lipoprotein cholesterol (HDL-C) levels have been shown to be protective against cardiovascular disease. However, the association of specific lipoprotein classes and ischemic stroke has not been well defined.
Objectives:To evaluate the association between HDL-C and ischemic stroke in men and women, and to compare the results with a control sample of the same age group.
Methods:A hospital based case-control study was done comparing serum HDL-C levels in 48 ischemic stroke patients to 50 controls recruited from Al-Imamain Al-Kadhemain Medical City, all patients and control had negative past medical history, negative history for smoking and alcohol. Serum lipid profile was determined in all of them.
Results :This study showed that regarding the serum HDL-C levels, 41 (85.4%) patients were found to have low levels (less than 40 mg/dl) while among the control group, only 19 (38%) have shown low serum HDL-C level.
Conclusion:The study showed that there is a significant association between the low level of serum HDL-C cholesterol and the risk of ischemic stroke in this population.
Keywords: cholesterol, lipoproteins, HDL-cholesterol, ischemic stroke

Background:Multiple sclerosis (MS) is a chronic inflammatory autoimmune disease with unknown etiology. Variation in the HLA-DRB1 gene is the potent genetic risk factor for promoting MS. Other agents relate with an increased risk of developing MS include the cytokines levels such as interleukin-10 (IL-10) and the vitamin D (vit. D) deficiency.
Objectives:To study a possible role of HLA-DRB1, vit. D deficiency as a risk factor for MS development and to estimate the level of IL-10 in the serum of MS patients and its role in disease initiation or progression.
Methods:Sixty MS patients, of them 30 were newly diagnosed with an age range between 13 and 58 years were included in this study, in addition to thirty healthy volunteers their gender and age matched with patients group serve as a control group. Blood samples collected to assess serum levels of vit. D and IL-10 by Enzyme-Linked Immunosorbant Assay (ELISA) and for DNA extraction, which used in the HLA-DRB1 2 digit genotyping.
Results :The HLA-DRB1 genotyping revealed that the HLA-DRB1*15 frequency was higher but statistically insignificant in the MS patients as compared with healthy control group. IL-10 level was significantly lower in MS patients on treatment than the control group. On the other hand, vit. D in the newly diagnosed MS patients was significantly different from the control group (higher in the control group), but there was no variance with MS patients on treatment, the level of vit. D in the studied groups was less than global value.
Conclusion:In MS patients the frequency of HLA-DRB1*15 was higher than control group but the difference was not significant. In addition, the level of IL-10 and vit. D may have a role in the development of MS.
Keywords:Multiple sclerosis, human leukocyte antigen, IL-10

Background: Methotrexate is folic acid antagonist, used in the therapy of various types of diseases. Oxidative stress and inflammation have the major role in methotrexate toxicity.
Objective: To study the protective effects of felodipine against methotrexate-induced hepatotoxicity in rabbits.
Methods: Twenty four rabbits divided randomly into three groups. Group I was left without treatment, group II received a dose of 20 mg/kg methotrexate (MTX) intraperitoneally from 3rd day for three successive days and group III received a dose of 0.5 mg/kg felodipine orally for 7 days in addition to MTX therapy similar to group (2). On 8th day the following parameters (liver enzymes, liver tissue homogenate of glutathione, malondialdehyde and tumor necrosis factor-α) were monitored. As well as assessment of histological changes on liver tissue sections after scarification.
Results: Administration of felodipine significantly decreased the elevated levels of alanine aminotransferase (ALT), aspartate aminotransferase (AST), alkaline phosphatase (ALP), malondialdehyde and tumor necrosis factor-alpha. It also elevated glutathione levels significantly, with improvement of histological features related to MTX exposure in group III compared with group II.
Conclusion: Felodipine can protect hepatic tissue against MTX-induced hepatotoxicity.
Keywords: Hepatotoxicity, Methotrexate, Felodipine, Glutathione, Malondialdehyde, Tumor Necrosis Factor-alpha.

Background Oral squamous cell carcinoma is the most common malignant neoplasm of oral mucosa. Human papilloma (HPV) virus cause a broad scope of diseases from benign to invasive tumors, types 16 and 18 classified as carcinogenic to humans.
Objective To assess the occurrence rate of human papilloma virus genotypes in oral cancer patients and their association with various risk factors.
Methods Fifty five (55) unstimulated whole saliva samples were collected from 35 histopathologically confirmed patients with oral cancer and 20 apparently healthy subjects were enrolled in this study. Genomic DNA was extracted from exfoliate cells to amplify HPV-DNA using HPV-L1 gene sequence primers by polymerase chain reaction method, the viral genotyping was performed using direct sequencing method.
Results The mean age of patients group was 52.23±13.73 years, while in healthy subjects group was (50.55±12.5) years. Risk of smoking was highly significant with odds ratio 60.79 and a 95% confidence interval of 3.40-1086.71. However, the risk of alcoholism was significant with odds ratio 27.77 and a 95% confidence interval of 1.51-511.27. Forty-six percent (16/35) of oral cancer patients were positive for detection of HPV-DNA (P < 0.0002). The most frequent HPV genotypes in patients group was HPV-18 accounting for (31%) of cases (P < 0.05). The rate of HPV was significantly higher among younger ages (< 50 years) with P = 0.042. In addition, the rate of HPV was higher with other variables (male, tongue tissue, grade I differentiation, squamous cell carcinoma) with no significant association (P = 0.273, P = 0.739, P = 0.173, and P = 0.700 respectively).
Conclusion Human papilloma virus types 16 and 18 may be a risk factor for oral cancer independent of alcohol and tobacco.

Background Infection with Giardia lamblia (G. lamblia) parasite regarded as the most important causative agent for diarrhea, and a major public health problem.
Objectives Molecular identification and characterization of G. lamblia genotypes and association with gender, age and presence of different clinical signs.
Methods One hundred children with diarrhea were included. Fecal samples were taken from them during the period from May 2014 to February 2015. The age range was 2 months to 18 years. All stool samples were examined by microscopic examination, multiplex real time polymerase chain reaction and nested PCR.
Results Among 42 fecal samples from patients with giardiasis diagnosed by multiplex real time PCR, amplification of triosphosphate isomerase gene of G. lamblia was successful among 25/42 (59.52%) samples. However, the amplification of these samples showed that 7 (28%) contained genotype A and 18 (72%) samples contained genotype B; genotype B was more prevalent than A in males 11/18 (61.11%) and females 7/18 (38.89%) respectively. Regarding age, the results showed that no differences in distribution of genotypes were found statistically among different age groups of patients. Regarding to clinical aspects, the rates of abdominal pain, weight loss, anorexia and fever of giardiasis genotype B are higher than the genotype A.
Conclusion G. lamblia genotype B is the most frequent genotype among children with diarrhea. Also, the presence of the clinical aspects is genotype specific.

Background Hyponatremia is a common electrolyte disorder encountered in patients of stroke, which is usually either due to inappropriate secretion of antidiuretic hormone (SIADH) or cerebral salt wasting syndrome (CSWS). Making an accurate diagnosis is important because the treatment of each condition is quite different.
Objectives We conducted this study to determine the incidence and etiology of hyponatremia in patients of stroke.
Methods A cross sectional study of 100 patients diagnosed to have stroke (50 ischemic, 50 hemorrhagic) based on clinical history, examination and brain images. Patients were evaluated for hyponatremia (serum sodium < 135 mmol/L) during the second week of their admission.
Results Out of 100 patients, 17 patients had hyponatremia, all Patients with serum sodium level in hyponatremic range were limited to patients with hemorrhagic stroke, while no patients with ischemic stroke had a low serum sodium level, this difference was significantly different, P-value was < 0.001.
Conclusion Incidence of hyponatremia in our study population was 17%, all Patients with hyponatremia were limited to patients with hemorrhagic stroke, in patients of hyponatremia; 82% were having SIADH and 18% were having CSWS.