Journal of the Faculty of Medicine Baghdad

Background:Breast abscesses could be successfully treated by percutaneous aspiration of pus and irrigation of the cavity with saline solution.
Objective:To assess the feasibility and effectiveness of percutaneous needle aspiration of breast abscesses under local anesthesia in the outpatient clinic.
Patient and methods:A prospective study of forty three women with breast abscesses attended outpatient clinic at Tikrit teaching hospital and privit clinic for the period from January 2008 to January 2010.All patients had preliminary breast ultrasoundexamination. Percutaneous needle aspiration of pus under local anesthesia was done ,followed by systemic antibiotics. Repeated aspiration was carried out later when deemed necessary and follow up byultrasound was conducted.
Results:Twenty three (53.4%) of patients obtained complete resolution (no focal collection) after one aspiration , 9 (21%) required two aspiration and 8 (18.6% )required more than two aspiration for cure (residual collection). In 3 ( 7% ) of patients, the treatment failed where symptoms not resolved after 3 days, with further pus collection despite aspiration and antibiotics , where surgical drainage were required.
Conclusions:Percutaneous needle drainage of breast abscesses after preliminary breast US is feasible as a primary and definitive treatment for breast abscesses if complete or near complete drainage is achieved.
Key words: breast, abscess, aspiration.

Background: Ganglions are the most common benign cystic swellings found around the wrist,they can be treated conservatively or by surgical excision,but the net results revieled no significant difference.Complete evacuation of the cysts followed by intracystic autologus blood instillation has given encouraging results.
Objective: To assess the efficacy and safety of aspiration of wrist ganglions and instillation of autologus blood inside the cysts.
Patients and Methods: Aprospective study was conducted on forty patients with wrist ganglions.20% of the patients underwent aspiration of the cysts alone,and the other 20 underwent aspiration of the cysts followed by autologus blood instillation, then an immobilization for seven to ten days.Two years follow-up was done for detection any recurrence.
Results: Most of the patients were females,and the dorsal aspect of the wrist affected more than the volar one. Most of the patients presented mainly because of cosmetic reasons.Recurrence was the only complication encountered and involved 50% in those of group A and 20% in those of group B.
Conclusion: Our technique of aspirating the wrist ganglions and instillating autologus blood is a simple,safe,and effective method for treating wrist ganglions.
Key words: Autologus blood, wrist ganglions.Conservative ganglion management.

Background: Chronic lymphocytic leukemia (CLL) is a heterogeneous disease with an extremely variable course. Survival after diagnosis can range from months to decades and wide variability exists in the rate of disease progression and the incidence of disease-related complications among patients with CLL. Staging helps to define prognosis and to decide when to initiate therapy.
Objective: To asses response to oral alkylating therapy and to evaluate the adverse events that can complicate the disease itself or the treatment, including infections, autoimmune and other complications. The survival events are also been assessed.
Patients and methods: Forty nine Iraqi CLL patients, their age ranged between 40-90 years were followed with median duration of 28 months. During the follow up period of these patients, the events that complicated the disease or therapy were recorded. The primary endpoints were response rates, quality of response, Secondary endpoints of the study were overall survival , progression-free survival and event free survival. Response rates were calculated for 40 patients who were treated for at least 6 months. All patients were treated with intermittent pulse therapy of oral single alkylating agent.
Results: The majority of patients recruited either had intermediate or advanced stage disease in 45(91%) patients .Autoimmune phenomena, were documented in 5(10.2%)patients. There was increased incidence of infections with either viral or bacterial pathogen, complicating the course of disease in 20 (40.8%). Remission state was mainly with partial response in 26/40(65%).In12(24.4%) patients the disease progressed and death occurred in 6(12.2% ) patients ,4(8.1% )of them were CLL(related) and 2(4.08%)of them unrelated(stroke, ischemic heart disease) to CLL with median progression free survival(PFS)and overall survival(OS) for these patients were not reached, with 2 years PFS and OS were70%.
Conclusion: Although CLL is an indolent disease still the course is complicated by many events like autoimmune problem and infections whether related to CLL or to treatments. Alkylating agent were effective therapy in the treatment of CLL and the majority of patients in this study partially responded
Key word: Chronic Lymphocytic Leukemia : Alkylating agent

Background: Arm span is the closest physiologic measurement to standing height. Increased arm span to standing height ratio, which indicates a possible loss of height, due to aging, often results from osteoporosis-related vertebral collapse or other causes. This has possible consequences on lung functions.
Objective: To evaluate the effects of aging related loss of height to severity of dyspnea.
Method:Patients visited pulmonary function test laboratoryat Baghdad teaching hospital outpatient clinic department from first of November 2009 to thirty first of December 2010 for preoperative assessment were recruited to participate in our study. All recruited subjects were evaluated with a clinical history and physical examination followed by measurements of arm span, standing height, weight, forced expiratory volume in one second (FEV1) and forced vital capacity (FVC). Patients 40 years old of age and older were included .Patients with chronic disabilities (cardiac, respiratory or systemic diseases) were excluded. Patients were classified according to their gender and Medical Research Council severity of dyspnea.
Results: one hundred thirty one subjects aged 40 years and older were recruited for this study. Arm span to height ratio was significantly negatively correlated with FEV1/FVC ratio, FVC, and posi-tively correlated with severity of dyspnea.
Conclusion:There is a significant association between increased arm span to height ratio with in-creased severity of dyspnea. The role of arm span measurements in assessment of pulmonary func-tion tests in older patients and the association between loss of height and dyspnea deserves further evaluation.
Keywords:Arm Span,height ratio, dyspnea.

Background:Dyslipideamia is an important major risk factor for cardiovascular disease (CVD), which is the leading cause of death in the developed and developing countries. The world health organization estimates that dyslipideamia is associated with more than half of global cases of ischemic heart disease and more than 4 million deaths per year.
Objective:To assess the serum lipid profile in hypertensive patients.
Patients and methods: A case – control study was carried out at AL – Mustansyria , AL- Dubbat primary care centers for family Medicine and Medical city out patients clinic.Lipid profile were studied in 100 hypertensive patients and 100 healthy volunteers individuals attending these clinics matched for age and sex, serving as a control group. Full history was taken, complete clinical examination was done and various laboratory investigations were carried for all individuals in both groups.
Results: The mean age was (50.9±9.1)year ; (49.7±9.7)year for hypertensive and control individuals. With 50 % for males and females in both groups. The hypertensive patients had significantly higher body mass index than controls (P=0.005).The hypertensive patients had significantly higher total cholesterol (TC), triglycerides (TG), low density lipoprotein (LDL), and lower high density lipoprotein (HDL),( 204.6±20.8, 162.7±45.2,126.0±23.0, 46.1±7.4) , than control group (176.0±11.8, 151.5± 120.8, 102.6±121.6, 56.2±7.5). In hypertensive patients the TC was significantly increasing with age, overweight, and more in males than females. The TG were slightly more in males than females. LDL had increasing value with gender and BMI. Also there is significant association between serum HDL and obesity in both hypertensive and control patients but more with hypertensive patients.
Conclusion:There is a significant relationship between dyslipideamia, B.M.I and hypertension.
Keywords: Hypertension, dyslipidemia, obesity.

Background:Pediatric acute myeloid leukemia (AML) has a poor prognosis, and novel therapies are needed. The FLT3 tyrosine kinase inhibitorsrepresents a promising target in pediatric AML.
Objectives:This study was done to estimate the frequency of FLT3- ITD mutation in childhood acute myeloid leukemia using conventional PCR & correlate this mutation with the clinical presentation and response to induction therapy.
Patients, Materials &Methods: Twenty children with AML, and 16 children with reactive bone marrow as negative control were enrolled in this study. Those patients were attending Child Welfare Teaching Hospital in Baghdad from March 2010 to July 2011 .For each patient hematological investigations including complete blood picture, and bone marrow aspiration were done.FLT3-ITD mutation was detected by conventional PCR technology using specific primers. Complete hematological remission achievement after induction chemotherapy was assessed by clinical examinations and full laboratory investigations.
Results: Out of 20 AML children who participated in this study, 2 (10%) had FLT3-ITD mutation. The mean age of patients who had the mutation was higher than those without the mutation; and the mutated patientswere males, (P> 0.05).The FLT3-ITD mutation showed no correlation to clinical presentation.The peripheral blood & bone marrow blast cell percent werenon significantly higherin mutated patients as compared to non mutated patients. Regardingits relation to FAB classification, the FLT3-ITD mutation was only detected in M3(1/20) and M3v(1/20), and no mutation was found in other subtypes(M1,M2,M5). Furthermore, mutated patients showed lower response to inductiontherapy as compared to non mutated patients.
Conclusions: This is a noval study in one Iraqi teaching hospital to detect FLT3-ITD mutation by using conventional PCR in children with AML. This mutation was detected in 10% of thosechildren , and since they were male,older age group,and presented with higher peripheral blood &bone marrow blast cell percent thus we may propose that it may be used as a marker for the aggressiveness of the disease and can be used to modulate the treatment strategy for those patients.
Keywords: Childhood leukemia,acute myeloid leukemia,FMS-related tyrosine kinase gene, internal tandem duplicationmutation,polymerase chain reaction,prognosis.

Background: Several factors render chronic lymphocytic leukemia (CLL) an interesting subject for study by researchers. These include marked progress in understanding the molecular biology of normal and neoplastic lymphocytes and recent advances in molecular genetics techniques. Among molecular markers, matrix metalloproteinase-9 (MMP-9), have been widely studied.
Objectives: The aim of the study is to evaluate the role of MMP-9 in the pathogenesis of CLL and to assess its prognostic role.
Patients and methods:
A retrospective cross-sectional study done on 60 patients with chronic lymphocytic leukemia compared with 20 controls (anemic patients), all recruited at the Medical City Teaching Hospital laboratories from January 2004 to December 2007. The bone marrow biopsy of each patient was re-examined histologically. MRNA-In situ hybridization was performed to detect MMP-9.
Results: The frequency of MMP-9 positivity was 78.3% (47 of 60 cases). A significant inverse correlation was found between increasing MMP-9 scores and lower PCV level. A significantly larger number of patients with high score were associated with advanced modified Rai stage than patients with low score. In addition, there was a significant positive correlation between increasing scores of MMP-9 and advancing clinical stage.
Conclusion: MMP-9 positivity was high and the score was significantly associated with advanced clinical stage of the disease.
Keywords: Chronic lymphocytic leukemia; MMP-9; in-situ hybridization.

Background: Among different air pollutants, cigarette smoke contains toxic chemicals, mutagenic and carcinogenic compounds, which can adversely affect male fertility. In this study, semen parameters and reproductive hormonal concentrations of subfertile smokers were compared with subfertile non-smokers.
Objectives: evaluation of the effect of cigarette smoking on male fertility by evaluating several semen parameters as well as some reproductive hormones in a group of smoker and non smokersubfertile Iraqi subjects.
Patients and Methods: At the male infertility clinic of Al-yarmuk teaching hospital, Almustanseria medical college, Baghdad, Iraq from the 1st of October 2010 to the end of June 2011, 88 men (49 non-smokers, and 39 smokers) with history of subfertility for at least 1 year were evaluated by medical history, physical examination, semen analyses and reproductive hormonal profile.
Results:There was a significant impairment of semen parameters namely sperm count, sperm motility and normal sperm morphology in subfertile smokers (means ± SD were 23±28.01, 11.25±16.96 and 35.41±26.44 respectively as compared to subfertilenon smokers in which means ± SD were 53.67±22.16, 27.04±15.70, 52.04±17.90 respectively and P values were < 0.005 for the 3 parameters with a non significant changes in reproductive hormonal profile between smokers and non smokers.
Conclusion: Smoking does affect conventional semen parameters namely sperm count, motility and morphology significantlywith mild non significantchanges in male reproductive hormonal analysis.
Keywords: male subfertility, smoking, semen, reproductive hormones

Background: Neonatal Septicemia (NNS) is generalized microbial symptomatic infection during the first 28 days of life.It's the most serious complication in Neonatal Intensive Care Units (NICU) that demand urgent diagnosis and accurate treatment.
Objective: To reveal the relationship of neonatal septicemia with birth weight (one of the neonatal risk factors).
Patients and Methods: Blood sample was obtained from 76 neonates aged 1 hour-28 days who were diagnosed clinically (poor feeding, respiratory distress, fever, hypothermia, gastrointestinal and/or central nervous system symptoms)and bacteriologically to have neonatal septicemia.
Results:One of the most important neonatal factor predisposing to infection is low birth weight, significant positive culture results were found among the group with birth weight 0.9–2 Kg.Gram negative bacteria constituted 71% of the total isolates.
Conclusion: The low birth weight infants were at high risk to neonatal Septicemia.
Keywords: Neonatal septicemia (NNS), birth weight

Background:Lactobacillus fermentum selected as an alternative treatment to prevent or treat urogenital infection based on their probiotics properties and production of bacteriocins.
Objective: The present work was done to study the inhibition activity of L. fermentum cell free supernatant against urogenital pathogens Enterococcus faecium and Enterococcus faecalisinvitro.
Materials and methods: L.fermentum isolates have been collected from vaginal swabs . A supernatant of these isolates has been prepared and its antibacterial activity against 3 isolates of E.faecium and 3 isolates of E.faecalis has been studied.
Results: Different concentrations have been prepared and the most effective one was 1000µg/ml and the most affected isolate of E.faecalis was no. 3 which its MIC was 64µg/ml and MBC was 128 µg/ml, while the most affected isolate of E. faecium was no. 1 which its MIC was 128 µg/ml and MBC was 256 µg/ml .
Conclusion:L. fermentumCFS showed significant activity against both Enterococcus isolates and showed closely related results.
Keywords: Lactobacillus fermentum , Antibacterial activity , Antagonstic

Background:Ovulation constitutes a central event in ovarian physiology, and ovulatory dysfunction which is a relevant cause of female infertility. Mammalian ovulation is comparable to aninflammatory reaction since many of the molecules responsible for inducing the inflammatorycascade including PGs, leukotrienes and various cytokines have been describedin the ovary.
Objectives:This study was designed to compare between the effects of some NSAIDs(aspirin,diclofenac sodium and meloxicam)on the ovulatory process and the reproductive tract of female mice.
Materials and methods:Twenty four female mice were subdivided into 4groups (6 animals/group).The first received distilled water serve as control group, the second receivedaspirin (7.5 mg/kg.B.W) ,thethird received diclofenac sodium(2mg/kg.B.W) and the fourth received meloxicam(0.001mg/kg.B.W) subcutaneously at proestrous phase,Blood was collected at metestrousfor subsequent hormonal assay. The whole reproductive tract was excised out, examined, weighed and ova were flushed.
Results :Female mice that received 7.5 mg/kg.B.W of aspirin,showedenlarged, congested ovaries with cystic appearance and congested uteri with prominent blood vessels.Mice that received 2mg /kg.B.W.diclofenac and those received 0.01 mg/kg.B.W. meloxicam showed more congestion and more obvious cystic appearance of ovaries with uteri more bulky compared to controls that showed no congestion and no cystic appearance of the ovaries with thin non congested uteri.Highly significant (P ˂ 0.001) increase in the ovarian weight and highly significant decrease in number of ova flushedwhile no significant changes (P ˃ 0.05) were seen in the uterine weight nor in hormonal levels of LH and FSH between controls and each of animals that received aspirin, diclofenac and meloxicam respectively.
Conclusion:Short -term administration of low-dose (aspirin, diclofenac& meloxicam) to female mice at proestrous cause a highly significant increase in the ovarian weight with morphological changes of ovaries and uteri and a highly significant decrease in the ovulatory rate as compared to controls .Greater effect were produced by meloxicam with a lower dose compare to diclofenac and aspirin.
Keywords: NSAIDs, reproductive system, ovulatory rate.

Background: The effect of Helium Neon laser (He-Ne 632.8 nm) was reported to protect cells from damage. We studied lymphocyte cells pre irradiated with (UVC 260 nm) to induce DNA damage. Investigations were carried using gel electrophoresis and test for cell viability. It has also been reported that effect depends on incubation period after damage. The extent of damage to the cells depends on the period of irradiation with UVC also on its intensity.
Objective: In this work we studied the effect of UVC on DNA damage and cell survival
Also study of the effect of He-Ne laser on cell survival after all being pre irradiated with UVC light and its protective effect on DNA post UV damage.
Method: This study was conducted in pathology department post graduate laboratory - College of medicine-Baghdad University. The total number of samples was (147). Blood samples were collected from healthy donors came to the blood bank, the amount of blood drown varies from 5ml to 7ml in heparin tubes .The work was carried out during the period between November 2010 to August 2011. In this experiments examination of samples was carried out to test the radiation effect on cell viability by using trypan blue dye, the experiments were preformed after 1, 24 and 72 hours post UVC irradiation to test the repair development. In other experiments Gel electrophoresis were carried out on samples to study the effect of radiation on the DNA fragmentation.
Result: Results reveal a reduced DNA fragmentation appeared on gel electrophoresis experiments as the smear length is reduced significantly for both UV10 and UV20 , other results for cell viability tests revelled that He-Ne can increase survival of cells pre irradiated with UVC irradiation giving (66%, 57%, 70%( improvement in UV exposure for10 min and (59%,56%,59%) improvement for UV exposure for 20 min respectively .
Conclusion: The effect of the laser in the improvement of cell survival may be attributed to the induction of endogenous radioprotectore and probably enzymes induced by laser irradiation which may be either reduce the free radical by scavenging effect or by improved cell repair, we may conclude that He-Ne laser can protect cells from radiation damage
Keywords: DNA damage, Low Level Laser Therapy (LLLT), laser and cell survival, UVC damage and cell survival.

Background:Gastrointestinal cancers (GITc) is a worldwide problem. In Iraq , Gastric cancer is the 9th commonest of the top cancers while colorectal cancers it is considered as the 7th commonest ten cancers.IL-10 appears to be more of a pro-tumor than anti-tumor properties in both colorectal and gastric cancers.
Objective:is to estimate the serum level of IL-10 in the Iraqi colorectal and gastric cancer Patientsand its relation to the progress of disease.
Patients and Methods:In ourstudy ,54 serum samples werecollected starting from the 1st of January to mid of March 2011, to investigate the IL-10 serum level by using ELISA kit. 38colorectal and gastric cancer patients (H.Pylori +ve) and 16 of healthy control group.
Results: The results showed that IL-10 serum levels of both GIT tumors were increased significantly (p<0.05) comparing with the healthy control group.
Conclusion:In conclusion, the high serum level of IL-10 in colorectal cancers is due to the pro-tumor properties of IL-10 while in gastric cancer while the association of IL-10 genotypes specifically the single nucleotide polymorphism of the IL-10 promoter region may be the source of its serum increasing level.
Keywords: IL-10, Colorectal Cancer, Gastric Cancer.

Gallbladder disease is relatively common and its complications are seen every now and then. One of the rare complications is gallbladder perforation. In our case we were faced with a picture similar to perforation of the gallbladder upon surgical exploration, with empyema of gallbladder and pericholecystic abscess and a stonelocated between the gallbladder and the liver bed (inside the abscess) and no perforation in the gallbladder or fistula with the biliary tree could be discerned.
Keywords: Gallbladder empyema, pericholecystic abscess, gallstone, acute cholecystitis

Background:recent data indicate the prevalence of cardiovascular disease in patientswith high cystatin-C level;it can be used as a good predictor for assessment of mortality in cardiovascular diseases regardless of the status of renal function.
Patients and methods: Onehundred twenty (120) patients with ischemic heart disease admitted to this study at Baghdad teaching hospital for the period from January 2011 to September2011,Those patients categorized into two groups (60) diabetic and (60) non diabetic in comparison to fifty healthy control.Fasting serum cystatin-C was measured in all patients and controls.
Results: The level of serum cystatin-C, in diabetic patients with ischemic heart disease was (2.05±0.55 µg/L). Its level in non diabetic patients with ischemic heart disease was (1.19±0.59 µg/L)both were significantly higher(p<0.001)than its level in healthy control(0.38±0.062 µg/L).
Conclusion:Cystatin-C is good prognostic biomarker in patients with ischemic heart disease with or without diabetes mellitus.
Keyword:cystatin-C, ischemic heart disease, diabetes mellitus.

Gallbladder disease is relatively common and its complications are seen every now and then. One of the rare complications is gallbladder perforation. In our case we were faced with a picture similar to perforation of the gallbladder upon surgical exploration, with empyema of gallbladder and pericholecystic abscess and a stonelocated between the gallbladder and the liver bed (inside the abscess) and no perforation in the gallbladder or fistula with the biliary tree could be discerned.
Keywords: Gallbladder empyema, pericholecystic abscess, gallstone, acute cholecystitis

Background: hair graying is an aging sign; it is associated with ischemic heart disease. Metabolic syndrome often associates with increased risk for atherosclerotic arterial disease.
Objective: To test retrospectively the association between onset of hair graying and risk of metabolic syndrome.
Methods: Four hundred and eighty one gray hair individuals, with no history of atherosclerotic diseases were included. The individuals have been divided into metabolic syndrome and control groups. Each individual was asked about the decade (2nd-6th) of onset of hair grayness.
Results: Patients with metabolic syndrome had peak onset of hair grayness in the 4th decade which was statistically higher than the control group (p values= 0.045). While the peak onset in the control group was in the 5th decade which was different from the metabolic syndrome group (p-value = 0.024). The difference was not significant in the 2nd, 3rd and 6th decades of life.
Conclusion: Patients with metabolic syndrome had an earlier age of onset of hair grayness.
Keywords: hair grayness, metabolic syndrome.

Background:The initiation and maintenance of reproductive functions are related to an optimal body weight in women. Body weight affectthe ovarian reserve which is basically an estimate of how many oocytes (eggs) are left in the ovaries.
Objective: To study the relationship between obesity and serum and ultrasound markers of ovarian reserve in mid-reproductive age women (21- 35 years old).
Patients and method:Twenty participants (“obese”) had a body mass index (BMI) of 30 to 35 Kg/m2 and another 20 participants (“non-obese”) had a BMI20-29 kg/m2. The obese women had a mean age of 27.9 years and the non-obese women had a mean age of29.5 years. Blood samples were collected from all participants, anthropometric measurements were calculated, and transvaginal ultrasonography was performed to measure the antral follicle count (AFC) during the early follicular phase. The blood samples were assayed for antimüllerian hormone (AMH), follicle-stimulating hormone (FSH) and estradiol (E2).
Results: Therewas no significant difference between the two groups regarding ovarian reserve markers and there is no significant correlation between these markers and BMI, except forserum E2 in the obese group.
Conclusion: Obesity has no effect on the levels of serum FSH, AMH, orAFCindicating that obesity is unlikely to affect ovarian reserve in the mid-reproductive age group.
Keywords: Antimüllerian hormone (AMH),follicle stimulating
Hormone (FSH), body mass index (BMI),obesity,antralfollicleCount (AFC), ovarian reserve