Mustansiriya Medical Journal

Aims: To evaluate and assess the rate of rheumatological manifestations in patients with chronic viral hepatitis. Patients and Methods: Sixty four patients with chronic viral hepatitis were included in this cross-sectional study. The diagnosis of viral hepatitis is established by clinical & laboratory study. Full history was taken from all patients with special concentration on rheumatological manifestations and complete clinical examination was done for all of them, blood test including liver function tests, viral serology, viral load, and renal function. Results: All together, sixty four patients were recruited and studied, fifty (32males and 18 females) of them (78.1%) had shown rheumatological manifestations. Thirty one of patients were reported with HCV infection & 19 patients with HBV infection. The rate of chronic fatigue was reported in 24 patients (48%). Myalgia was presents in 21patients (42%) which was more in patients with HCV. Arthralgia was present in 19 patients (38%). Sicca syndrome was presented in 12 patients (24%). Schirmer's test was positive in 2 patients (4%). Skin rash occur in 6 patients (11.1%). It's nonspecific purpuric rash, Arthritis was reported in 3 patients (6%), all of them with HCV infection. Also there were 16 patients (32%) of all patients on treatment with interferon-alpha or antivirus measure or both. Conclusions: Chronic viral hepatitis infection patients shows various rheumatological manifestations in more than 75% of cases so it is suggested to investigate patients with unexplained rheumatological manifestations who are at risk for viral hepatitis for these viral infections

Aims: to evaluate the role of testicular biopsy in the study of
azoospermic patients.
Patients and methods: a total of 67 infertile men with azoospermia were
studied over 5 years period (February 2005 – March 2009). Their mean
age was 33 years. They underwent bilateral testicular biopsy under
general anaesthesia and the specimens were categorized according to
histopathological patterns.
Results: the histological evaluation of the testes revealed normal
spermatogenesis in 12 patients (17.9 %), hypospermatogenesis in 4 (5.9
%), spermatogenic arrest in 39 (58.2 %), sertoli cell only in 7 (10.4 %) and
complete tubular hyalinization in 5 patients (7.4 %).
Conclusions: This study highlights the role of testicular biopsy as a
reliable and useful technique for the investigation of patients with
azoospermia.

Background: Post discectomy disc space infection is relatively
uncommon 4 %; nevertheless it is the most disabling causes of failed back
surgery.
Aims: To assess the effectiveness of intra-discal vancomycin in
discectomy operation, we evaluated operative time, blood loss,
postoperative complications (discitis) by measuring CRP, ESR and
temperature in the preoperative and postoperative period. Blood culture
was done in complicated case postoperatively. Social habit (smoking &
drinking alcohol) and past medical history (Diabetes Mellitus) had been
taking in consideration.
Patients and Methods: This is a prospective study on 150 patients
operated upon by lumber discectomy, 75 cases have been treated by
injection of 4 ml of (2 mg/ml) vancomycin in the disc space that removed
while in the other 75, 4 ml of normal saline was injected in the disc space
(placebo).
Results: There were 6 cases of postoperative discitis, all in the placebo
group. There were 4 men and 2 women, ranging in age between 26 and
63 years. 3 were diabetics. All cases were in L4-5 disc space. The
frequency of discitis was (4 %).In vancomycin group the frequency was
0% and in placebo group 6/75 (8 %).
Conclusions: We concluded that the intra-operative prophylaxis with
vancomycin intra-discaly is effective in prevention of postoperative
discitis.

Background: Leishmaniasis is a parasitic disease caused by a Leishmania species, transmitted to humans through bites of female sand fly and is endemic in Iraq. Aims: To study the epidemiological, clinical, diagnostic and therapeutic aspects of visceral leishmaniasis in Iraqi children. Patients and Methods: This was a retrospective study done on patients with Kala-azar admitted to Welfare Child Hospital-Medical City from October 2004 to September 2005. The diagnosis was based on serological test and/or bone marrow exam. For each patient the following data were reviewed: age, sex, time of admission, signs, symptoms, laboratory investigations and treatments. Results: A total of 50 visceral leishmaniasis cases were included. All patients were in the age range 0-10 years. Most cases occur in winter 70%. Fever was recorded in 100%, splenomegaly in 92%, hepatomegaly in 80%, and pallor in 70% of cases. Concomitant conditions were frequent: 34% of cases had cough; jaundice was present in 26%; diarrhea in 18%; vomiting in 12% whereas lymphadenopathy was present only in 1% of cases. Sodium stibogluconate (pentostam) was most often prescribed medication (86% of cases) while miltefosine was less prescribed (14% of cases). Conclusions: in Iraq, kala-azar should be suspected in any patient with prolonged fever and/or hepatosplenomegaly with pancytopenia whereas in case of presence of lymphadenopathy the kala-azar would be the last possible differential diagnosis. Also Pentostam remains the most common prescribed medication for kala-azar in our country.

Background: Psoriasis is a common skin disorder affecting 1% to 3% of the population all over the world. Many etiological factors have been implicated but trace elements, especially zinc, may play an important role. Aims: This study was done to evaluate the serum level of zinc in patients with psoriasis and it's relation to clinical types, duration and surface area of the disease. Patients and Methods: Fifty patients (25 males & 25 females) with different ages and different types of psoriasis were chosen for this study. Also 50 non-psoriatic volunteers, sex and age matched were served as controls, evaluated for serum zinc level. Results: The result of this study has shown that 49 (98%) of psoriatic patients have low serum zinc compared with 2 (4 %) among controls (P=0.0001). The type of psoriasis may have an effect on serum zinc, the lowest mean serum zinc is found in palmo-planter (plaque) psoriasis (14% of patients) (P=0.025). Conclusions: From this study we can conclude that zinc deficiency may play a role in psoriasis since most patients (98%) have low serum level

Background: Azoospermia account for about 10–15% of male infertility cases. It denotes the final result of different testicular alterations, ranging from non-obstructive to obstructive azoospermia which could be corrected surgically. The former is associated with impairment of spermatogenic process, including hypospermatogenesis, maturation arrest and complete absence of germ cells-Sertoli cell-only syndrome (SCOS). To ascertain such azoospermia aetiology, Testicular biopsy is considered as the standard method. However, the popularity of Fine needle aspiration (FNA) cytology has gained as simple and minimally invasive way that can help in assessing testicular function accurately. Aims: To determine causes of azoospermia, by assessing the cytological findings in testicular FNA. Patients and Methods: A prospective study for 95 azoospermic patients was conducted from Jan 2010-Dec 2011 at private laboratory using FNA procedure. Here, detailed history and physical examination were done along with semen analysis to confirm true azoospermia. Both testes were aspirated to obviate sampling errors when appropriate. Routine Haematoxylin and Eosin staining was also performed on the smears. Results: Adequate samples were obtained from 84 (88.4%) cases, while 11 patients (11.6%) had scanty smears where cytological diagnosis could not be obtained. These adequate smears were categorized as normal spermatogenesis in 38 (45.2%) patients, maturation arrest at spermatocyte/spermatid level, and Sertoli cell only syndrome in 27 (32.2%) and 19 (22.6%) patients, respectively. Conclusions: FNAC could permit characterization of specific cytological pictures related to testicular damage nature. It is able to identify different azoospermic subjects and represents a reliable and prognostic parameter of seminiferous epithelium status.

Background: Pre-eclampsia (PE) is a common pregnancy specific syndrome that is characterized by hypertension and proteinuria. Evidence shows that pre-eclampsia is associated with alterations in placental microRNA expression. Aims: The purpose of this study was to compare the expression of the microRNA 210 in placentas from pre-eclamptic pregnancies versus normal placentas. Patients and Methods: The study was carried out in the department of Gynecology and Obstetrics at Al-Yarmouk Teaching Hospital for the period from December 2009 to December 2010. Hundred pregnant women of age ranging from fifteen to forty years old, their gestational age ranging between twenty nine to forty weeks were divided into three groups: first group: mild Pre-eclampsia (twenty), second group: severe pre-eclampsia (thirty) & third group (fifty) normotensive pregnant women of comparable gestation were taken as a control . After delivery the Placentas from all patients (the study and the control groups) were obtained and studied for the microRNA 210 expression which was assessed by microRNA microarray and real-time reverse transcriptase-polymerase chain reaction analysis. Results: MicroRNA 210 was over expressed in the placentas of pre-eclamptic pregnancies compared with normal placentas. In mild pre-eclampsia group the mean micro RNA-210 activity was 1.68±0.25, in severe pre-eclampsia group the mean microRNA-210 activity was 1.89±0.13 and for the control group the mean microRNA-210 activity was 0.99±015. There was highly statistical significance in microRNA-210 activity of the studied groups since the P value for the mild pre-eclampsia versus the control was 0.0001. For the severe pre-eclampsia versus the control it was 0.0001 and for the severe pre-eclampsia versus mild pre-eclampsia was 0.0001. Conclusions: The results showed that microRNA 210 was over expressed in pre-eclamptic pregnancies (mild and severe), which suggests its involvement in the pathogenesis of pre-eclampsia.

Background: Reproductive health implies that people are able to have a responsible, satisfying and safer sex life, have the capability to reproduce, and the freedom to decide if, when, and how often to do so. The primary effects of media exposure are increased violent and aggressive behavior, increased high risk behaviors including alcohol and tobacco use, and accelerated onset of sexual activity. Aims: To assess the information about sex matters of male students in Babel governorate secondary schools including homosexuality, source of sex information, religion status, sexual relation before marriage or out of marriage, and information about AIDS. Patients and Methods: A cross-sectional survey using self-administered questionnaire about the knowledge concerning sex matters distributed to 1156 male students selected randomly from Babel governorate secondary schools to be filled in 15-20 minutes, during the period from 1stJanuary to the last of February 2011. Results: Less than half of the sampled students (44.8%) reported information about sex matters, 53.1% in urban and 36.5% in rural area. The main sources of information about sex matters were friends, schools, and families which constitute about 53%. Attitude towards homosexuality showed that homosexuality was defined correctly by 28.4% only, 9.1% agreed with sexual relation between males, 18.1% agreed with sexual relation before marriage, 37% agreed with sexual relation out of marriage and 80% they had information about AIDS. Conclusions: The family had a major role in education of their children, the schools remain the corner-stone in health education as well the effect of peers. New and modern teaching in our school is needed

Background: Liposomes are new drug delivery systems consist of lipid bilayer membrane that encapsulate water and lipid soluble drugs. Materials and methods: Liposomal suspension was prepared using chloroform film method. Different amount of cholesterol and lecithin (100, 200, 300, 400 and 600 mg) were used and their effect on particle size, encapsulation efficiency and drug release was studied. Cholesterol used in different ratios such as (1:1, 1:2 and 2:1) for Cholesterol: Lecithin respectively to evaluate its effect on particle size, encapsulation efficiency and drug release. The effect of increasing salbutamol HCl amount from 10mg to 20mg on encapsulation efficiency was also studied. Results: The morphology of the prepared formulae showed uniform unilamellar liposomes enclosing the drug in the internal aqueous phase. The observed results of our work suggest that chloroform film method is a good alternative method for the preparation of liposomes for water soluble drugs because of its simplicity, low cost, time saving and few processing steps. Conclusions: The work suggests a formula that may improve the permeability of salbutamol HCl through mucosal membrane

Background: Hydatid cyst is an infection caused by cestode species of Echinococcus granulosus and often localized in viscera of animals and humans. Hydatid cyst is typically filled with a clear fluid (hydatid fluid) that is sterile bacteriologically. Bacterial infection of hydatid fluid is sometimes present, but not always and this leads to sterilizing the cyst and prevents producing protoscolicies. Aims: The present work aims to study the prevalence of hydatidosis in sheep slaughtered in Al-Shuala and Al-Karkh abattoirs in Baghdad city and isolation of the possible bacteria that infect hydatid fluid of hydatid cyst. Materials and Methods: A 6-months period observation of two slaughter slabs of sheep (condemned livers), inspection was done in the same slaughter slabs to assess the hydatid cyst and application of bacteriological examination with culture on the present hydatid cyst fluid. Results: The study showed that the prevalence of hydatidosis was 124 (9.9%) of 1258 examined livers. Of the 124 hydatid livers, 32 (25.8%) were fertile and the rest were sterile and calcified. A bacteriological study of fertile hydatid cysts has be done under sterile conditions to isolation of bacteria , of the thirty two fertile cyst cultured in this study, 18 (56.3%) were infected with different types of bacterial isolates including Escherichia coli (38.9%), Klebsiella spp. (27.8%), Staphylococcus spp. (25.0%), Proteus spp. (11.1%) & Pseudomonas spp. (8.2%). Conclusions: the prevalence of hydatidosis in addition to bacterial infection in liver isolated from sheep seriously affects the keeping quality of liver as an important food production and important to the health of the consumers.

About 44% of diabetes mellitus type 1 (DM1) patients were positive for one or more Coxsackie B virus IgM Serotypes, compared to zero in the healthy control subjects, those samples showed a significant strong positive correlation with glutamic acid decarboxylase auto-antibodies, this may indicate the role of these viruses in the pathogenesis of DMI. This work was done in cooperation between Baghdad University, Baghdad – Iraq and the National Center of diabetes, endocrinology and genetic, Amman – Jordan, in a sabbatical leave study.

Background: neonates experience physiological responses to endotracheal intubation, including bradycardia and oxygen desaturation. The bradycardia may be associated with severe hemodynamic disturbances like significant hypotension which may threaten patient's safety. Aims: To determine the effectiveness of single dose IV atropine, 5 minutes before induction of anesthesia on reflex bradycardia to laryngoscopy in sick neonate baby. Patients and Methods: In a randomized double blinded, placebo controlled clinical trial, thirty neonates aged 1-10 days, term, 2.5-3.5kg and from both sexes, were enrolled to receive 0.02mg/kg IV atropine (n=15), as study group and placebo group had received equivalent volume of normal saline five minutes before induction of anaesthesia (n=15), as control group. The induction technique was the same in all patients. The incidence of bradycardia just after intubation was recorded. Results: data analyses showed that the overall incidence of bradycardia just after intubation in the study group was significantly lower than the control group. Conclusions: A single dose IV atropine five minutes before induction of anaesthesia in neonate baby significantly decreases the incidence of bradycardia after intubation.