Published: 1/7/2015 – Start page 99 , End Page -182
Vol.57. Issue , No. : 2. , 2015
Article title : Review Of surgery of VSD in Ibn Al-Nafees Teaching Hospital Description :
Adel Kh. Dawood* MBChB, FICMS
Background: Ventricular septal defect (VSD) is the most commonly recognized congenital heart defect. Isolated VSDs represent about 20-30% of all congenital cardiac malformations and have a prevalence of 1- 2 % per 1,000 live births.
Objective: This study is planned to review the outcome of surgical closure of VSD at Ibn Al-Nafees Teaching Hospital (Department Cardiac Surgery) Baghdad/Iraq.
Patients and methods: This study includes 50 cases of VSD both isolated and VSD associated with other congenital malformations admitted and underwent surgical repair of age range between 3 to 28 years and weight range between 9 to 80 kg. Different type of VSD, were found and repaired whether isolated or with other associated congenital anomalies which dealt with at the same time.
Results: The following VSD types were found: 40 peri- membranous 80%, 3 outlet 6%, 5 inlet 10% and 2 muscular 4%. Additional surgery were 3 pulmonary valvotomy 6%, 3 right ventricular outflow patch 6%, 7 closure of atrial septal defect 14%, 2 excision of subaortic ridge 4% and 2 aortic valve replacement 4%. One patient required reoperation for bleeding. Four patients had complete heart block that required temporary pacemaker. Over all operative mortality were two cases (4%), median postoperative hospital length stay was 7 days (range 5-18 days).
Conclusions: Surgical closure of VSD is a safe and effective therapy in isolated VSD or VSD with other malformations and reoperation is minimal. Other cardiac malformations can be repaired at the same time with the closure of VSD with good results and very minimal complications.
Key wards: Ventricular septal defect, pulmonary hypertention, cardio- pulmonary bypass.
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Article title : Sciatic nerve injection injury in children: Management and outcome Description :
Tarik A. Wahid* FRCS
Ali T. AbdulWahid ** MBChB, FIBMS
Background: Sciatic nerve injury is a common complication following IM gluteal injection in children. A controversy still exists regarding management and outcome.
Objective: To find the outcome of conservative and surgical treatment and compare it with other studies.
Patients and Methods: This is a retrospective study of 24 children( less than 15 years old) with sciatic nerve injection injury at the gluteal region. The child age, gender, type of injection drug, time of injury with complete neurological examination and EMG study were recorded. Conservative treatment including physiotherapy and surgical treatment including surgical exploration and neurolysis at the buttock region were done with follow-up 6 months to one year.
Results: Patient's age ranged from 6 months to 15 years; there were 18 male and 6 female. The most common IM drugs are analgesic in 40% and antibiotic in 18%. Neurological complaint was 22 foot drop (33.3%) and pain in 2 patient (8.7%). Surgery was done in 16 cases (66.6%) and 8 patients (33.3%) were treated conservatively . Outcome of surgery was good in (62.5%) and poor in (37.5).
Conclusions: we recommend surgery 2-3 months after conservative treatment including physiotherapy, analgesia, and EMG follow up, if no neurological recovery occurred. The outcome of surgery was good in the child with sciatic nerve injection injury
Key Words: sciatic nerve, Intramuscular injection, injury, gluteal region.
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Article title : loose Seton in management of high anal fistula. Description :
Nabeel J. Sagban CABMS, FIBMS, MBChB
Background : The treatment of complex (high) anal fistulae needs to balance the occasional conflicting outcome of cure and continence. There is a multitude of surgical treatment options available for high fistula-in-ano. The best surgical operation for high anal fistulas is difficult to nominate because they have varying cure and incontinence rates . A loose Seton is a loop of flexible material (silastic tube, silk, nylon) placed through the fistula track to allow drainage by keeping the external skin opening patent . Some surgeons use the loose Seton to allow drainage and others believe that it promotes healing by inducing fibrosis
Aim: The efficacy of use of loose Seton in management of high anal fistula.
Patient and method: A prospective cohort study of 26 patients with high anal fistula managed by loose Seton placement between February- 2009 and February-2010 in 3rd surgical unit, fifth floor, Baghdad teaching Hospital The seton is removed after 3 months in outpatient clinic, follow up for 6 months.
Results: Out of these 26 patients, 23 were males and 3 were females, the male to female ratio was 7.7:1. Peak occurrence was noted between 30 to 40 years. Minor incontinence was noted in two patients, these patients lost control of flatus which persisted for 4 months. No fecal incontinence noticed in any patient. .In twenty one patient the fistula were successfully eliminated (Successful rate =81%) by loose Seton treatment alone, while recurrence fistula in five patients (Failure rate =19%).
Conclusion: The use of one stage loose Seton is safe and effective in the treatment of high anal fistula.
Key words : Seton , high anal fistula.
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Article title : Old patient migraine in comparrision with younger adult migrain Description :
Akram M.AL-Mahdawi* CABM, FRCP
Gheyath Al Gawwam** FIBMS
Saad Hadi Al-ANI*** FIBMS
Background: Migraine is a common chronic episodic disabling primary headache disorder. Migraine can affect all age groups elderly and young age with different presentation of symptoms between two age groups. The prevelance of migraine is highest between 20 and 55 years peaking at age around 40 years of age and the declines thereafter, however the primary headache disorder does also exist in older population.
Objective: This study was undertaken in order to find out the differences in the characteristics of migraine headache between elderly and young for easy diagnosis and treatment.
Patient and Method: We retrospectively assessed subjects seen from March 2010 to October 2010 in Baghdad Teaching Hospital neurology out-patient clinic. We applied a questionnaire based the criteria of episodic migraine headache (with and without aura) according to the international Classification of headache disorder; we elect 50 migrainous patients with age < 50 years old and compare them with other 50 migrainous patients > 50 years old..
Results: headache was more unilateral in the young group (84%) compared with ( 52%) in older patients (p=0.001). Throbbing headache and disability had been reported less in old group than in young .Pain aggravation with activity was significant more in the young group (p=0.004), the duration of pain was less in the elderly .The number of attacks also less in general when compared with the young. The presence of aura in the older group (12%) versus (24%) in young. Photophobia and phonophobia were less in elderly (P<0.0001), (P<0.0001) respectively. While nausea, diarrhea, rhinorrhoea, tearing eyes were more in older group than young. Vomiting (P=0.025) and sleeping late (as a triggering factor) (P=0.017) were more prominent features in young than older group.
Conclusion: The study showed a decrease of most features in the above 50 years old group whether the differences are significant like (unilateral site of pain ,aggravation with activity, Sleeping late, Photophobia, Phonophobia, Vomiting ) and no statistical significant differences like (nausea , tiredness, hungry, uncomfortable sleep, food and need rest).
Key words: Migraine, elderly patient, Younger patient
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Article title : Relation between Gallbladder Wall Thickness, Assessed by Sonography, and Difficulties in Laparoscopic Cholecystectomy Description :
Majeed H. Alamiri* MBChB , DGS, FICMS
Muthanna K . Adwan** MBChB
Background: Laparoscopic cholecystectomy is the standard treatment for symptomatic gallbladder disease. Preoperative prediction of a difficult laparoscopic cholecystectomy can help the surgeon to prepare better for intraoperative risk and the risk of conversion to open cholecystectomy.
Objectives: Evaluation of the influence of gallbladder wall thickness, assessed by sonography preoperatively, on the outcome of laparoscopic cholecystectomy and to evaluate any intra- or postoperative complications in relation to them.
Patients and Methods: This prospective clinical trial conducted in Department of Surgery, Al-yarmouk Teaching Hospital, between October 2010 and October 2012.Abdominal sonography performed in 122 consecutive patients before laparoscopic cholecystectomy. The surgeon re-verified sonographic findings in the operating room.
Difficulty of laparoscopy was evaluated with multiple parameters related to the gall bladder wall thickness, so classified as easy or difficult laparoscopy or conversion.
Results: Out of 122 patients with cholecystolithiasis on sonography, we encountered straight forward laparoscopic cholecystectomy in 87 patients (71.31%), difficult laparoscopic cholecystectomy in 27 (22.13%) and the procedure was converted to open cholecystectomy in 8 patients (6.55%). 47 patients(38.5%) had sonography revealing gallbladder wall thickness (>3 mm), and 75 patients (61.47%) had wall thickness < 3mm .
Conclusions: Gallbladder wall thickening is the most sensitive indicator of technical difficulties during laparoscopic cholecystectomy. Such difficulties may require conversion to Laparotomy.
Key word: Laparoscopic cholecystectomy, gallbladder wall thickness
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Article title : The Efficacy of Solifenacin Added to Α-Adrenergic Antagonists in the Treatment of Lower Urinary Tract Symptoms in Males with Benign Prostate Hyperplasia (The Iraqi Experience) Description :
Nibbras I. AL-Hamdani* FICMS
Saad D. Daraji ** FICMS, FABU, FEBU
Ali W. Zeki*** FICMS
Background: The response of overactive bladder (OAB) symptoms seen in men with Lower urinary tract symptoms/Benign prostate hyperplasia (LUTS/BPH) raises the possibility that a combination of α-adrenergic blocker therapy with anticholinergic therapy could both reduce the risk of retention or deteriorating bladder function and also add to the treatment of the remaining obstructive symptoms of LUTS/BPH.
Objective: Is to investigate the efficacy and tolerability of 5mg solifenacin in the treatment of lower urinary tract symptoms in patients with benign prostatic hyperplasia in combination with an alpha-blocker.
Patients and methods: This is a prospective study of 29 patients with benign prostatic hyperplasia already on alpha-blockers, given solifenacin 5mg once daily. International prostate symptom score (IPSS), patient micturition diaries, quality of life index (QOL), post-void residual urine (PVR) and maximum flow rate (Qmax) and urodynamic findings were recorded before and after three months of therapy. Adverse events were documented.
Results: At baseline, the total IPSS was 15.3+5.7 that decreased to 10.8+5.3 (net change -4.5, P value <0.03). Although the mean IPSS for voiding symptoms was not significant, significant change was noted in the storage symptoms (from 8.4+2.4 to 5.1+2.5 P value <0.001). The quality of life index was significantly improved for the patients enrolled from 4.4+1.4 to 2.8+1.3. The maximum flow rate increased from 11.6+5.7 to 14.3+6.1 with a net change of +2.7 ml/sec (P value <0.01) ml/sec. Two patients stopped the medication because of side effects. The side effects included dry mouth (17.24%) followed by constipation (6.90%) then headache and blurred vision (3.45%) for each. No urine retention developed in any patient.
Conclusions: The use of solifenacin in selected cases in the treatment of LUTS in patients with BPH is highly effective addition to alpha-blockers.
Key words: Lower urinary tract symptoms, benign prostate hyperplasia, Anticholinergic medication.
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Article title : Do low back pain changes correlate with sagittal lumbar alignment changes after total hip replacement arthroplasty? Description :
Firas Abdalhadi Alobidi* FICMS ( Ortho.)
Background: The hip joint and lumbar spine are both anatomically and functionally closely related as had shown by many authors. So the abnormality in one area can affect the other e.g. hip joint osteoarthritis can cause lumbar sagittal malalignment and backache.
Objectives: is to see if there is significant improvement in backache after total hip replacement? And which degree of backache improvement is associated with significant changes in lumbar lordosis?
Methods and patients: a prospective open trial study was performed on 30 patients who had severe hip osteoarthritis and chronic low back pain. Total hip replacement was performed to all patients. Backache and lumbar lordosis were measured by visual analogue scale and Cobb's angle respectively both before and 6 months after surgery. Patients were divided into 3 groups according to grade of improvement in backache after surgery.
Results: The improvement in low back pain after surgery was statistically significant for all patients and for each group separately, while the changes in lumbar lordosis were not statistically significant neither for all patients nor for any group separately.
Conclusions: total hip replacement surgery has significant positive effect on backache. There is no significant correlation between improvement in backache and changes in lumbar lordosis.
Key words: low back pain+lumbar lordosis+hip replacement.
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Article title : Treatment of Forty Adult Patients with Hodgkin Disease; Baghdad Teaching Hospital Experience Description :
Mohammed S. Abbas* FICMS(Hemat.)
Alaadin S. Naji* FICMS(Hemat.)
Ahmed A. AL - Saffar* FICMS(Hemat.)
Mazin A. Shubbar* FICMS(Hemat.)
Bassam F. Matti* FICMS(Hemat.)
Adil Siwan* FICMS(Hemat.)
Ammar F. Majeed* FICMS(Hemat.)
Ali M.Jawad* CABM,FRCP
Background: Hodgkin disease was the first cancer in which the curative potential of combination chemotherapy was demonstrated. The affected patients are often young and there is a great potential for adding years of productive life by giving curative therapy even when the disease is advanced.
Objective: to describe the experience of the hematology unit,Baghdad Teaching Hospital, in the management of 40 adult patients with Hodgkin disease.
Patients and Methods: a retrospective cohort study of forty adult Iraqi patients with Hodgkin disease between 2005 and 2013 in the hematology unit. Patients were treated initially with 6-8 cycles of ABVD chemotherapy protocol (doxorubicine+ bleomycin+ vinblastin+ dacarbazine) , nine patients received additional involved field radiotherapy for residual masses or bulky disease. Overall survival and progression free survivals were estimated using Kaplan Meier survival plot.
Results: The mean age was 28.6±12.88 years with females forming 61.5% of patients, mean duration of follow up was 27.9± 20.6 months. Staging showed that 55% and 27.5% had stage II and III respectively. B symptoms were found in 72.5% patients , bulky disease in 42.5% patients. Complete Response+ Complete Response undetermined was seen in 85% of cases. First Relapse occurred in 14%, and death in 7.5% of the patients. The 8 year overall survival and progression free survival were 82% and 50% respectively while the mean overall survival and progression free survival times were 84.7 and 59.9 months respectively.
Conclusion: The results of the treatment of adult patients with Hodgkin disease in our unit is rather comparable to the results from other studies.
Key words: Hodgkin disease, ABVD, Survival.
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Article title : Antiphospholipid antibodies in forty young patients with stroke Description :
Khudhair A. AL- Khalissi* MRCP (UK)
Mohamed S. Abass** CABM, FICM Hem.
Ali A. Nabat *** CABM
Background: Cerebral ischemia associated with Antiphospholipid Syndrome(APS) is a common arterial manifestation in adults.
Objectives: To look for the frequency of Antiphospholipid Antibodies (aPL), and their relation with other risk factors in young patients with cerebral ischemia.
Patients and methods: A retrospective study of 40 young patient’s ≤ 50 years with stroke collected from medical and neurological wards of Baghdad Teaching Hospital (BTH) from January - December 2009. All were inquired about the presence of risk factors of stroke, and sent for aPL including Anticardiolipin (ACL) and Lupus Anticoagulant (LA).
Results: Eight (20%) had ACL. Nine (22.5%) had LA. Both were present in 6(15%). ACL and/or LA were present in 11 (27.5%). Thirty three (82.5) patients had at least one risk factor, 8 of them had aPL, while 7(17.5%) had no risk factor and only 3 of them had aPL (p 0.1806).
Conclusion: Antiphospholipid Syndrome is a possible risk factor of stroke and any young patient with stroke should be screened for aPL .
Key words: Stroke, Antiphospholipid Syndrome, Antiphospholipid Antibodies.
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Article title : AH jump as predictor for successful Ablation of atrioventricular nodal reentrant tachycardia (AVNRT) Description :
Ameen Al-Alwany* MBChB, MSc.MD, PhD
Hilal B. Al-Saffar** MBChB, CABM , FRC, FACC
Najeeb H. Mohammed** MBChB, MSc, DM., PhD
Background: Atrioventricular nodal reentrant tachycardia (AVNRT) is the commonest regular supraventricular tachyarrhythmia. Ablation in the area of slow pathway (SP) has been successfully implemented in every day clinical electrophysiological practice for more than 20 years. Although the procedure is generally regarded as effective and safe, data on long-term effects and predictors of success or failure are incomplete.
Objectives: This study was designated to prove that AH interval is an electrophysiological parameter which serves as a predictor for successful AVNRT ablation.
Methods: While performing an electrophysiological study using a programmed atrial stimulation, thirty nine (39) patients (25 female and 14 males) with a mean age 51 ± 16.7 years with AVNRT were assessed and underwent AVNRT radiofrequency ablation using diagnostic and ablation catheters inserted via the right femoral veins. This study was performed during the period from February, 2013 to march, 2014 at the unit of Electrophysiogy in Leipzig heart center.
Results: Acute successful AVNRT ablation was achieved in 39 (100%) patients, including 23 (59%) with slow pathway (SP) ablation and 16 (41%) with SP modification. Patients with SP modification were younger male, had faster AVNRT cycle length, and had more frequent isoproterenol usage before ablation. During
six months follow-up period, all patients experienced no AVNRT recurrences. .
Conclusions: AH jump served as predictor for successful Ablation of atrioventricular nodal reentrant
tachycardia with a better outcome.
Keywords: Electrophysiological study, AVNRT, AH Jump, catheter ablation .
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Article title : Evaluation of the outcome of myringoplasty in active versus inactive chronic otitis media without cholesteatoma Description :
Firdaws F. Ridha* CABMS , FICMS, ENT
Raed A. Khefi* CABMS, FICMS, ENT
Muhanned M. Alwan* MBChB
Background: Myringoplasty is a procedure used to seal(reconstruct) a perforated tympanic membrane using a graft material by underlay or overlay techniques . Temporalis fascia is the commonly used graft material.
Aim of study: to evaluate the difference in outcome of myringoplasty in cases of active and inactive chronic otitis media without cholesteatoma.
Patients and Methods: a prospective study of 54 cases of myringoplasty in adult age group whom age ranges from (20-40 years) and the duration of the disease ranges from (6-24 months). All patients were complaining of chronic otitis media without cholesteatoma assessed clinically, audiologically and radiologically, all cases operated under general anesthesia and temporalis fascia grafting (underlay technique) via post-auricular incision.
Results: twenty six (48.2%) patients had an active chronic otitis media without cholesteatoma while the remaining twenty eight (51.8%) patients had an inactive chronic otitis media without cholesteatoma those with an active disease 21 (80.8%) cases have successful closure of the perforation while in those 28 cases with an inactive disease 24 (85.7%) cases have successful closure of the perforation.
Factors of gender, age, side of the perforation, duration of the perforation, and the pre-operative management for the active ears had no significant effect on the outcome of myringoplasty, P values = 0.5, 0.1, 0.9, 0.5, 0.6, 0.6 and 0.7 respectively which are > 0.05.
The overall percentage of success of grafting was 83.3% and the failure of grafting was 16.7%.
Conclusion:- The activity of the middle ear (infection) has little impact on the success rate of closure of tympanic membrane perforation.
Key words: myringoplasty, active and inactive chronic otitis media.
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Article title : The role of Wilm̛̛s Tumor1 immunohistochemical marker in surface epithelial ovarian tumors Description :
Muna I. AL Hafedh* MBChB
Sahira A. Ali* MBChB, PhD( Pathology)
Lubab F. Talal* FICMS-Pathology (Histopathology)
Background: Wilms’ tumor 1 is a tumor suppressor gene. The gene is located in chromosome 11p13. And its expression was found in many solid tumors (including ovarian tumor) and also expressed in hematologic malignancies, Recent studies found that WT1 to be involved in angiogenesis.
Objectives: To evaluate the expression of WT1 in surface epithelial ovarian tumorand study the possibility of using WT1 as replacement of both;ovarian tumor marker CA125 and a endothelial cell phenotypic marker CD34.
Patients and methods: This is a study of a retrospective ( cross sectional ) of sixty cases with total abdominal hysterectomy and bilateral salpingo - oopherectomy collected from department of Histopathology – Teaching Laboratories / Medical City Teaching Hospital , as well as Al alwya hospital and Al Habibia hospital in Baghdad during the period of study from December 2007 to December 2012. Thirty cases diagnosed as surface epithelial ovarian tumors and thirty cases of histologically normal ovarian tissue which were included as a control group. Formalin - fixed, paraffin - embedded ovarian tissue blocks from 60 cases were used . Three section of 4 micron for each taken and stained with WT1, CD34, and CA125 immunohistochemical marker on positively charged slides.
Results: there were a significant correlation between expression of WT1 and histological types of surface epithelial ovarian tumor with a higher expression in serous tumors among other cancer types (P-value < 0.001).There was a significant positive correlation between the expression of WT1 and CA125 scores ( p-value < 0.001).There was a significant correlation between WT1microvessel density (MVD) expression and CD34- microvessel density (MVD) expression in ovarian tumors (P-value = 0.05).On the other hand, there were no significant correlation of WT1 with the age of cases (P-value = 0.9) and with the grade of ovarian tumors ( P-value = 0.23) .
Conclusions: The present study demonstrates high expression of WT1 in both tumor and endothelial cells in surface epithelial ovarian tumors, and it had dual usages in evaluation of both ovarian tumor cells and the vascular density. That was proved by demonstrating a significant correlation between WT1 and CA125 expression, and between WT1-MVD and CD34- MVD . There was no statistically significant association between WT1 expression and different tumor grades. There was significance differences in WT1expression among different histological subtypes of primary ovarian carcinomas, with serous carcinoma as the most frequent type.
Key words: Ovarian tumor; WT1; CA125; CD34.
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Article title : Evaluation of the proliferation marker Ki67 as a prognostic factor in patients with breast carcinoma Description :
Fatima S. Al-Sarraf MBCHB*
Issra A. Hussien MBCHB, FIBMS (Pathology)*
Background: Breast cancer is the most frequent cancer in women worldwide and in Iraq. Proliferation rates of neoplastic process can be useful in predicting prognosis, aggressiveness of cancers and to guide treatment protocols in clinical practice.
Objectives: To evaluate the role of Ki67 as a proliferative marker through analysing the associations between Ki67 with the clinic-pathological parameters, hormone receptors and Her2/neu expression.
Patients and methods: Forty paraffin blocks belonging to patient with breast carcinoma and ten blocks with benign diseases were included in this retrospective cross-sectional study and used for the immunohistochemical assessment of hormone receptors, Her2/neu and Ki67.
Results: Mean age of the malignant cases was (50.30±9) years; invasive ductal carcinoma was the main histopathological type (87.5%). Three quarters of the cases were with (Grade II) and (T2). Positive lymph node reported in (72.5%) of cases. Malignant cases positively expressed ER, PR, Her2/neu (score 3+) and Ki67 in (75%), (72.5%), (17.5%) and (75%) respectively. Luminal B subtype was the commonest among studied cases.
Conclusions: Ki67 proliferative index represented a valuable tool and provided information about aggressiveness and prognosis of breast carcinoma, significant correlations found between Ki67 and tumor grade, lymph node involvement and Her2/neu score.
Key words: Ki67, Breast carcinoma, prognostic factor.
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Article title : Evaluation of coeliac disease serological markers Description :
leen K. Kamil* MBChB ,FIBMS
Background: celiac disease, is an autoimmune inflammatory disease of the small intestine that is precipitated by the ingestion of gluten, a component of wheat protein, in genetically susceptible persons. Serologic tests for antibodies against Endomysium, Reticulin, and Gliadin identify most patients with the disease. Early diagnosis and management are important to forestall serious consequences of malabsorption, such as osteoporosis and anemia
Aims of the study: This study compared the sensitivity, specificity, and predictive value of, anti-reticulin and anti-gliadin antibodies according to anti endomysium antibodies , in consecutive patients investigated for celiac disease antibodies.
Patient& Methods: Total 509 patients (236 males&273 females) celiac disease patients who were referred to the immunology department in Teaching labs from January till December 2012 for serological detection of auto antibodies . Anti- Gliadin (IgG &IgA ) were measured by Enzyme Linked Immunosorbent Assay. whereas Anti-Endomyseal IgA & Anti-Reticulin IgA were detected by Indirect immunofluorescent technique on monkey oesophagus & kidney tissue respectively.
Results: Most the cases for celiac disease were reported in the age group (1-10)years as antibodies against Gliadin (IgG,IgA) ,Anti-Endomesial IgA antibodies and anti-Reticulin IgA were detected in 130(66.7%),127(65.8%),39(79.6%) and 49(68.1%) respectively. Both anti-Gliadin IgA and anti Reticulin were detected significantly in females p values( 0.047, 0.008) respectively. The study showed that anti-Gliadin IgA is the most sensitive according to anti Endomyseal IgA and anti Reticulin was the most specific for screening of celiac disease. ; While Receiver Operating Characteristic (ROC) curve showed that anti gliadin IgA had the best sensitivity and specificity according to anti Endomysium test results.
Conclusion: Predictive performance of the serological celiac disease tests showed that anti Gliadin IgA had the best sensitivity &specificity according to traditional anti Endomysium antibody test results.
Key words: Coeliac Disease Diagnosis, Endomysial Antibodies, Gliadin Antibodies, Reticulin antibodies
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Article title : The Importance of Auto-antibodies in the aborted Females with toxoplasmosis Description :
Suha A. AL-Fakhar* MSc, PhD
Raad A.AL-Asady** MBChB , PhD
Huda A. Rasheed*** MSc, PhD
Background: Antiphospholipid syndrome (APS) is an autoimmune`multisystem pathologic condition, characterized by recurrent arterial or venous thrombosis, pregnancy loss and thrombocytopenia. Also, APS were reported in many infectious disease including viral, bacterial, and parasitic infections (e.g.toxoplasmosis). There are however interesting association between the parasite response and specific auto-antibodies (aPL- serine Abs&aCL-Abs).
Objective: To represent the role of autoantibodies in association with toxoplasmosis in the occurrence of the recent abortion.
Patients and Methods: The present study included 76 women: 42women had recent abortion and 34 healthy women with no history of abortion, which constitute the control group, their ages ranged between (15-40) years. ELISA method was used for detection IgM-Abs of T.gondii, aPL-serine Abs and aCL- screen Abs. in the blood samples collected.
Results: It was found that there was a statistical, high significant correlation between antiphosphatidyl-serine Abs and anti-toxoplasma IgM Abs, P-value<0.05. While no statistical significant correlation was found between anti-cardiolipin screen Abs and anti-toxoplasma Abs IgM Abs,P-value >0.05.
Conclusion: Anitphosphatidyl serine –Abs in association with acute phase of toxoplasmosis had important role in recent abortion, more than the role of anticardiolipin Abs.
Keywords: APS&toxoplasmosis, antiphosphatidyl serine- Abs, anticardiolipin Abs & abortion.
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Article title : Experimental Study the role of LasA Protease of Pseudomonas aeruginosa in the Treatment of Bacterial Keratitis Caused by Staphylococcus aureaus Description :
Aida H. Al – saa'edi* BVM & MSc
Munera CH. Al – Abaadi** PhD
Jassim M. Karhoot*** PhD
Samira A. Funtil**** BSc
Background: LasA protease play a major role in the colonization of the bacteria to the cornea during bacterial keratitis by preventing other bacteria from colonization to the cornea, for example in the mixed infection with S. aureus the enzyme eradicate the bacteria by their lysis it and finally eliminate the competitive for P. aeruginosa bacteria.
Objective: To study the role of LasA protease of Pseudomonas aeruginosa in the treatment of experimental keratitis caused by S. aureus.
Patients and methods: One hundred - twenty clinical samples (corneal scraping) were collected from patients suspected with bacterial keratitis presenting to Ibn Al-Haitham Teaching Hospital from May 2013 until November 2013. The bacterial isolate of P. aeruginosa that harbored LasA gene and capable of production of enzyme was analyzed by Real - time PCR. LasA protease enzyme was extracted by cold centrifugation and purified by gel - filtration chromatography.
Results: The results of the experimental treatment of bacterial keratitis (in vivo) of infected rabbits eyes caused by S. aureus has showed that the efficacy of LasA protease was effective as Lysostaphin drug in eradicating the S.aureus from the infected corneas. While Vancomycin drug gave very little potency in the eradicating S. aureus from corneas in comparison with potency of LasA protease and Lysostaphin during this time but showed good potency with very late period ( approximately after 3 days) after application of treatment.
Conclusion: The current study revealed that the LasA protease efficacy in the experimental treatment of bacterial keratitis of rabbit's eye corneas was good and similar to that of Lysostaphin in eradicating S. aureus from corneas of these animals and was higher than that of Vancomycin.
Key words: LasA protease, treatment of bacterial keratitis, S. aureus.
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Article title : Evaluation of Human Urinary N-acetyl beta – D- glucosaminidase index in children with urinary tract anomalies Description :
Raghad J. Ali* BSc
Firyal H. Al-Obaidi** BSc ,MSc
Nariman F. Ahmed*** FICMS/PN,CABP
Hussein Hummdy**** MBChB
Background: The kidneys perform glomerular filtration, tubular reabsorption, and tubular secretion and the study of urinary excretion of some enzymes considered as a sensitive test for the detection of early stages of renal disease, particularly N-acetyl-β-D-glucosaminidase (NAG) which is a hydrolytic lysosomal enzyme present in the epithelial cells of the proximal convoluted tubule. Increased urinary NAG due to tubular damage could be used as a marker by a simple non invasive test for prediction of urinary tract problems like pelviureteric junction(PUJ) obstruction ,vesicouretric reflux(VUR) and pyelonephritis.
Objectives: to assess urinary NAG/ urinary creatinine (NAG/ Cr) ratio in children with different urinary tract anomalies and compare it with normal healthy children.
Patients and Methods: A prospective study was conducted from November, 2012 to April, 2013. Urine samples were collected from 51 patients with Urinary tract problems, and 40 healthy children as a control group, their age range (1month-13years). Children were admitted to Pediatric nephrology department, Children Welfare Teaching Hospital / Medical City Complex, Baghdad, Iraq. The Glomerular filtration rate was in normal range in all of them. Urine samples were tested for NAG by (ELISA,Cusabio ,China) while, both Serum creatinine (S-Cr) and urine creatinine (U-Cr) were estimated by Jaffe’s kinetic method.
Results: The current results revealed that NAG/creatinine index was significantly higher in patients with vesicoureteral reflux, Pelviureteric junction obstruction and pyelonephritis in comparison with cystitis.
Conclusions: The assessment of urinary NAG could be considered as a useful marker in prediction of the vesicoureteral reflux, hydronephrosis secondary to Pelviureteric junction obstruction .Urinary NAG is elevated in children with pyelonephritis and it can be considered as a further criterion in the diagnosis of upper urinary tract infection.
Keywords: Urinary N-acetyl-beta-D-glucosaminidase, urinary tract infection, vesicouretric reflux,hydronephrosis., Pelviureteric junction obstruction.
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Article title : Determination of Serum Adiponectin Levels in Normal Weight Women with Polycystic Ovary Syndrome Description :
Rana A. Hamdi * MSc in clinical biochemistry,
Nawar S. Mohammed* MSc in clinical biochemistry,
Afraa M. AL-Naddawi ** MBChB, CABOG, FIBOG
Background: Polycystic ovary syndrome (PCOS) is a common endocrine disorder in women of reproductive age with primary manifestations of infertility, menstrual dysfunction and clinical or biochemical hyperandrogenism (hirsutism, acne and elevated androgen).Adiponectin is the most abundant adipokine. It has insulin-sensitizing, anti-atherogenic, and anti-inflammatory actions.
Objective: Low adiponectin levels in women with PCOS have been largely attributed to obesity which is common among these patients. Therefore, the aim of this study was to measure adiponectin levels in normal weight women with PCOS and its contribution to development of disease.
Subjects and Methods: Fifty two (52) women were included in this study with age range (21-34 years). Subjects were divided into two groups: group A: twenty seven (27) women with PCOS and group B: twenty five (25) women without PCOS (serve as controls). PCOS can be diagnosed when two of the three following criteria are present (oligoovulation and/or anovulation, clinical and/or biochemical hyperandrogenism and polycystic ovaries as defined by ultrasonography).
Results: Mean serum adiponectin level was significantly lower in women with PCOS comparing to those BMI-matched controls (P=0.000).
Conclusion:Serum adiponectin levels are not independently determined by the degree of obesity in women but underlying disease may also have some role and this may due to insulin resistance in these patients thus determining serum adiponectin may serve as a useful marker in detecting cases of normal weight women with PCOS.
Keywords: Polycystic ovary syndrome, insulin resistance, adiponectin.
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Article title : The Impacts of Subclinical Varicoceles on Infertile Males Description :
Ibrahim J. Hammadi* MB ChB, MSc ART
Ghassan Th. Saeed** MB ChB, MSc PhD
Read How. Abed Tawney*** MB ChB, FICMs (Radiology)
Background: it is well known that the varicocele affects male fertility and had adverse effects on the findings of the standard seminal analysis. According to size of that veins; the varicoceles are divided into clinical that are discovered in physical examination and their harmful effects are proved and subclinical varicoceles that are only discovered by Doppler examination. And till now, the indication of surgery in cases of subclinical varicocele is still controversial because of poor information about the impact of those non-clinically founded blood vessels on the testicular function.
Objective: To assess the seminal fluid, testicular volume, and hormone levels in infertile patients with subclinical varicoceles.
Patients and methods: two groups were studied; 79 infertile patients with subclinical varicoceles and 50 healthy males with normal scrotal ultrasound were included as control group. Semen samples were collected from all subjects after at least 48 hours of sexual abstinence in sterile wide containers by masturbation and analyzed for sperm concentration and percentage motility according to WHO criteria (2010). Serum FSH, LH, and Testosterone (T) levels were assessed using Radioimmunoassay. Ultrasound examination was done to evaluate the pampiniform plexus caliber and also measuring the testicular size.
Results: LH and Testosterone levels were not statistically different among the two groups. FSH levels were significantly higher in infertile men with subclinical varicoceles than in control group (p<0.04). The testicular size was significantly smaller in subclinical varicocele group. Regarding the sperm concentration and motility, there were also significant lower percentages in infertile men with subclinical varicoceles (p<0.02) and (p<0.05) respectively.
Conclusion: Infertile patients with subclinical varicoceles have higher levels of FSH, smaller testes, and lower percentages of sperm concentration and motility.
Key words: Subclinical varicoceles, Testicular volume, FSH.
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