Journal of the Faculty of Medicine Baghdad

Background: Glomerular injury can be caused by immunologic, infectious, toxic, metabolic and heamodynamic factors. The glomerular response to injury determines the pathology, which can be observed in renal biopsy. The purpose of this study was to analyze different histopathological subtypes of primary and secondary glomerular diseases in children.
Patients and methods: A retrospective study was done on 100 renal biopsy cases in children welfare teaching hospital between December 2003 and December 2007. Ultrasonically guided biopsies were taken and only light microscopy was used to examine the specimens.
Results: The study group included 100 cases with renal diseases, 83 (83%) cases of which having primary glomerular disease, the remainder 17 (17%) cases represented secondary glomerular disease. The patients age ranged between (1month-15 years).The frequency of the different entities of primary glomerular disease was: focal segmental glomerulosclerosis (FSGS %) 27 (27%), Minimal change disease22 (22%), Mesangioproliferative glomerulonephritis21 (21%), Mesangiocapillary Glomerulonephritis7(7%) and congenital nephrotic syndrome 6 (6%).patients with secondary glomerular diseases: 14 (14%) patients had Systemic Lupus Erythromatosis(SLE), 2(2%) Henoch-Schonlein Purpura and 1(1%) Amyloidosis .
Conclusion: The results of this study were comparable to other studies, with Focal segmental glomerulonephritis being the most common primary glomerular diseases and systemic lupus erythromatosis being the most common secondary glomerular diseases in children. Further study on a much larger scale with the utilization of immunoflourescent and electron microscopy with full serology and infectious screening is needed to provide deeper understanding of these different diseases.
Keywords: Glomerular diseases, renal biopsy, Children

Background: Inhibitor development and HCV are considered the most serious complications of hemophilia treatment. Many factors may increase the risk of complications which include: type of hemophilia, age of the patient, age of onset, duration of the disease, & number of replacement per month.
Patients and methods: A descriptive study included 200 patients less than 20 years of age admitted to the Hemophilia Center in Children Welfare Teaching Hospital , medical city in Baghdad , their data ( ag , sex , disease onset and duration , severity of hemophilia ) were collected over 8 months period from 1st January to 31st August 2006. Mixing tests and serology tests for HCV and HBV were performed for all patients.
Results: The study showed that 156 (78%) patients had hemophilia A, 44(22%) patients had hemophilia B, and 122 (61%) patients were older than 10 years, in 166 (83%) patients the disease was diagnosed before 2 years of age. Twenty (12.8 %) patients with hemophilia A and 4(9%) patients with hemophilia B developed inhibitors (+ve mixing test). Age more than 10 years, disease onset before 2 years and severe hemophilia were the most common associated findings in patients with inhibitors in 19(79%) , 22(91%), 15(62.5%) patients respectively. Eighty (40%) patients had HCV and 6(3%) patients had HBV, patients older than 10 years , disease duration more than 5 years and severe hemophilia were the most common associated findings with HCV in 68(57.6%), 64 (56%), and 44(45%) patients respectively.
Conclusions: The risk of inhibitor development was associated more with Hemophilia A, age more than 10 years, early onset and severe disease but the association was statistically insignificant. The rate of HCV infection was high, that needs special attention and effective screening program.
Keywords: Hemophilia, Inhibitors, and Hepatitis.

Background: The umbilicus, before and shortly after sloughing of the cord, can be a source of infection or toxicity. The infection can be severe, such as septicaemia
or tetanus neonatorum.
Method: Mothers of 200 neonates seen at the Children Welfare Hospital, outpatient department, Baghdad, and at Al-Takia health centre, Baquba, were interviewed about the separation of the umbilical stump and the care of the umbilicus after delivery at home or hospital, in the period, January to July 2003, excluding March and April, the time of active military invasion of the country.
Results: For occlusion of the cord a plastic clamp was used in all hospital deliveries, and 80% of home deliveries. A cotton thread or a surgical silk were used for the others. The stump separation was as early as the second day after birth or as late as the 25th .day, but it was most commonly on the seventh day after birth. (Mean 9.5 +/- SD 10.5) A variety of substances were applied to the umbilicus, included azarcon, alcohol, kohl, and charcoal. Almost forty per cent of the mothers did not receive any tetanus toxoid.
Conclusion: Mothers may be assured that occasionally a normal stump separation may be as late as 25th day after birth. Many of the present practices at home in the care of the umbilicus may form a real risk of infection and toxicity.
Keyword: Newborn, Umbilical Care.

Background: Left ventricular hypertrophy and diastolic dysfunction are considered to be an important risk factor for cardiovascular morbidity and mortality in asymptomatic hypertensive patients. At the bedside, left ventricular geometric remodeling and diastolic dysfunction in hypertension can not be diagnosed without echocardiography which is a useful adjunct to the medical history, physical examination, ECG, and chest radiography. Hence, it provides an opportunity for good management and prognosis of what appears to be preclinical hypertensive complication.
Subjects and Methods: 127 subjects with essential hypertension of either sex attending echo unit were subjected to medical history, clinical examination, physical measurements, ECG, M-mode and Doppler echocardiography. They were classified as 46 treated hypertensives where they were on regular antihypertensive medication, and 81 untreated hypertensive patients. In addition, they were sex and age matched to 39 healthy subjects who served as control group.
Results: The results of this study revealed that hypertensive patients especially those with stage II hypertension were prone to develop left ventricular hypertrophy (LVH) of concentric geometric pattern and diastolic dysfunction. However, small percentage of those patients found to have diastolic dysfunction despite they were without LVH. In addition, Doppler echocardiography clarify that hypertensives with abnormal transmitral inflow profile; of left ventricular impaired relaxation pattern suffered left ventricular systolic dysfunction. Moreover, in this study there was no evidence of pseudonormal transmitral inflow filling pattern which is excluded after Valsalva maneuver.
Conclusion: There is a strong association between left ventricular hypertrophy and diastolic dysfunction which was more common in patients with stage II hypertension. However, left ventricular diastolic dysfunction is usually follows left ventricular hypertrophy, but it still may proceed especially in those patients with left ventricular hypertrophy (LVH) of concentric geometric pattern. In addition, left ventricle diastolic dysfunction is not necessary coincide with the development of systolic dysfunction, namely normal ejection fraction and fractional shortening.
Keywords: Hypertension, Left Ventricular Hypertrophy (LVH), Diastolic dysfunction, Valsalva maneuver.

Background: The plant (Khat) contains at least 40 types of alkaloids. It has an adrenergic like effect especially on the heart one of these alkaloid is cathedulins group which has molecular height of 600-1200mm.I/L. it is used frequently mainly at the African horn region (e.g. yemen). This plant alkaloids used by people in form of bands (each band is about 50gm, two bands 100gm and so on).
Patients and methods: Three groups of Patients have been included in this study. Group A: (30) patients with dilated cardiomyopathy, Group B: (50) patients with history of ischemic heart disease with clinical presentation of ischemic cardiomyopathy and Group C: (80) cases (50 cases of ischemic cardiomyopathy, 30 cases dilated cardiomyopathy). Used as control group to see the difference from stopping the Khat without adding any medication during the follow up peroid this was over a year with monthly checkup. The place of this was Yemen-Sannaa general hospital and Sannaa private international clinic.
Results: This study showed that the age range of patients and volunteers was similar, mean age (35-65 years), all were male because this plant is used by most of the males and there was difficulty in discussing this problem with the female these three groups were categorized into two groups according to the amounts of all khat bands consumed.
Group1: people using about 50gm of this plant and did comprise 75% of all the cases.
Group2: people using about 50-150gm of this plant and comprising 25% of all the cases.
This study did not show any significant correlation between the incidence of dilated cardiomyopathy and the chronic use of this plant alkaoild, also there was no correlation between the duration of using this alkaloid and probability of getting these cardiac disorders. Stopping consuming this alkaloid did not change the clinical feature dramatically except reduction of liver enzymes elevation.
Conclusion: No significant correlation between using the plant khat and development of ischemic and non ischemic dilated cardiomyopathy.
Keywords: Khat, Myocardial Disease.

Background: intestinal anastomosis is one of the most commonly performed procedures it required to re-establish gastrointestinal continuity after surgical resection, traumatic disruption or bypass procedures. In last decade, advances in intestinal stapling devices have led to an increased frequency of stapled anastomosis. There are varieties of proposed benefit from a stapled technique: better blood supply, reduced tissue manipulation, less edema, uniformity of suture, adequate or perhaps wider lumen at the site of anastomosis, ease and rapidity.
Patient and methods: a prospective study was conducted on 103 patients who suffered from benign and malignant diseases in addition to trauma patients. They were divided in to two groups (SA)(stapled group) which involved 51 patients where the anastomosis were done by stapler and other group of 52 patients where the anastomosis were done by hand sewing named as HS group (hand sewing group). Both groups had the same preoperative characters such as age and gender, and the types of outcome analyzed were specific mortality, clinical anastomotic leak, stricture, anastomotic hemorrhage, reoperation, wound infection and hospital stay.
Results: A total of 9 patients (17.6%) in SA group developed complications compared to 20 patients (38.5%) in HS group (p-value 0.019). nine patients developed fistula in HS group (17.3%) compared to two patients (3.9%) in SA group (p- value 0.035). mean postoperative hospitalization time for SA group (6.5) days while for HS group (8.8) days (p-value 0.75) . there is a significant difference regarding fistula in favor of stapled anastomosis .
Conclusion: staples anastomosis is safe and effective and associated with fewer leaks than hand sewn anastomosis.
Keywords: stapled intestinal anastomosis, sewn intestinal anastomosis.

Background:Varicoceles, present in 15% to 20% of men, are the most common abnormal finding among men presenting with infertility, yet controversy exists regarding their etiology. Anecdotal experience suggests that varicoceles are more prevalent in lean men, supporting the "nutcracker" effect of the superior mesenteric artery compressing the left renal vein over the aorta.
Materials and methods: A total of 206 males with varicocele attending the urological out patient clinic were evaluated from their physical screening examinations. All subjects underwent history taking and physical examinations to evaluate for the presence and severity of varicocele ht,weight and BMI, those compared with 206 men without varicocele (control group)were selected randomly from general population.
Results : The mean (± SD) BMI of the 206 patients with varicocele was 25.2721 While that of control group was 28.8441((P =0.0001).which is clinically significant. Varicocele grade significantly decreased with increasing BMI category (p =0.0001).
Conclusions: The results of this study indicate that there is a decreasing incidence of varicocele and varicocele grade with increasing BMI. Supporting the possibility that obesity results in a decreased nutcracker effect in which the adipose tissue prevents compression of the renal vein.
Keywords: Varicocele, Body Mass Index.

Background: Patients who undergo craniectomy or removal of part of the skull bone following trauma to give a release to the brain are later managed by auto graft, or synthetic acrylic graft.
Patients and method: 20 patients transferred to specialized surgical hospital from U.S mellitary Ibn Sinna hospital with removal the skull bone implanted in the abdomenol wall or thigh and managed by returning of the bone to the scalp compared with 20 patients managed in our hospital to start by craniectomy and implantation of a synthetic bone graft acrylic, the comparism included the surgery, time of delay, out come, complication.
Results: We divided the patients to group A and B, A were the ones treated by Autograft & B by synthetic graft (Acrylic). In both groups half of the patients were between 20 and 40 years of age, with male predominance, the delay of surgery were more group B, but the complications were more in group A, & 25% required surgical intervention & removal of the graft.
Conclusion: we think that Acrylic cranioplasty is better than Auto graft cranioplasty in traumatic cases as it carries better cosmetic results & final out come.
Keywords (Acrylic) bone graft, Autogenic, synthetic bone, head injury.

Background: To test effectiveness and safety of topical methotrexate 0.5%gel and to introduce new formula of methotrexate gel using suitable media for delivery.
Patients and Methods: The clinical work was performed at the Department of Dermatology and Venereology in Baghdad Teaching Hospital during the period from January 2008 to October 2008. While preparation of formula was performed in the laboratories of the Department of Pharmacology-College of Medicine-University of Baghdad. Patients were divided in to two groups according to the type of treatment, group (I) 32 patients treated with methotrexate 0.5% gel and group(II) (placebo group) included 33 patients treated with placebo gel.
Results: A total of 65 patients with limited plaque psoriasis were included in this study. For the MTX group the mean PASI score before treatment was 7.07 while at 2, 4, 6 and 8 weeks treatment, it was decreased to 5.17, 3.93, 3.07 and 2.35 respectively. At eight weeks treatment 25(78%) patients achieved good response (reduction in PASI score 50%), while 5(15.6%) patients achieved partial response (reduction in PASI score 25-49%) and 2(6.25%) patients had poor response (reduction in PASI score >25%). For placebo group the pretreatment mean PASI score was 7.12 and after 2, 4, 6 and 8 weeks treatment it became 6.32, 6.07, 5.99 and 6.2 respectively. Clinically the response of the patients to placebo gel at 8 weeks treatment was partial in 10(30.3%) patients and poor in 23(69.7%) patients while no patients achieved good response.
Conclusions: MTX 0.5% gel is effective treatment option for plaque psoriasis and also appears to be safe treatment since side effects were transient, limited and reduced with continuation of therapy.
Key words: Psoriasis and methotrexate 0.5% gel

Background: Fibromyalgia syndrome (FMS) is a common rheumatologic syndrome with multiple systemic manifestations & associated with many diseases. The aim of the study is to assess the relationship between FMS and BMI (Body mass index) in a sample of Iraqi patients.
Patients and Methods: Fifty patients with FMS, 46 (92%) females and 4 (8%) males; their mean age (47.44), and 25 healthy control individuals were studied; 13 (52%) are females and 12 (48%) are males, their mean ages (41.4) years. All FMS features and criteria are studied for patients and control, patients with secondary FMS was excluded. Body mass index (BMI) is determined for both groups.
Results: The ratio between female and male was 11:1. There was a statistical significant relation between patient with FMS and BMI (P-value= 0.001) but there was no statistical significant relation in age score between patient with FMS and BMI (P-value= 0.531). All variables which are sleep disturbance, headache, fatigue, numbness, stressful events, depression and irritable bowel symptoms have statistical significant difference between FMS patients and controls (P-value < 0.05) except anxiety which has no statistical significant relation (P-value= 0.123).The relationship between BMI and the variables in the FMS patients show no statistical significant relation (P-value > 0.05) except sleep disturbance which show significant relation (P-value= 0.045).
Conclusions: There is a statistically significant relationship between FMS and increased BMI.
Key words: Fibromyalgia syndrome, Body mass index

Background: In Iraq, Primary Health Care (PHC) services are provided trough a network of about 1900 PHC Centers (PHCC). Recently, attempts were made to enhance the practice of primary health care to encompass the family health model. Expressed attendants' satisfaction and opinion about provided care at any health care setting is an important predictor of utilization and continuity of obtaining care from the same source. The objective: is to describe and compare satisfaction of attendants of a Family Medicine Training Center (FMTC) and a PHCC in Baghdad.
Subjects and Methods: a comparative cross sectional study conducted on a random sample of 300 attendants from each center. Attendants’ satisfaction towards the center’s building; doctor's approach, provided medical services and attendants’ continuity manner were studied.
Results: About 53% of FMTC attendants and 40% of PHCC attendants stated a very good building's location. Around 7.3% of PHCC attendants, and 3.7% of FMTC attendants considered hygienic standard as "poor", (P=0.05). Doctor reception was considered as “poor” in 2.7% of FMTC attendants compared to 0% for the PHCC, (P=0.000). Around 16% of FMTC attendants considered the time spent by the doctor as "inadequate" compared to 4.7% of PHCC attendants, (P=0.000). Around 48% of PHCC attendants were given appointment for follow up, compared to 19% of FMC attendants (P=0.000). About 58% reported availability of investigations and drugs in FMTC compared to 40.3% for PHCC attendants, (P=0.000). Conclusion: FMTC attendants are more satisfied to building's related variables and availability of medical services but less satisfied by doctor's approach with less intention to continue attending the center.

Background: This study was carried out from first of June 2008 till first of June 2009 at thallassemia center Diyala governorate on families who have more than one affected member with thalassemia and other member who also gives positive results for hepatitis C infection in addition to the index (infected) case.
Material and methods: The study sample includes (13) families with (13) index cases who test positive for anti-hepatitis C antibody. Each family have at least two patients with thalassemia, the overall number is (29).
Results: This study reveals that 76.92% (10 families) have at least one more member in the same family who also test positive for anti-hepatitis C antibody. Prevalence after exclusion of index cases is 68.75%.
Conclusion: Anti-hepatitis C antibody is high among thalassemic siblings and routes of transmission of infections other than blood transfusion should be considered among thalassemic siblings.
Keywords: Hepatitis C, Thalassemia, routes of transmission.

Background: Human leukocyte antigen (HLA) is the most polymorphic genetic system in man. The genes of this region seem to influence susceptibility to certain diseases.
Patients and methods: Polymerase chain reaction-Sequence Specific Primers PCR-SSP is the method used to asses HLA-typing of 100 blood samples of 60 AIH patients and 40 healthy normal controls.
Results: An increased frequency of HLA-DR3, DR4 and DR7 was observed for patients group versus control group with P-value (0.0001, 0.05, and 0.001) respectively, while DR*0211 (DR2) may be formed the basis for protection against the disease. HLA-DQ on the other hand, yielded on association in Iraqi patients with AIH.
Conclusions: This finding demonstrated that HLA-DR3, DR4 and DR7 might play a role in AIH susceptibility.
Key words: autoimmune hepatitis, Human leukocyte antigen (HLA), PCR –SSP assay.

References:

Background: β-thalassemia major is a genetic disorder characterized by reduced rate of β-globin chain production. Clinically, β-thalassemia major is a severe, transfusion-dependant disorder; repeated blood transfusion will lead eventually to chronic liver disease.
Patients and Methods: One hundred patients ; 56 males and 44 females who were known cases with β-thalassemia major on regular blood transfusion, aged between 6 months and 18 years, were studied in a private pathology laboratory, between January 2002-January 2006.Blood was drawn to estimate serum glutamic pyruvate transaminase (SGPT) and serum glutamic oxaloacetic transaminase (SGOT) levels.
Results: Sixty-six patients (66%) had elevated SGPT and SGOT levels ranging between two and more than five fold increase than normal.Thirty-four patients (34%) had normal SGPT and SGOT values of less than 40 i.u. /L. The levels of SGPT and SGOT were significantly higher in splenectomised patients than nonsplenectomised.
Conclusion: Serum transaminases were elevated in (66%) of transfused patients with B-thalassemia major.
Keywords: Serum Transminases, Thalassemia Major, Transfusion-Dependant.

Background: Indeterminate colitis (IC) originally referred to those 10–15% of cases of inflammatory bowel disease (IBD) in which there was difficulty distinguishing between ulcerative colitis (UC) and Crohn’s disease (CD) in the colectomy specimen and histopathology examination. However, IC is increasingly used when a definitive diagnosis of UC or CD cannot be made at colonoscopy examination, colonic biopsies or at colectomy. The diagnostic difficulties may explain the variably reported prevalence of IC. Clinically, most patients with IC evolve to a definite diagnosis of UC or CD on follow up.
Patients and methods: PATIENTS GROUP: Consisted of 80 patients with indeterminate colitis (IC), their age ranged (16-84 years), mean age was 45.5 years, 50 (62.5%) were males and 30 (37.5%) were females. CONTROL GROUP: Consist of 40 healthy volunteers, mean age was 39.3 years, 20 of them were male and the rest were females. Anti-Saccharomyces cerevisiae antibodies (ASCA) were detected using indirect immunofluorescence test (IIF) test.
Results: Results of ASCA antibodies in the serum of IC patients showed significant higher frequency (66.2%)(p>0.001) than control group(7.5%). The commonest isotype of this ASCA antibody was IgG (53.7%) that is significantly higher than control group (P>0.001). The sensitivity of ASCA was 63.1 %, specificity was 28.5% and positive predictive value of ASCA was 80% and negative predictive value was 78.5%.
Conclusions: In conclusion, higher frequency of ASCA (IgG) expression in IC was useful in early estimation of IC and could be used as serological marker.
Keywords: Anti Saccharomyces Cerevisiae Antibody (ASCA), indeterminate colitis, immuno fluorescence.

Background: Chronic myeloid leukemia (CML) is a stem cell disorder associated with an acquired chromosomal abnormality, Philadelphia chromosome (Ph), which arises from the reciprocal translocation of part of long arm of chromosome 9, in which proto-oncogene ablson gene (abl) is located, to long arm of chromosome 22, in which break point cluster region gene (bcr) is located. The bcr-abl fusion gene can be detected using several molecular methods. For its simplicity, rapidity, and sensitivity, Reverse Transcriptase-Polymerase Chain Reaction (RT-PCR) is one of the most common techniques used for analyzing whether a target gene is being expressed or not.
Patients and methods: Venous blood (VB) sample from hematologically and clinically diagnosed 34 CML patients and10 acute lymphoid leukemia (ALL) were collected. Also, 10 healthy individuals were included as health negative control. RNA was extracted from these samples using commercial kit. Molecular screening for the presence of bcr-abl in these samples was done using Monoplex- Two Steps-Reverse Transcriptase-Polymerase Chain Reaction (M-TS-RT-PCR). Amplified products were electrophoresid in 1.5% agarose gel.
Results: The results showed that all CML patients were positive for bcr-abl while all the others were negative for this gene.
Conclusion: Monoplex - Two steps – RT-PCR has been successfully used to detect and subtype bcr-abl fusion gene. It is a fast and effective technique that should be done upfront at diagnosis in patients with CML, as its molecular type is crucial in the treatment follow-ups.
Key words: CML- bcr-abl detection- monoplex- two steps – RT-PCR

Background: - This study was carried out to investigate the ability of Streptococcus bovis to colonise colorectal cancer.
Patients and Methods: - A total of 106 outpatients were subjected for colonscopy. Carcinoma biopsies from patients with colorectal cancer tissue from patient with polyps and normal mucosa stool and blood from all patient and controls were cultured and identified for S.bovis.
Results: - The histopatholgical findings confirmed that 38 patients had colorectal carninoma, 27 patients with benign polyps and 41 with normal colonic mucosa. The faecal carriage rate of S.bovis was 15(39.5%) in patient with colorected cancer, 5(18.5%) in patients with polyp and 7(17.1%) in control.
Conclusion: - Faecal colonization by Streptococcus bovis in colorectal cancer patient was higher than in control healthy people and patients with polyp.
Keywords: - Streptococcus bovis. Colorectal Carcinoma (CRC).

Background: Glycemic control and prevention of secondary complications are the most important aims of using pharmacological treatments in diabetes mellitus. Due to the high incidence of inadequate response to insulin and, we try to evaluate the effects of adjunct use of silymarin with insulin on glycemic control, lipid profile and renal function in type 1 diabetes mellitus patients.
Patients and Methods: Placebo-controlled, doubled blinded clinical trial method is utilized through which 60 type 1 DM patients allocated into two groups, 30 patients treated with insulin and silymarin 400 mg/day in two divided doses, while the other 30 patients treated with insulin and placebo for 60 days. Fasting serum glucose, HbA1c, C-peptide, lipid profile and microalbuminuria were evaluated at base line and after 60 days.
Results: Compared with placebo, silymarin significantly improves the effects of insulin through the reduction of fasting serum glucose, HbA1c and increase C-peptide level, associated with improving lipid profile and renal function.
Conclusion: Adjunct use of silymarin with insulin improves glycemic control associated with improving lipid profile and renal function, an effect that may be related to increased insulin sensitivity in peripheral tissues.
Keywords: Silymarin, Type1 DM, Glycemic control

Background: Acute exercise stress is associated with a lower lymphocyte functional response. It is suggested that exercise can enhance or reduce immunity depending on the frequency, duration, and intensity of the exercise.
Subjects and Methods: From November 2007 to January 2008, thirty healthy Volunteers were recruited from medical, paramedical staffs, and students of Baghdad College of Medicine (all males). Participants were chosen according to the following: (1)Age (between 20 and 35 years), (2) Non obese : Body mass index (BMI in kg/m2) was used as an index of obesity, (3) Non-smoker, (4) No recent medical problem, (5) No recent medications, and (6) No musculoskeletal complaint. After a general medical checkup, the thirty subjects were subjected to the exercise protocol. Blood samples were taken before, and immediately after the end of exercise.
Results: The mean age of individuals enrolled in the study was 29 ± 4years. Exercise induced significant granulocytosis whereas lymphocytes declined to a level significantly below the baseline. Trypan blue exclusion test showed that the initial percentage of nonviable lymphocytes was 2.90% ± 0.2%. After exhaustive exercise, cell viability decreased where percentage of nonviable cells was 4.3% ± 0.3% (p<0.005). Early apoptotic lymphocytes showed membrane blebbing and did not take the dye, while dead cells appeared blue from dye uptake. MDA was 3.0 ± 0.23 nmol/ml. An increment in the mean value of MDA was observed in the post exercise blood sample that was withdrawn immediately after exercise (p<0.005).
Conclusion: The present study shows that exhaustive exercise induces apoptosis in peripheral blood lymphocytes manifested by increased level of malondialdehyde, an oxidative stress marker. This finding supports the hypothesis that apoptosis could be involved in exercise-induced lymphocytopenia and this effect depends on exercise intensity.
Keywords: Apoptosis, Exercise, MDA, lymphocyte.

Background: Pre-eclampsia is culmination of a multi-step process that related in part to elevated oxidative stress and associated with hyperurecimia.
Patients and methods: Thirty normotensive and hundred pre-eclamptic pregnant women attending to Al-Basra hospital of pediatrics, obstetrics and gynecology were participated in this study. The patients were randomized into six groups. They were treated with methyldopa alone, methyldopa plus vitamin C, methyldopa plus vitamin E, methyldopa plus vitamin C and E, and methyldopa plus allopurinol. The oxidative stress (MDA), renal function parameters, systolic and diastolic blood pressure were evaluated before treatment and 14 day after initiation of therapy.
Results: Using allopurinol, vitamin C, vitamin E, and a combination of vitamin C and E together with methyldopa in pre-eclampsia can produce a significant reduction in the level of oxidative stress, on the other hand, some of these supplemental antioxidants can produce a significant reduction in systolic and diastolic blood pressures, serum creatinine and proteinurea as well as serum uric acid concentration in different extent.
Conclusion: Antioxidants and allopurinol when co-administrated with methyldopa, improves the maternal and biochemical indicators of pre-eclampsia and produce a better control of blood pressure.
Keywords: Pre-eclampsia, Antioxidants, Oxidative stress, Vitamin C, Vitamin E, Allopurinol

Background: Urany1 acetate (UA) mostly a kidney poison or chemical toxic and not nearly so much radiological also is not accumulative toxic, so it is not concentrated in the food chain nor would it cause pathological condition due to increase levels from expomers. Therefore, the study aimed to detect the target organ as most of the lethal dose (LD50) male rats died within 24 hours.
Methods: Study was done on (120) male rats of 2 months old, at varying dosage level of uranyl acetate ranging from LD 50 of 2.5 and 1.5gm/kg and varying dosage level, by oral intubation. There were (40) rats for LD 50 were given single oral dose from 2.5 to 1.5 gm /kg every day. Eighty rats for the main study, (20) rats each group as intermediate, low and high dose. After LD 50, the trail was done on groups of rats, starting as high dose as 150 mg / kg day by day then followed by intermediate dose 100 mg / kg and low dose level 75 mg / kg b.w every other day respectively with control untreated group. Duration of the study (55 day) on all rats were killed and followed by histopathological examination.
Results: The histopathological changes ranged from sever necrosis of the proximal convoluted tubules result in renal failure and that was mainly at the LD 50 and maximum level dose, rats either died after few hours or live for few days. Showing arched back and killed in poor condition, while rats treated with intermediate and low dose level showed less sever changes, mostly as dilated cortical tubules and / or cortical tubular basophilia, , only with occasional cortical tubular necrosis .
Conclusion: The Present study showed that the kidney, proximal convoluted tubules, the target for toxicological pathology of heavy metal and the main cause of death was renal failure in sever morbid cases.
Keywords: Uranyl acetate –kidney –rat dilated cortical tubules – renal failure

Background: Polycythemia (or polycythaemia or erythrocytosis) is a condition in which there is a net increase in the total number of blood cells, primarily red blood cells, in the body. The overproduction of red blood cells may be due to a primary process in the bone marrow (a so-called myeloproliferative syndrome), or it may be a reaction to chronically low oxygen levels or, rarely, a malignancy. Minerals are the building blocks of our bodies. They are required for body structure, fluid balance, protein structures and to produce hormones. They are the key for the health of every body system and function. They act as co-factors, catalysts or inhibitors of all enzymes in the body .
Patients and Methods: Blood Calcium, iron & Magnesium concentrations was determined by using colorimetric method, while Potassium, Copper& Zinc concentration was determined by using flam atomic absorption spectrometry method.
Results: Obtained results showed that the level of Potassium, Calcium and zinc in polycythemic subjects were significantly higher than that of healthy subjects (p<0.05), while serum iron, Copper in polycythemic subjects were significantly lower than that of healthy subjects. Magnesium level shows no significant difference between two studied groups.
Conclusion: Recent research indicates that minerals may play a significant role against a variety of degenerative diseases and processes.
Keywords: Polycythemia, Minerals, Sialic acid, calcium, iron, potassium, Copper, Zinc.

Background: Bicycling is a type of aerobic exercise that it is beneficial for the health of cardiovascular, pulmonary, and musculoskeletal systems .In this study, utilization of some of electrophysiological tests is to assess changes , from the functional point of view, in the peripheral nerves & their muscles that occur in relation to maximal exercise.
patients & methods: 100 young healthy males , age (18-35) years old, were collected during the period from 1st of April to 1st of October 2008 at the department of neurophysiology in the Ibn Sinna teaching hospital , Mosul city. They underwent electroneurographic assessment of common peroneal & tibial nerves, in addition to electromyographic assessment of Tibialis Anterior & Gastrocnemius muscles before & after exercise challenge test on bicycle ergometer.
Results: In this study, there is a higher value regarding compound motor action potential amplitudes & motor conduction velocity of both nerves, with increase in the values of motor unit potential amplitudes & interference pattern of both muscles post exercise in comparison to the pre exercise. In addition, there is positive correlation between MUP amplitude of Gastrocnemius muscle & tibial nerve.
Conclusion : the results indicates that within this age group the exercise challenge test leads to increase in the force produced with no signs of muscular fatigue electrophysiologically .
Keywords: Electromyography, cycling exercise, muscle fatigue.

Background: Breast Cancer is the commonest type of malignancy in Iraq. The Iraqi Cancer Registry displays an obvious trend for the disease to affect younger women with advanced stages at the time of presentation. This report presents a review on the main demographic characteristics and clinico-pathological parameters in Iraqi patients diagnosed with breast cancer.
Patients & Methods: The study was carried out on 721 out of a total of 5044 patients (14.3%) who complained of palpable breast lumps that were diagnosed as cancer. The procedure for tumor nuclear DNA Ploidy assessment was performed by means of Image Cytometry. Immuno-cytochemical and histochemical assays were applied for the determination of Estrogen and Progesterone receptor (ER/PR) contents and Her-2/neu expression of the tumor tissues.
Results: Approximately one third of the breast cancer patients were diagnosed in the age period (40-49 years), 71.9% came from urban areas and 75% were married. History of lactation and hormonal therapy was reported in 63.1% and 29% respectively, while positive family history was recorded in 16.2%. Although the lump was detected by the patient herself in 90.6%, yet only 32% sought medical advice within the first month. Accordingly 47% of these patients presented in advanced stages (III and IV).The main histological type was invasive ductal carcinoma; in which pathological changes of grade II and III were observed in 56.6% and 39.9% respectively. Cytophotometric DNA analysis showed that 80.3% of Iraqi mammary carcinomas were aneuploid. ER and PR positive tumor contents were demonstrated in 65.1% and 45.1% of the examined specimens respectively while Her-2/neu over expression was displayed in 46.4%.
Conclusions: The aforementioned data justifies increasing efforts for establishing comprehensive breast cancer control programs in our country. Further interventional research studies using molecular biomarkers should be promoted to address the factors contributing to the illustrated aggressive tumor behavioral forms
Keywords: Breast Cancer, Iraq, Clinical, Pathological Diagnosis, Aneuploidy, Hormone Receptors, Her-2/neu.

Case Report: Common bile duct perforation has been reported in adults after invasive procedures, spontaneous common bile duct perforation is a rare entity as a cute abdomen in adults. A few cases due to choledocholithiasis have been reported as a cause of spontaneous perforation. We report an adult patient who presented with acute abdomen after spontaneous common bile duct perforation due to unknown etiology who was treated successfully.
Keywords: Common bile duct-perforation- acute abdomen.