Journal of the Faculty of Medicine Baghdad

Background: Liver imaging is commonly undertaken in patients with cancer history because, after lymph nodes, the liver is the most frequently involved organ by metastases
Objectives: The aim of the study was to evaluate the role of liver MRI (magnetic resonance imaging) in characterization and detection of liver lesion in patients with extrahepatic primary
Methods: this is a cross sectional study of 70 patients with extrahepatic liver primary cancer who had their treatment in oncology teaching hospital underwent routine abdominal ultrasound to detect liver lesion(s) and suspicious cases then referred to MRI which was done in Ghazi Alharri and oncology teaching hospital from the period from 1st of September 2015 to end of November 2016 ,the patients age range from 31 to 75 years
Results: hemangioma is the most common solitary liver lesion in patients with extrahepatic primary cancer which represent 27% of lesions detected followed by simple cyst which represent 13% of the lesions, in another hand solitary metastasis seen in 7% of solitary lesions while metastasis is the leading cause behind multiple hepatic lesions and represent about 38% of lesions seen ,unlike solitary lesions, hemangioma is a rare cause and seen in 7% of cases
Conclusion: MRI is a required adjuvant tool in evaluation of suspicious liver lesion ,its value was illustrated in characterization and diagnosis of liver lesions depending on their appearance in T1 ,T2 and fat suppression T2 sequences in addition to assess their enhancement pattern after dynamic IV( intravenous) contrast injection.
Keywords: liver metastasis, MRI, dynamic liver intravenous contrast.

Background: peritoneal cavity can be involved in inflammatory and malignant diseases and using computed tomography(CT) findings of exudative ascites may help in the differentiation.
Objectives: 1-Describe CT features in patients with exudative ascites.2-Obtain useful CT findings to differentiate between tuberculous (TB) peritonitis and peritoneal carc inomatosis.
Patients &methods: A cross sectional study conducted in Medical City Teaching Complex from September 2009 to September 2010 studied patients with exudative ascites using CT scan and confirmed later with histopathology examination.CT scan results were presented according to cytology examination and biochemical analysis.
Results: 35 patients with exudative ascites were studied, including 19 males &16 females, age varied from 20 to73 years. While the amount of ascites (large or small) did not show statistically significant association with malignant disease,the density of ascitic fluid was slightly higher in TB[range(18-22) Housnfield Unit (HU), mean is 20HU]compared to malignant ascites [range(15-20) HU, mean is 18HU].Right subphrenic ascitic collections are associated with malignant disease (12 or 60% compared to 2 or 13.3% in TB) and pelvic ascitic collections were associated with TB disease (8 or 53.3% compared to 3 or 15% in malignant disease).
Conclusion: In addition to omental cake &thickened bowel wall, malignant exudative ascites on CT scan is likely to have lower density, located in the right subphrenic space than in the pelvic region compared to benign (tuberculous) exudative ascites
Keywords: exudative, ascites, malignancy, TB, CT scan,

Background:-Atherosclerosis is a systemic disease that often affects multiple vascular distributions in a single patient. The increased prevalence of renal artery stenosis in association with coronary artery disease has been well documented.
Objectives:-To examine in detail the prevalence of renal artery stenosis in patients undergoing cardiac catheterization for suspected coronary artery disease.
Patients &methods:-Between April 2010 and February 2011, two hundred patients underwent coronary and renal angiography at the same session in Ibn Al-bitar Hospital for Cardiac Surgery. Clinical and procedural data for patients undergoing renal angiography were prospectively collected and entered into database specially designed for the present study.
Results:-Two hundred patients were included in this study, 133 (66.5%) were males and a mean age of 53±12 years, age range (42-73year ). Significant renal artery stenosis (≥ 50% luminal narrowing) was identified in 18 patients (9%) made up the renal artery stenosis group. Age, hypertension, diabetes mellitus and renal impairment were significantly associated risk factors for renal artery stenosis. Gender, smoking and hyperlipidemia were not significantly associated with either group. The frequency of renal artery stenosis is significantly increased with the number of stenotic coronary segments; patient with two and three vessel disease had more frequent renal artery stenosis than the others.
Conclusion:-Renal artery stenosis is prevalent in a significant proportion of patients undergoing cardiac catheterization for suspected coronary artery disease & the number of coronary arteries with stenotic lesions is a remarkable predictor of significant renal artery stenosis.
Key words: Renal artery stenosis ,coronary atherosclerosis, renal angiography

Keywords: interstitial lung disease, Open lung biopsy
Background: The diagnosis of interstitial lung disease (ILD) is frequently delayed, because clinical clues are neglected and respiratory symptoms are ascribed to more common pulmonary diagnosis such as asthma and chronic obstructive pulmonary disease in the primary care setting.
Objective: To evaluate the diagnostic yield of open lung biopsy in patients with suspected ILD in relation to clinical and radiological features.
Patients and methods: Thirty-five patients were admitted with suspected interstitial lung disease (ILD), and scheduled for open lung biopsy (OLB) in Ghazi AL-Hariri hospital for surgical specialty, were included in this study. Data collected from the patient's files (who were subjected to open lung biopsies which had been histopathologically studied in the period from 1st of January 2013 to 31st of May 2015) and were studied retrospectively.
Results: There were 11 (31.4%) males and 24( 68.6%) females, the mean age was 46±14 years , dyspnea was the common presenting symptoms in patients 24(68.6%) , dry cough was the presenting symptoms in10 (28.6%)patients , bilateral diffuse crepitations were heard in 20 (57.2%) patients, bilateral fine basal crepitation were heard in 11 (31.4%) , clubbing with bilateral fine basal crepitations heard in 4 (11.4%) ,chest-x- rays findings were: lower zone infiltration in 11 (31.4%), reticulonodular infiltration in 10 (28.6), nodular infiltration in8 (22.9%) and opacities in6 (17.1%). CT findings were: basal infiltration in11 (31.4%), reticulonodular infiltration in 10 (28.6%), nodular infiltration in 8 (22.9%) and ground glass appearance s in 6 (17.1%). Histopathological examination (obtained from Open lung biopsy) results were: had usual interstitial pneumonia (idiopathic pulmonary fibrosis) 21(60%), 7 (20%) metastasis, 5 (14.3%) pulmonary TB and 2(5.7%) broncho-alveolar cell carcinoma.
Conclusion: Open lung biopsy can give a high diagnostic yield and confirm or alters the diagnosis in a significant number of patients with suspected interstitial lung diseases. The usual interstitial pneumonia pattern is the commonest histopathologic pattern seen in IL

Background: Glucose-6 Phosphate Dehydrogenase (G6PD) Deficiency is one of the commonest inherited enzyme abnormalities in humans, caused by many mutations that reduce the stability of the enzyme and its level as red cells progress in age.
Objectives: To determine the useful hematologic indicators of hemolysis, observe an early detection of G6PD enzyme deficiency (if any), and the available therapeutic measures.
Patients and Methods: 123 patients with G6PD deficiency and hemolysis after exposure to fava beans whom visited AL-Elwiya Pediatric Teaching Hospital from the 1st of February 2016 till 31st of May 2016 were entered this study retrospectively. Hemolysis laboratory indicators were observed. Management supportive measures were put in consideration also.
Results: We found that 10-20% levels of hematocrit and normochromic normocytic anemia were the most frequent on presentation, while a range of 15.1-20% of reticulocyte counts was the most common with lower rates in females group. Hyperbilirubinemia was seen with nil patients had abnormal renal function tests. About three quarters (76.4%) of the total number of involved cases had glucose-6-phosphate dehydrogenase (G6PD) deficiency.
Only 4 patients required no blood transfusion, 102 patients (82.9%) needed transfusion once, and the rest 17 (13.8%) had more than one blood transfusion. Most of cases (91.1%) recovered within the first 3 days. However; all cases were recovered by the fourth day of admission.
Conclusion: Hemoglobin and blood morphology with hyperbilirubinemia were useful hematologic indicators of hemolytic process, while blood transfusion was the most used therapeutic measure, and recovery was expected within 2-3 days.

Background: “According to the current knowledge, changes in lipid profile in pregnancy is a major contributor in the pathogenesis of preeclampsia. The present study was designed to compare the changes in lipid profile in normal pregnancy and in patients with history of recurrent pre-eclampsia (PE).”
Objective: Assessment the relationship between lipid profiles changes in women with history of recurrent preeclampsia in comparison to normal pregnancy in early pregnancy.
Patients and Methods: Measurement of lipid profile changes in women with history of recurrent preeclampsia (more than two preeclampsia in previous pregnancies) at 12 to 16 weeks of pregnancy and compared to normal pregnancy as a control group who does not have history of preeclampsia also early in pregnancy
Results: The patients with history of recurrent Preeclampsia had significantly higher mean total cholesterol level compared to controls (216.1 ± 25.5 mg/dl) and (195.6 ± 23.2 mg/dl), respectively, (P<0.05).The mean HDL cholesterol (HDL-C) level was significantly lower in PE group (49.3 ± 9.2 mg/dl) than controls (52.2 ± 8.4 mg/dl), (P<0.05). The mean level of LDL cholesterol was (122.3 ± 28.7) mg/dl in PE group and it was significantly higher than the (108.6 ± 26.8 mg/dl) of controls, (P<0.05). Similarly, the mean VLDL cholesterol was also higher in women with history of recurrent preeclampsia than control group, (44.8 ± 12.6) vs. (34.8 ± 7.3) mg/dl, respectively, (P<0.05). The Triglycerides (TG) was also elevated in women with history of recurrent preeclampsia where the mean TG level was (224.2 ± 63.1 mg/dl) compared to (174.6 ± 36.3mg/dl) in controls, (P<0.05).
Conclusion: “This study showed that the women who have history of recurrent preeclampsia had disturbed lipid profile (increased levels of total TC, TG, VLDL-C and LDL-C concentration) in addition to decrease the high density lipoprotein cholesterol (HDL-C) level in subsequent pregnancy compared to normal pregnancy.”

Background: Although, different protocols of chemotherapy are recommended for the treatment of metastatic breast cancer, still response rates are variable.
Objectives: The aim of this study is to investigate the effects and correlation of different chemotherapy administered to metastatic breast cancer patients on serum levels of some biomarkers.
Patients and methods: Thirty metastatic breast cancer patients were enrolled in the study. The patients received different protocols of chemotherapy. Blood samples were taken from the patients before and after the last cycle of each protocol and from 20 healthy control and serum levels of biomarkers IL-6, leptin, CA 15-3 and p53 were estimated by Elisa.
Results: The mean serum levels of IL-6, leptin, CA 15-3 and p53 were significantly (P ≤ 0.01) higher in patients before and after chemotherapy compared to controls. A significant (P≤0.01) higher mean levels of IL-6, leptin and p53 was found in the patients after chemotherapy compared to before chemotherapy with the exception of mean serum levels of CA 15-3 that did not differed significantly (P≥0.174) after chemotherapy compared to before chemotherapy. A significant correlation was found between hormone status and the mean serum level of leptin and between the mean serum levels of CA15-3 and IL-6.
Conclusion: The results highlights that the biomarkers IL-6, leptin, CA 15-3, p53 play a role in breast cancer progression and metastasis and could be helpful in predicting and monitoring chemosensitivity to these chemotherapeutic drugs.

Background: Rheumatoid arthritis is an autoimmune disease characterized by chronic synovial inflammation. The insufficient immune clearance of the apoptotic cell results into the formation of anti-cyclic citrullinated peptide antibodies which may play a critical role in the initiations of inflammatory responses. These antibodies together with Matrix Metalloproteinase-3 play an important role in joint destruction in rheumatoid arthritis disease.
Objectives: to study the value of anti-cyclic citrullinated peptide antibodies, and Matrix Metalloproteinase-3 in differentiation between active and inactive rheumatoid arthritis.
Patients and Methods: A cross- sectional study was conducted on 60 Iraqi patients with rheumatoid arthritis (16 males and 44 females) aging from 29 to 74 years who presented to the Rheumatology Consultation Clinic of Baghdad Teaching Hospital / Medical City during the period of July 2013 to the end of October 2013. The patients were divided, according to rheumatoid arthritis activity depending on Disease Activity Score 28 and erythrocyte sedimentation rate, into two groups: 30 patients with active rheumatoid arthritis and the other 30 patients with inactive rheumatoid arthritis. Quantitative sandwich enzyme immunoassay technique was used to measure serum level of anti-cyclic citrullinated peptide antibodies, and Matrix Metalloproteinase-3.
Results: The means concentration of anti-cyclic citrullinated peptide antibodies, and Matrix Metalloproteinase-3 were significantly higher in rheumatoid arthritis cases with active disease compared to those with inactive disease. The disease activity index DAS28 showed a statistically significant strong positive (direct) linear correlation with serum MMP3 (r=0.762) and serum ACCP (r=0.806). In addition, serum MMP3 showed a statistically significant moderately strong positive (direct) linear correlation with serum ACCP (r=0.64). Both serum MMP3 and ACCP had a higher validity than blood ESR (which is used itself in calculating DAS28) is predicting an active disease status.
Conclusion: Anti-cyclic citrullinated peptide antibodies and Matrix Metalloproteinase-3 could be useful biological markers for assessment of rheumatoid arthritis disease activity.

Background: Clostridium perfringens enterotoxin (CPE), which is one of the most common cause’s foodborne illnesses and contribute to diarrhea that is associated with broadspectrum antibiotic treatment.
Objectives: This study focuses on diagnosis of Clostridium perfringens enterotoxin (CPE) from patients suffering from food poisoning and diarrhea associated with antibiotic treatment cases in stool samples and to determine the resistance of isolated against antibiotics.
Methods: Samples were taken during the period of first of June 2015 until the end of April 2016 from Baghdad hospitals. Enzyme Linked Immunosorbent Assay (ELISA) was used to detect Clostridium perfringens enterotoxin in stool samples. Api 20A kit and culture to confirm isolation and identification was used, disk diffusion was performed for antibiotic resistance.
Results: The infection cases increased among old adult age group, were (8.7%) and their age range was (64≥) years old,and children (5.3%) their age range was(15≤) years old. Overall positivity was (23%) in present studied groups and infection increased with causes of food poisoning (61.5%).
Conclusion: This study revealed that the majority percent from age ≥64year (8.7%) and this percent decreased under this age. The future advances research should explain the epidemiology of enterotoxigenic C. perfringens and also participate to the prevention of C. perfringens food poisoning outbreaks and other CPE-associated human diseases.

Background: The need for assisted reproduction technologies (ART) for the establishment of pregnancies has steadily increased worldwide. Therefore, it is of vital importance that an efficient sperm preparation technique used for retrieval of high-quality spermatozoa contributes to the creations of high-quality embryos, with high implantation potential.
Objective: to study the effect of swim up technique on human sperm motility and DNA integrity.
Subject and methods: A prospective study carried on 70 samples of human semen; each sample, divided into 2 parts, one part was prepared by swim-up technique and the other not, and then study sperm motility and DNA integrity in both parts. Sperm DNA integrity was determined using a modified alkaline single cell gel electrophoresis (comet) assay and acridine orange test (AOT), and motility was determined by light microscope.
Result(s): the results showed that swim up technique give a significant. increasing in motility percentage and a significant. decreasing in DNA damage (P< 0.05) than unprepared human sperm.
Conclusion(s): Swim up technique for sperm preparation is increasing motility and decreasing DNA damage.

Background: Vitamin D and Leptin appears to play a range of roles in beta cell growth and insulin secretion and most importantly interaction with other hormonal mediators and regulators of energy and metabolism. Objective: The aim of this study was to measure serum leptin and vitamin D levels and to investigate their relationships with vitamin D and other clinical laboratory parameters in patients with type II diabetes. Subjects and Methods: Blood samples were taken from 80 patients with type II diabetes mellitus encountered during their attending the Internal Medicine clinic consultancy in Ramadi Teaching Hospital and the National Diabetes Center for Treatment and Research at Al-Mustansiriya University and 60 healthy subject. From December 2014 to November 2015. Investigations included serum Leptin, 25OHD, Insulin, HbA1c using ELISA and biochemical test.
Results: The median concentration of serum 25 OH vitamin D of patients (15.70 ng/ ml) was significantly lower than healthy controls (20.27 ng/ ml). The rate of vitamin D deficiency (VDD) was significantly higher in patients (82.5%) than healthy controls (48.3%). The serum insulin and HOMA-
IR were significant increase in patients had vitamin D < 20 ng/ml when compared with an insufficient/normal group. There were no significant differences in leptin levels between type II DM and healthy control. Conclusion: These results strongly support the role of vitamin D deficiency and serum leptin in pathogenesis of type II diabetes.

Background: There are many sources for Leptin secretion, and it is activated by binding with its receptor known as leptin receptor, that play a role in male infertility.
Objective: To assess the levels of leptin and leptin receptors in seminal plasma among primary infertile men and its impact on semen parameters.
Patients and Methods: A case control study of 75 primary infertile males and 40 healthy individuals who were enrolled in this study during March 2013 to May 2013. Estimation of age, body mass index (BMI), semen analysis, seminal plasma leptin, leptin receptor and testosterone hormone concentration were done for all study subjects.
Results: Highly significant difference found in mean of semen parameters of infertile male compared with healthy controls. Mean concentration of seminal plasma leptin and leptin receptor of infertile men were significantly were elevated, while serum testosterone concentration significantly decreased compared with healthy control.
Conclusion: There is emerging evidence that the leptin concentration negatively impacts fertility through its correlation with age, BMI, testosterone hormone and semen parameters.

Background: Brucellosis (Malta fever) is one of the zoonotic diseases that endemic in all the world, this disease has a history from 1937 in Iraq when the microorganism was first isolated via an Iraqi clinician.
Objective: To demonstrate brucellosis infection among Iraqi provinces and reveal relationship between Brucellosis with seasons, residence place, gender and age of the patients. In addition to diagnosis of brucellosis from patients in Baghdad province suspects of infection by serological methods (Rose Bengal test) and culture method in diagnosis of brucellosis in human.
Patients and Methods: This cross sectional study was conducted at Iraqi hospitals in different Iraqi provinces. The blood sample (serum) was obtained from 1825 patients from different age groups after reported the patient history and diagnosed clinically to have Malta fever.
Results: During The study period in Iraqi provinces in 2015, One thousands and eight hundred twenty five patients were diagnosed clinically and serologically to have brucellosis infection. The infection is more predominant in rural females in the months of summer and among Iraqi Kurdistan people. In Baghdad regions the serologic test was positive in most cases (71.3%) while only 38.3% were positive for Brucella culture.
Conclusion: Our results indicate that patients were contact with infected livestock or suspected infection of Brucella like: goat, sheep, cow and buffalo located in epidemiological regions in Iraq province across the study period .

Background: Among many possible causes, CD14, CD 56, were implicated in immune mechanisms and might be involved in pregnancy loss. However the role of these Immunological factors have not been clearly elucidated. Some authors have shown that women with reproductive failure (such as spontaneous miscarriage) have increased CD14, uNK cells numbers, where as other authors reported no difference or even reduced numbers.
Objective: The aim of this study was to have an insight in a panel of the immunological factors shared in the placental microenvironment in an attempt to find a close relationships of these markers to the state of abortions.
Methods: Immunohistochemistry technique assay was used to detect CD14 and CD56 in 40 women with spontaneous miscarriage and in 40 healthy deliveries in Baghdad/Iraq.
Results: The CD56 protein detected as by IHC in 60.0% and 5.0% of miscarriage and healthy delivered women groups respectively which showed statistically Significant differences ( p<0.05) . The CD14 – IHC reactions were found in 37.5% and 7.5% of miscarriage and control placental tissues, respectively with statistically significant differences (p <0.05).
Conclusion: The increased expression of CD14 marker in the miscarriage patients as well as significant correlations of CD56+NK cells with the state of spontaneous abortion introducing these markers as a good immunological biomarkers for predicting possibility of abortions.

Background: Histamine is one of the biogenic amines that belong among the naturally occurring substances. It can be formed in food as a result of metabolic processes of microorganisms .If the concentration of histamine is above a normal level (5mg/100g) this could possiblydue to bacterial contamination of food harmful affect may occur.
Objective: The purpose of this study was to detect histamine forming bacteria and quantification of histamine in fresh meat product available in local meat markets in Baghdad.
Methods: Histamine level determination in some red meats product was performed by known colorimetric methods. This method enables a rapid and precise determination of histamine in many samples,I n this study, total number of ten red meat were collected from Baghdad local market. Meats were analyzed for histamine. Extraction and determination of histamine in all meat samples were made by colorimetric method.One gram of red meat samples were added to 99ml of sterile peptone water to make dilution 10-1, further dilution were made, 0.1 ml was put to inoculate selective culturemedia, incubated at 37C for 24 hours. Microbes which have beendiagnosed were aStaphylococcus spp.and Pseudomonas spp. by conventional methods.
Results: In this study histamine was detected in all red meat samples at concentration ranging from 0.87 to 17.30 mg/100g.Relatively, the histamine level was higher in amber, followed by Al-Hana and Al-murad. Histamine contents were established according to (WHO) regulation.Tested samples containPseudomonas spp. and Staphylococcus spp.
Conclusions: Regarding the presence of biogenic amines in meat, it also would be useful the studyof their role in formation of certain compound in meat and meat products.Contamination of red meat samples with Pseudomonas spp. May be attributed to cross –contamination

Background:Non-host-adapted Salmonella serovar Typhimurium is a facultative intracellular bacterium, which invades and multiplies within mononuclear phagocytes in liver, spleen, lymph nodes and Peyer’s plaques. Salmonella infection is a crucial medical and veterinary problem globally. S. Typhimurium causes various clinical symptoms, from asymptomatic infection to typhoid-like syndromes in infants or highly susceptible animals, for instance mice.
Objective: The present study was carried out to investigate the efficacy of anthrax protective antigen (PA)as a potent adjuvant mixed with killed Salmonella Typhimurium (S.T.) to enhance the immunization capacity of the last.
Materials and Methods: Two groups of mice were immunized with either the mixture of S.T. and PA or S.T. alone, in addition to a control group immunized with phosphate buffered saline. Skin test and ELISA test were performed to evaluate cell-mediated and humoral immunity, respectively.
Results: The mixture group showed the best results in cell-mediated immunity.Furthermore, ELISA reading 14 days from booster dose was higher in the mixture group than S.T. alone. The mixture revealed high Ab titres compared to control or S.T. cohort 53 days from the beginning of immunization.These results were verified by histopathological examination.
Conclusions: Our findings suggest anthrax PA as a suitable and robust adjuvant for inactivated Salmonella Typhimurium vaccine in mice.

Background: Diagnostic laparoscopy is the standard procedure performed as the final test in the infertility work up before progressing to infertility treatment, but it was found that laparoscopy may increase the risk of pelvic infection which is one of the causes of infertility either in men or women.
Objectives: To assess the cervix microbiologically in patients who were planned to have diagnostic laparoscopy as part of infertility investigations.
Patients and methods: A cross sectional study done at department of obstetrics & gynecology, Baghdad teaching hospital, Medical city, Baghdad, Iraq in 2013, over a period of 7 months, cervical swabs were taken from 30 women complaining of infertility, just before diagnostic laparoscopy was done for them. For these swabs; gram stain, culture for bacteria, PCR (polymerase chain reaction) technique for detection of Chlamydial infection, and direct microscopical examination for Trichomonal infection were done.
Results: We noticed higher percentage of cervical infections in patients who had past history of cervical cauterization, dilatation and curettage and / or hysterosalpingography.
Conclusion: Cervical swab for bacteriology before any uterine instrumentation should be done as a routine investigation.

Background: Since the discovery of penicillin and till now, antibiotics are considered the most important regime in treating bacterial infections, insipid the fast development of bacterial resistance to many antibiotics over decades. Methicillin resistance Staphylococcus aureus (MRSA) is one of these bacteria types that emerged resistance to all current antibiotic classes. Fortunately, many studies proved phototherapy as a promising supporting to antibiotics in clinical fields.
Objectives: The purpose of this study is to evaluate the effect of three lasers wavelengths (red, blue, and green) with 50 mW power density on the susceptibility of clinical MRSA isolates.
Materials and methods: 45 clinical identified MRSA isolates are exposed to 632, 532, and 405 nm (red, blue, and green) Diode lasers. The susceptibility tests with 12 antibiotics are determined by disk diffusion method and minimum inhibition concentration (MIC) tests.
Results: The results demonstrate an increasing in the clear zone of antibiotics for all the isolates, especially for the red wavelength which was more effective, rather than the blue and green lasers which come next respectively. The effective inhibition doses of the antibiotics are decreased for lasered MRSA. The red wavelength is again more effective than the two others lasers.
Conclusion: the visible laser wavelength (red, blue, and green) improved the in vitro action of the antibiotics against MRSA.