IRAQI JOURNAL OF MEDICAL SCIENCES

Cervical cancer (CC) represents the most common cancer among women in developing countries. Present confirmation suggests that human papillomavirus (HPV) testing is more efficient than cytology for CC screening. Even if implementing a high-quality cytology programme in these countries is probable, it would only be fairly effective. This is because the presently used Pap test misses approximately 50% of high-grade precursor lesions and cancers with a single screening.
Several screening alternatives have been planned for areas with incomplete resources. Amid these, visual inspection with acetic acid (VIA) includes the application to the cervix of 5% diluted acetic acid (vinegar), making the dysplastic epithelium turn white (acetowhitening). Screening with HPV testing and VIA have been verified to be effective and potentially cost-effective in low-resource settings, allowing for fewer follow-up visits (e.g., screen-and-treat approaches) and, in the case of HPV testing, automated processing of laboratory specimens that reduces resource and quality control necessities

Keywords:Cervical cancer, screening, cytology, human papillomavirus testing, visual inspection with acetic acid

Background:Inhaler is a device holding a medicine taking by breathing (inhalation). It is estimated that about 25 billion dollars spent for inhalers annually, 5-7 billion dollars are wasted because of inhaler misuse.
Objective:To evaluate inhaler use technique among Iraqi asthmatic and chronic obstructive pulmonary diseases (COPD) patients and identify the technical mistakes in using inhalers.
Methods:The study protocol consisted of interview session to answer the study questionnaire and assessment session to estimate the performance of using inhaler in three cities in the middle of Iraq during the interval between 1st of August and 20th of September 2015. Chi-square test and trend chi-square test were used for univariate association between potential determinants and correctness of inhalation technique. Relevant determinants were entered into a multivariate logistic regression model.
Results:A total of 364 patients participated in this study, 39.6% of patients were using their inhalers inadequately. Patients using turbuhaler, older patients (>60 years old) and patients with low level of education or shorter duration of use were significantly associated with more inhaler use mistakes.
Conclusion:This study showed that substantial proportion of patients with asthma or COPD using their inhaler inadequately. The worse performance was among patients using turbuhaler and best among those using disckus inhaler.
Keywords:Inhaler administration, asthma, COPD, pMDI, turbuhaler, disckus inhaler

Background:The harmful effect of manganese chloride on postnatal spermatogenesis was evidently concluded in previous experimental researches, however, the molecular changes related to this effect of manganese chloride needs further elaboration.
Objective:To investigate the toxic effect of prenatal manganese chloride exposure on adult mice testes using malondialdehyde (MDA) antibodies as an immunohistochemical marker.
Methods:In this study, 30 pregnant mice were divided into control and experimental groups. The experimental animals were given 0.1 ml of manganese chloride solution (8000 mg/Liter concentration) orally during the first 17 days of pregnancy. The control group of pregnant mice was given 0.1 ml of distilled water orally rather than the solution of manganese chloride. Paraffin sections of the offspring mice testes were stained for general histological features and for anti-MDA immunohistochemical evaluation. The Aperio Image Scope v.9 software was used to evaluate the immunohistochemical reaction.
Results:Sections of testes from mice of the experimental group showed distorted morphology and organization of the stages of sperm development with distorted histological criteria of the interstitial tissue. Results from mice testes revealed statistically significant variability of anti-malondialdehyde (MDA) immunohistochemical expression in the experimental group compared to that of the control group.
Conclusion:Manganese chloride induced lipid peroxidation as part of its toxic effect. This lipid peroxidation caused cellular injury leading to apoptosis and autophagy.
Keywords:Testes, development, manganese chloride, mice, toxicity, immnuohistochemistry, apoptosis

Background: Ductectasia of the breast is a benign condition. It is characterized by dilatation of the mammary ducts, which is often associated with periductal inflammation. Recurrent sepsis is often resistant to non-operative management. Furthermore, it can be very difficult to exclude malignancy.
Objective:To evaluate the significance of Hadfield operation (radical excision of major mammary ducts) in treatment of ductectasia and in detecting coexistent early carcinoma of the breast that cannot be visualized by ultrasound and mammography.
Methods:A Prospective study in Al-Imamein Al-Kadhimein Medical City for female patients with ductectasia of the breast over the period from April 2007 to April 2015. Ultrasound was done for all patients to prove the diagnosis and to exclude any suspicious mass. Mammography was done for patients above 40 years old. Patients with breast mass diagnosed clinically or by investigations were excluded from the study. Patients were divided into two groups according to the type of treatment; (Group A) patients were treated conservatively by antibiotics and analgesia, and (Group B) patients were treated surgically by radical excision of the major mammary ducts (Hadfield operation). Follow up of all patients for at least one year.
Results:Over eight years of the study, the total number was 720 female patients, their age ranges from 21 – 55 years with mean age (33±48 year). Group A includes 614 (85.28%) patients, all of them were still complains of nipple discharge and not cured. Group B includes 106 (14.72%) patients all of them were cured from nipple discharge. One patient in Group B accidentally found to have ductal carcinoma in situ of the breast which was not visualized by preoperative ultrasound or by mammography.
Conclusion:Conservative management of ductectasia of the breast does not relief symptoms of nipple discharge, while surgical excision of major mammary ducts relief symptoms of nipple discharge. Co-existence of breast carcinoma in situ (which was not appeared by preoperative ultrasound and mammography of the breast) in specimen of excised mammary ducts is an interested finding.
Keywords: Ductectasia of the breast; Hadfield operation; early breast carcinoma

Background:The effluents of wastewater treatment plants may contain infectious human viruses representing a major public health issue. Wastewater must be analyzed for viruses' detection using easy and rapid protocol.
Objective:To compare between two viral concentration methods used for detection of enteric viruses in wastewater and treated effluent. Then assess the presence of viral genomes by cell culture and polymerase chain reaction (PCR).
Methods:Fifty samples of wastewater were collected from two wastewater treatment plants during one year survey (January-December 2009) in order to compare two virus concentration methods; the polyethylene glycol (PEG) precipitation and the two-phase separation method, advised by the World Health Organization guidelines. Then assess the presence of viral genomes of human enteroviruses (EV), human adenoviruses (HAdV), hepatitis A and E viruses (HAV and HEV), human noroviruses (HuNoV), human rotaviruses (RV) and human astroviruses (HAstV) by cell culture and PCR technique.
Results:This study, using three statistical tests, showed that there was no significant difference between the two concentration methods: the PEG precipitation and the two-phase separation (P>0.05).
Conclusion:Considering this study with protocol time, cost and simplicity. The PEG precipitation seems to be an alternative method of the two-phase separation method.
Keywords:Wastewater, enteric-virus, concentration methods, PCR, cell culture, Morocco

Background: Polycystic ovary syndrome (PCOS) is the most common endocrine-metabolic disorder affecting women of reproductive age characterized by multiple hormonal imbalances, reflecting on a clinical presentation dominated by manifestations of hyperandrogenism, which generate short and long term consequences on female health. Skin is a major target for androgen activity, several hyperandrogenemia-triggered dermatologic alterations can be seen in PCOS, most commonly hirsutism, androgenic alopecia, acne, seborrhea, onycholysis, and onychorrhexis. Zinc is one of the most important trace elements required as a catalytic, structural, and regulatory ion for the activities of more than 300 enzymes, proteins, and transcriptional factors. Zinc insufficiency in the female can lead to complications such as impaired synthesis/secretion of follicular stimulating hormone (FSH) and luteinizing hormone (LH), abnormal ovarian development.
Objective:To assess serum zinc level in patients with PCOS.
Methods:A case-controlled study was conducted in Al-Imamein Al-Kadhemein Medical City from the period of March to June 2016. Eighty females were enrolled in this study; their age ranged from 20 to 32 years. They were divided into 4 groups: Group I: Twenty patients with PCOS with body mass index (BMI) ranged from 30.0-40.0. Group II: Twenty normal healthy control obese ladies with BMI ranged from 30.0-40.0. Group III: Twenty patients with polycystic ovary syndrome with BMI ranged from 18.5-29.9. Group IV: Twenty females as a healthy control non-obese ladies with BMI ranged from 18.5-29.9.
Results:Serum zinc level was significantly decreased in obese PCO group than in non-obese PCO group. Serum prolactin (PRL) level and LH levels were elevated in PCO group which was highly significant. There was negative correlation between serum zinc level and BMI in PCO patients. Also, negative correlation was observed between serum zinc level and serum PRL level in non-obese PCO patients.
Conclusion:Serum zinc level reduced in obese PCOS than in non-obese PCO.
Keywords: Serum zinc level, polycystic ovary syndrome

Background: Tanycytes are highly specialized ependymal cells (ECs) that line the regions of circumventricular organs (CVOs) where the blood-brain barrier is absent. These cells show tight junctions (TJs) that form a blood–cerebrospinal fluid barrier at the regions of these organs, thus modulating the transport mechanisms between the cerebrospinal fluid and the brain capillaries.
Objective:To investigate the presence of TJs between ECs of the sulcus medianus organ (SMO) in the floor of the 4th ventricle in comparison to the region of the median eminence (ME) of the hypothalamus, a known CVO in the brain.
Methods:Ten adult male rats (Rattus Norvegicus Albinus) aged 3-6 months were used to study the general histological morphology of ECs at the SMO and ME regions by H. and E. stain, and to explore the immunofluorescence labelling of these cells for TJs using anti-ZO1 FITC.
Results:The ECs were arranged in 2-3 layers in the depth of the median sulcus (MS) at the SMO region as seen with H. and E. stain. Immunofluorescent labelling with anti-ZO1 FITC revealed the presence of TJs between ECs of the SMO in a way similar to that reported between tanycytes of the ME.
Conclusion:The SMO contained tanycytes or tanycyte-like cells that exhibited TJ complexes. This unique cell population added a strong evidence for the presence of a CVO in the rostral part of the MS to link CVOs on both sides of the cerebral aqueduct.
Keywords: Tanycytes, circumventricular organs, sulcus medianus organum, tight junctions

Background: Rhinosinusitis is inflammation of the sinuses, most commonly caused by a viral or bacterial infection or by allergic (or non-allergic; non-allergic could be due to infection). Fungal infections of the sinuses are uncommon and usually occur in individuals who are immunocompromised. However, recently, the occurrence of fungal sinusitis has increased in the immunocompetent population.
Objective:Isolation and identification of fungi in Rhinosinusitis with antifungal sensitivity..
Methods:The study was carried out on 112 patients who were suffering from rhinosinusitis, and then identification was done for the isolated fungi associated with rhinosinusitis 1-Specimens (Swabs (from nose and sinuses) and Water nasal washing) collection. 2- Direct microscopic exam. 3-Fungal isolation and diagnosis. 4-Anti-Fungal sensitivity test. 5- Patients (112 patient) were diagnosed by specialist Doctors according to the clinical symptoms and CT scan findings and biopsy. attending Al-Yarmouk Teaching hospital, and Baghdad Medical City. From February to June 2015.
Results:The results showed that 38 (33.9%) patients were suffering from fungal infection in this study. The most common fungi isolated were Aspergillus spp. 18 (47.3%), followed by Rhizopus spp. 7 (18.4%), Trichophyton spp. 5 (13.1%), Penicillium spp. 3 (7.8%), yeast Candida spp. 2 (5.2%), Alternaria spp. 1 (2.6%), Cryptococcus neoformans 1 (2.6%) and Blastomyces dermatitidis 1 (2.6%). The antifungal of the most common three fungi isolated, which were (Aspergillus spp., Rhizopus spp., and Trichophyton spp.,) was determined for Amphotericin B, Griseofulvin and Ketoconazole. The result showed that tested fungi were sensitive to Amphotericin B and resistant to Griseofulvin and Ketoconazole.
Conclusion:Fungal rhinosinusitis was moderate infection. Aspergillus spp., Rhizopus spp. and Trichophyton spp. were the most commonly fungus iolated from rhinosinusitis. They were sensitive to Amphotericin B and resistant to grisofulvin and ketoconazole.
Keywords:Fungal sinusitis, rhinosinusitis, sinusitis, fungal infection in the nose.

Background:Typhoid fever is endemic in Iraq. Hot weather and the frequent interruptions of electricity and water supply during the summer months have resulted in increased incidence. Increased health and disease awareness and improved attitude of residents do indeed reduce the prevalence of typhoid.
Objective:To assess the mothers’ knowledge, attitude and practice on typhoid fever.
Methods:A cross sectional study was conducted at Al-Kadhimiya Pediatrics Hospital. Data collection took place from 10th April 2015 till 20th October 2015. Sample size was (267). Sampling method was based on convenience method. P value <0.05 was considered significant. Statistical analysis was done using SPSS software version 20.
Results:Sample size was 267 (N=267). Only 1 (0.4%) of the mothers had low score, 54 (20.2%) of the mothers had average score, 147 (55.1%) of the mothers had good score, 65 (24.3%) of the mothers had very good score. There was a weak, positive correlation between age of mothers in years and overall knowledge, attitude and practice score, a weak, negative correlation between number of children and overall knowledge, attitude and practice score. Also, there was statistically significant association between mothers’ educational levels and their knowledge, attitude and practice category. A statistically significant association between mothers’ occupational status and their knowledge, attitude and practice category was found.
Conclusion:There are wide spread wrong beliefs about typhoid fever in relation to exposure to sunlight.
Keywords: Knowledge, attitude, practice, typhoid fever

Background:In the course of cyclic hormonal fluctuation, cytological changes in the vaginal epithelium can be correlated with the phases of the menstrual cycle, this can be utilized in diagnosis of hormonal status in women with pathological cycles as in polycystic ovarian syndrome (PCOS).
Objective:To evaluate the effects of estrogen (E2) and progesterone hormones in PCOS on the vaginal cytology in different phases of menstrual cycle, and its relation to ovulation period.
Methods:A non-random sample of one hundred women were enrolled in this study, divided into two groups; 50 women free from PCOS, and 50 were PCOS according to the criteria of Rotterdam 2003. All were underwent hormonal assay including estrogen and progesterone on 2nd and 21st day of the cycle respectively, vaginal smears cytology on the 2nd day, 14th and 21st day of the cycle, stained with H&E, the (parabasal, squamous, leukocytes) were identified and counted, ultrasound examination was done on 14th day of the cycle, that divide the sample into ovulatory and an ovulatory subgroups accordingly.
Results:At the 2nd day of the cycle, there was a significant reduction in squamous cell count, highly significant increase in leukocyte, E2 hormone level increased markedly, with a significant negative correlation to leukocytes cells in patients' groups at P≤0.05. Squamous cells of vaginal smear attained more acidophilic cytoplasm and increase in nuclear pyknosis. At the 14th day of the cycle, a significant increase in squamous cells count at P≤0.05, cornified squamous cells predominantly seen associated with low ovulation rates of 44%. Ovulation showed significant reduction in parabasal cells count in patients group at P≤0.05. At 21st day of the cycle, progesterone level was reduced with a significant reduction in squamous cells, parabasal cells and leukocytes counts in patients, with no significant correlation between progesterone and vaginal cytology cells, squamous cells consisted of mature cornified cells that seen predominantly in vaginal smear.
Conclusion:Hormonal changes in PCOS presented mainly by the effect of elevated E2 hormone, that associated with increase in squamous cells count and cornification, with reduction in leukocytes and parabasal cells toward mid cycle. Progesterone hormone exert no significant effect on vaginal cytology in PCOS.
Keywords: PCOS, vaginal cytology, ovulation

Background: Parvovirus B19 (PV-B19) is a single strand DNA virus that is responsible for causing several diseases in humans. Parvovirus B19 induced persistent anemia or/and pancytopenia or/and reticulocyteopenia in renal transplant recipients (RTRs).
Objective:To find out any association between PV-B19 reactivation / primary infections with abnormal renal function tests, and post-transplantation period in renal transplant patients.
Methods:A quality enzyme linked immunosorbent assay technique was applied for detection of anti-human PV-B19 IgM (DRG-Germany) and IgG (DRG- Germany) in sera of 50 renal transplant recipients followed up for three successive months and 50 normal were collected from the Center of Kidney Diseases and Transplantation in the Medical City of Baghdad and Al-Khayal Hospital and other many private laboratories, Iraq, during the period from August 2015 till February 2016. The age was ranged from 11-57 years.
Results:This prospective study included fifty renal transplant recipients with fifty subjects as a control group. The mean ± standard deviation of ages for RTRs was 32.90 ±12.76, which was comparable to that of healthy controls mean 34.02 ± 14.23 ranging for both RTRs and control group between 11-57 years old. Thirty five (70%) RTR aged less than 40 years, and the remaining fifteen (30%) were above 40 years old, and 38/50 (76%) of these RTRs were males. Seropositivity rate in control was 2/50 (4%) but seropositivity rate in patients was 10% (5 cases) and 10% (5 cases) as turning positive for an individual occurrence of human PV-B19 IgM alone at P value = 0.0299 and 9/50 (18%) from control positive for IgG, while 60% (30 cases) for a similar individual rate of positive human parvovirus B19 IgG at P value < 0.0001.
Conclusion:The human PV-B19 infection rate was significantly higher among renal transplant recipients than normal controls. Infections correlated with abnormal renal functions tests, and which may in turn cause anemia and/or reticulocytopenia.
Keywords: Parvovirus-B19, anemia, reticulocytopenia, renal transplant recipients, ELISA

Background:Viral infections in pregnancy are major causes of maternal and fetal morbidity and mortality. Infections develop in the neonate transplacentally, perinatally or postnatally.
Objective:To determine the frequency of cytomegalovirus and human herpesvirus-1antigens in product of conceptus tissues of pregnant women with spontaneous abortion and to study the association of the various socio-demographic and antenatal factors.
Methods:Fifty (50) product of conceptus tissues samples were collected during the period from September 2013 till April 2014 from pregnant women with spontaneous abortion attended at Al-Batool Teaching Hospital for Maternity and Children in Baqubah city. All sociodemographic and antenatal characteristics such as age, education level, economic level, occupation, residence, gestational age, history of abortion and gravity were recorded. Human cytomegalovirus and human herpes virus-1 antigens were detected by immunohistochemistry technique in Department of Microbiology, College of Medicine, University of Diyala.
Results:Among 50 formalin-fixed, paraffin embedded product of conceptus tissues blocks, the results showed that positivity frequency of human cytomegalovirus and human herpesvirus-1 antigens were 36% (18 out of 50) for each one. Patients age varied from (15-45) years with mean of 29.48 years. The highest rate of viral infection was diagnosed in the age 26-35 years. Multiple variables regarding frequencies of cytomegalovirus and human herpesvirus-1antigens simultaneously, was evaluated, and none of the variables had significant difference.
Conclusion: Human cytomegalovirus and human herpesvirus-1 seems to play a significant role in first trimester pregnancy loss and its infection rate is comparable with that in the other countries, also pregnant women in Baqubah city may have the risk for acquiring viral infection during pregnancy and consequently adverse pregnancy outcomes.
Keywords: Abortion, cytomegalovirus, human herpes virus, immunohistochemistry, pregnant women

This is a case report of a patient who achieved a successful vaginal birth for five times attended by a traditional birth attendant twice after two cesarean sections and thrice after three cesarean sections.
Keywords:Vaginal birth after cesarean delivery, VBAC, VBAC delivery, trial of labor after cesarean delivery, prior cesarean delivery, risks for uterine rupture, vaginal delivery