Mustansiriya Medical Journal

Background : The exact pathogenic mechanism by which varicoceles cause impaired testicular function remains poorly understood . One of the possible mechanisms is the generation of seminal oxidative stress. In addition, the impact of bilateral varicocele on spermatogenesis is still poorly studied . Aims : To study the changes in seminal antioxidant defenses in relation to unilateral and bilateral varicocele, and to correlate them with changes in sperm concentration and total motility. Patients and methods : A prospective, randomized, controlled study , whereby 60 semen samples were collected and analyzed. Twenty samples were from healthy subjects , having no varicocele ( control group ), 20 samples from patients with unilateral varicocele and 20 samples from patients with bilateral varicocele . For each semen sample, measurement of the seminal concentration of the antioxidants ( Albumin, Glutathione peroxidase and Superoxide dismutase ) was done and the seminal concentration of the oxidative stress marker, Malondialdehyde. In addition sperm concentration and total motility were also estimated. Comparison of the results in the 3 groups was done . Results : Measurement of semen parameters revealed a drop in the mean value of the 3 antioxidants and an increase in the mean value of Malondialdehyde, which was statistically significant in the 2 varicocele groups in comparison with control, and in bilateral varicocele in comparison with unilateral varicocele . Another drop was in the mean sperm concentration and mean percentage of sperm total motility, which was statistically significant in the 2 varicocele groups in comparison with control, but was statistically not significant between the 2 varicocele groups . Conclusions : Bilateral varicocele causes more significant drop in seminal antioxidant defenses than unilateral varicocele which seems to add a more negative impact on spermatogenesis .

Back ground: Serum concentrations of homocysteine decrease during normotensive pregnancy, but increases in pre-eclampsia like some other pregnancy complications. Hyperhomocysteinemia has been hypothesized to be associated with placental micro vascularization disease. Objectives: To evaluate the concentration of maternal &umbilical homocysteine in pre-eclamptic women in comparison with that of normotensive pregnant women. Study design: A case control study. Setting: Department of Gynecology and Obstetrics at Al-Yarmouk Teaching Hospital for a period of one year from April 2010 to April 2011. Patients & methods: Hundred singleton pregnant women with gestational age between 37 to 40 weeks were divided into two groups: (Study group): 50 pregnant patients with pre-eclampsia , 30 of them presented with severe pre-eclampsia and 20 presented with mild pre-eclampsia were compared to ( control group ) which include 50 normotensive pregnant patients. Bloods was collected from women in both groups, serum homocysteine and cord blood homocysteine were measured in patient with pre-eclampsia and were compared with that of normotensive patient. Results:Mean maternal serum homocysteine level in comparison between the study & the control groups was highly significant as the P value was (0.0001).Mean umbilical homocysteine level in comparison between the study & the control groups was highly significant as P value was (0.0001).Maternal homocysteine levels were found to have a significant strong direct correlation with the umbilical homocysteine in the severe pre-eclampsia since the r value was (0.808) while in the mild and the control groups, they were moderately correlated as the r value was (0.536,0.526) respectively. Conclusion :This study has shown a significant increase in homocystein concentration in maternal and umbilical cord blood of the fetuses in pre- eclamptic women compared with the values obtained from women of normal pregnancy.

Objectives; to know whether resistance index in fetal renal artery is significantly reduced among overdue pregnant women with oligohydramnios Methods; a total of 25 overdue pregnant women with oligohydramnios versus 25 with normal liquor were selected to participate in the study with their resistance index in the renal artery, umbilical artery and middle cerebral artery were measured Results; resistance index in the renal artery of the fetus was significantly higher among women with oligohydramnios than control normal women; 0.73±0.03 versus 0.70±0.01. No statistically significant change was observed among the two groups with regard to the umbilical artery and middle cerebral artery resistance index. Conclusion; since the fetal artery resistance index was found to be significantly higher among overdue pregnant women with oligohydramnios, this biometric variable may be used as a screening test for fetuses at risk of hypoxia.

Background :The serum level of neopterin, a marker associated with cell-mediated immunity, is increased in coronary artery disease and chronic kidney disease (CKD) especially in end stage renal disease (ESRD ) and may be a risk marker for adverse outcomes resulting from these diseases. Objective: to compare the levels of neopterin in two systemic inflammatory diseases cardiovascular disease and end stage disease(CVD& ESRD) and study its correlationwith other serum parameters. Subjects & Methods: The study involved 38 male patients with ESRD and 40 male patients with CVD (age range of 30- 60 years ) .They were attending Kidney disease and Transplantation Unit and Coronary Care Unit (CCU) at Baghdad Teaching Hospital ( Medical City ) during the period from December 2012 to March 2013 with 58 healthy subjects (control group ) of matching age and weight. Fasting venous blood was obtained for glucose, lipid profile, urea and creatinine measurement which were done immediately after separation of the serum by standard routine methods. The determination of neopterin was done using Enzyme-Linked Immuno Sorbent Assay. (ELISA, Sandwich assay). Results:the results revealed a significant difference in neopterin level between each group of patients (CVD & ESRD) with its control group (45.5 ± 11.9.vs16.48± 3.09) and (95.89 ± 11.3 vs.16.66± 2.83) respectively. In addition to inverse correlation between neopterin and estimated glomerular filtration rate (eGFR) in ESRD patients (p< 0.05), and significant inverse correlation with triglyceride (TG) in CVD patients (p < 0.05). Conclusion: The most important results of this study suggest that the neopterin level, which is considered a useful marker of systemic inflammation, in ESRD patients is higher than in CVD patients.

Background: Fractures of the radial neck are mainly seen in children and require meticulous management to avoid elbow disabilities. Age, grade of the fracture and association with other elbow injuries affect the surgical approach to be used for treatment. Aim: This study was performed to detect the outcome of using transcapitellar K-wire fixation for treatment of radial neck fractures. Patients & Methods: Twelve patients with displaced (Broberg-Morrey II, III & IV) radial neck fractures were included. Eight patients (Group A) were children below skeletal maturity (10-18 years) and four patients were over 18 years of age (Group B) who achieved full skeletal maturity. Kaplan’s approach for open reduction and internal fixation using K-wires was used, and the patients were followed up for 6 months. Each patient was assessed for outcome according to predefined criteria ranging from excellent to good, fair and poor. Results: In group A, two patients had excellent outcome, one patient had fair outcome and the rest had good outcome. In group B, two patients had good outcome while the other two had fair outcome; however, none of the patients had poor outcome. Valgus deformity of >10oand elbow stiffness of >20o developed in three patients, with stiffness mainly affecting supination & extension. Of the patients with fair outcome, one developed implant failure due to poor compliance, while another patient developed neuropraxia of the posterior interosseous nerve that resolved spontaneously. Conclusion: Several surgical methods have been proposed for treatment of radial neck fractures with variable results and outcomes. While open reduction and K-wire fixation may not be the first line of these methods, it remains a safe method and provides advantages like short operative time, no exposure to image intensifier, less blood loss and less risk of neurovascular injury. However, for optimal results with minimal complications, the procedure requires early intervention, good patient compliance and prolonged follow-up.

Background: Cervical cancer is second most common cancer among women worldwide. It is preventable disease because there is usually a phase of pre-malignancy, dysplasia or intraepithelial neoplasia. As the cervix is relatively accessible organ to examine, cells can be easily obtained in the premalignant phase. Cervical cytology by Papanicolaou smear is an effective means of screening for cervical premalignant and malignant conditions. Aim of the study: To describe the socio-demographic characteristics of women referred through cervical screening, in addition to cyto-pathological classification of Papanicolaou smears taken. Patients and Methods: Cross section study carried out from January through June 2012 on a sample of 300 women attending departments of obstetrics and gynecology in two teaching hospitals, and one national cancer center, in Baghdad. All studied women were referred for Papanicolaou smears. Papanicolaou smears were collected; slides were handed to relevant cytopathology laboratories. When reports were due, results were classified according to Bethesda system in order to standardize results coming from different laboratories, and different examiners. Results: normal Papanicolaou smears were seen in (4%) of the studied women, (42%) had inflammatory reaction, (10%) had atypical cells of undetermined significant, (19%) had low grade squamous intraepithelial lesion, (20%) had high grade intraepithelial lesion, (1%) had cancer of the cervix, and in (3%) of the studied women the smear was inadequate. Mean time from referral till getting the result was (10 ± 6) days. Although Papanicolaou positivity was not significantly associated with residency, marital life duration and parity, it showed high significant association with usage of contraceptive hormones, and menopause. Conclusion: Premalignant and malignant lesions of cervix are not uncommon in referred women especially in menopausal women and those using hormonal contraception. Lesions can be detected early by Papanicolaou smear. There is discrepancy, and delay in reporting of Papanicolaou smear result, negatively reflected on screening program.

Aims: The study aims to assess the quality of life for adolescent patients with irritable bowel syndrome in the city of Baghdad, and determine the relationship between quality of life level and demographic characteristics for adolescent patients with irritable bowel syndrome. Patients and Methods: A descriptive study, using the assessment approach was conducted on a purposive "non-probability" sample of (100) patients (males and females) who are attending the Centre of diseases of the digestive system and liver / Medical City. A questionnaire was adapted from the World Health Organization quality of life questionnaire (1998) for the purpose of the study. It is comprised of (3) parts. The part I includes the demographic characteristics of the study sample (such as age, sex, marital status, educational level and employment status) and the part II includes the (nine) questions related to the medical information of a sample of the study, and Part III includes questions related to the quality of life of adolescent patients who suffer from irritable bowel syndrome. Data were collected through a self- administration method, during the period of the first of July to the sixteenth of August, 2012. Data were analyzed through the application of the descriptive statistical data analysis approach (frequency, percentage, mean of scores) and inferential statistical data analysis approach (Pearson correlation coefficient and chi-square). Results: The findings of the study indicated that quality of life was affected in environment domain, social domain and psychological domain and that age, gender, marital status, and employment status had significant relationship with quality of life domains. Conclusion: The study concluded that environment domain, social domain and psychological domain of quality of life were affected by the disease.

Background: Birth trauma is defined as injury to infant resulting from mechanical forces (such as compression or traction) during the process of birth . Objectives of the study: 1. To highlight the risk factors that may contribute to birth trauma. 2. To identify the common types of birth trauma in the obstetric units. Patients & Methods: During 6 months period a cross sectional study was conducted on 200 babies (100 babies delivered with birth trauma and 100 babies delivered without birth trauma for the control group) in Baghdad Teaching Hospital Results: Trauma of the cranium was the most common type. There is a significant association between birth trauma and birth weight , gestational age, multiple gestations , prolonged labor , babies from mothers who are primigravida , diabetic or having contracted pelvis .

Background: Sick newborns from apparently normal mothers, typically, have low Apgar scores and at such situation; there are great probabilities, for these newborns to develop several diseases, with poor outcomes. Also, there may be a chance for any prospect baby, to get same health state. Objective: This study was designed to correlate some of the placental topographic anatomical data with the newborn wellbeing, and to lay highlighting, on the presence of any placental abnormality, which could be caused by neither maternal nor fetal factors. Materials and methods: the study included 60 full term placentae of apparently normal mothers, who were admitted to Labor Room at al-Yarmook Teaching Hospital, al-Elwia Maternity Teaching Hospital and al- Khadhra`a Private Hospital, in Baghdad, for a normal vaginal delivery, or even for a caesarian section. The research was done over the period of 1stof February 2013 till end of 15thof April 2013. The newborns were scored high and low in Apgar score. The following anatomical data were selected in this study: the placental weight /newborn weight ratio, the mode of the umbilical cord insertion and the placental thickness, in each of the low and high Apgar score groups of fetuses, as indicators for the functional status of the placenta in these two groups. Results: The placental/newborn weight ratio in low Apgar score group of fetuses, was significantly lower than that in the high Apgar score ones. As regarding the umbilical cord mode of insertion; the eccentric type of insertion was more in both of fetal groups, nevertheless it was relatively higher in the high Apgar score group of fetuses, while the central type was more in the low Apgar score group of fetuses. The marginal type was only seen at the low Apgar score group of fetuses. The mean of thickness of placentae of low Apgar score group, was found to be less than that of the high Apgar score group, Conclusions: There was a strong and significant correlation between the fetal well being and data obtained from these topographic anatomical placental records.

Background: Cluster of differentiation number 44 (CD 44) is a family of cell-surface adhesion molecules which exist in several isoforms arising from mRNA alternative and encoded by using gene located at chromosome 11 on the short arm p13. The CD44 gene is composed of 10 constitutively spliced exons and 10 variable exons, residing between constitutive exons 5 and 6.In colorectal carcinoma, the relationship between the expression of variant exons and tumor progression is controversial. Some studies have suggested that the expression of certain variant exons resulted in increased tumor progression, while other has no correlation. Objectives: Investigate CD44 immunoreactivity in colorectal carcinoma and determine the association with clinicopathological features. Material and methods: Paraffin- embedded tumor specimens from (70) patients with colorectal adenocarcinoma and (70) healthy control were assessed by immunohistochemisrty for the expression of CD44. Result: Statistical analysis of CD44 expression revealed highly significant difference in colorectal carcinoma patients than in control group. Also there were a relationship between CD44 expression and range of clinicopathological features. Conclusion: CD44 is robust marker for colorectal carcinoma.

Brucellosis is a classical zoonosis; it is a common disease in the Middle East countries. Involvement of the Central Nervous System by Brucella microorganisms might be not uncommon and is parallel to the prevalence rate of the disease among population. The work reported here is for six cases with brucella meningoencephalitis diagnosed by isolation of Brucella microorganisms from their blood and spinal fluid together, with high anti-brucella antibodies in their blood and Cerebro Spinal Fluid (CSF). Cases of PUO admitted to Fever Hospital and Neurological unit in the Medical City Teaching Hospital were evaluated clinically and neurologically. Six cases (three males and three females) suspected of neurological involvement by the disease all had fever, sweating +/- joint pains, all had meningeal irritation signs, abnormal CSF findings and all had history of raw milk &/or cheese consumption. They all were treated by different courses of many antibiotics for different times with skeptical responses. The general complaint was varying between fever, vomiting, weight loss, severe depression, headache and sweating, one case had change of sensorium, and hearing loss, one had cranial nerve palsy and three had peripheral weakness. All the cases had pleocytic CSF changes and Br. melitensis types 2 and 3 and Br. abortus type 4 isolated from their blood and all but one had same Brucellae isolated from their CSF. All cases had high titers of anti-brucella antibodies raised both in the serum and CSF though the Rose Bengal and ELISA tests. The treatment given was different of two or three combinations of Rifampin, Tetracycline, Cefotaxim, and Streptomycin for eight weeks up to four months for those with lumber osteomyelitis and epidural abscess cases. The outcome of cases was satisfying; four cases were cured without sequale, one case with cerebral abscesses was died and one case developed hearing loss and peripheral nerve weakness. It can be concluded neurobrucellosis is a treatable disease with a favorable outcomeexcept when there is a myelopathy or deafness and careful awareness of the disease as it is not an uncommon complication of common and treatable disease in our community is required.

Background: Job satisfaction refers to how well a job provides fulfillment of a need or want or how well it serves as a source or means of enjoyment. It has a potential impact on productivity, absenteeism and turnover among health care employees, and as such it affects employees’ organizational commitment and the quality of health care services. Objective: this study aimed at assessing the level of job satisfaction among primary health care physicians in al-karkh district of baghdad governorate, and to explore the relationship of their personal and job characteristics with job satisfaction.
Methods: A cross sectional study was conducted involving 270 primary health care physicians. Data collection had been done using a self-administered questionnaire which included questions about socio-demographic and professional characteristics of study people, and questions about job satisfaction which were selected from Warr-Cook-Wall job satisfaction scale. Results: The overall job satisfaction was 35.2%. results showed a significant more satisfaction among older doctors, and those who examine less patients. There was no significant association between job satisfaction and gender, marital status, specialty. physicians were significantly dissatisfied with working environment, rate of pay, management, and working hours. However, they were more satisfied with relationship with their colleagues and opportunity to use their abilities. Conclusion: the study showed that the overall job satisfaction was much lower than neighboring as well as developed countries. the finding of the study can serve as a road map for health system policymakers for planning and implementing effective policies in order to meet the physicians' needs and so improve quality of primary health care provided to thousands of people every day.