Print ISSN: 2706-6207

Online ISSN: 2664-3154

Volume 11, Issue 1

Volume 11, Issue 1, Winter and Spring 2013

Incidence of Birth Defects at Birth among Babies Delivered at Maternity and Children Teaching Hospital in Ramadi

Bilal Kh. Al-Obaidi; Najdat Shukur Mahmood; Fakhri Jamil Al-Dalla Ali

Al- Anbar Medical Journal, 2013, Volume 11, Issue 1, Pages 1-10

Background: Birth defects are an important contributor to infant morbidity and mortality among all racial/ethnic groups, and the 3rd leading cause of infant mortality after cancer and accidents in developed countries
Objective: To estimate the incidence of major and minor birth defects at birth and trying to identify some of possible associated factors.
Methods: Between the 1st of February/2009 and the end of October/2009, 1494 newborns were enrolled in this study in Al- Ramadi Maternity and Children Teaching Hospital was examined for birth defects. Full information regarding the mother, newborn, and some socio-demographic factors were recorded after interview of the mother, and full examination was done by the investigator.
Results: Forty-seven newborns (31.46/1000 total birth) had birth defects. The incidence of major anomalies was 16.73 /1000 total birth and minor 14.73/1000 total birth. Among total births, the most common system involved was genitourinary system (27.7%), followed by central nervous system (19.2%), musculoskeletal system (19.2%), oral anomalies (6.4%), skin (6.4%), and then the others. The incidence of birth defects was significantly higher in preterm infants, low birth weight infants, babies who were breech in utero, and in babies of mothers in both extreme age (below 20 and above 35 years), or had bleeding during pregnancy, urinary tract infection during pregnancy, and polyhydramnios or oligohydramnios.
Conclusion: The incidence of birth defects is alarmingly high in Al- Ramadi city. The catastrophically successive wars imposed on Iraq undoubtedly have played some role in this problem. Attention should be made for defects at birth in genitourinary system, central nervous system and musculoskeletal system, however defects of cardiovascular system, and internal gastrointestinal tract may be evident sometime after birth

Effect of Tramadol on Ovine Ureteral Smooth Muscle Contractility: an in vitro Experimental Study

Atheer K. Zgair; Majid A. K. Lafi; Jamal A. Noman

Al- Anbar Medical Journal, 2013, Volume 11, Issue 1, Pages 11-16

Background: Tramadol was recently suggested to be an effective and relatively safe pharmacological treatment for pain and hyperalgesia in urinary colic from calculosis. It can apparently represent a valid therapeutic approach to this medical problem, especially in cases where conventional therapy cannot be applied. However, up to our knowledge, the in vitro effect of tramadol on ureteral smooth muscle contractility has not been investigated.
Objectives: The aim of this study is to investigate the effect of tramadol on the ovine spontaneous ureteral activity and attempt to determine its pharmacological basis.
Methods: In vitro experiments were performed on ureteral ring preparations in an organ bath. Contractions per minute (frequency) were calculated. The effect of tramadol, was obtained on its own and in the presence of naloxone, chlorpheniramine, phenoxybenzamine, atropine, or diclofenac; while, the effects of histamine, phenylephrine and acetylcholine (ACh) were recorded on their own and in the presence of their respective antagonists.
Results: Tramadol (50M) significantly enhanced the spontaneous rhythmic motility (1.21 ± 0.25 to 3.3 ± 0.54). Further, naloxone (2M), chlorpheniramine (M), atropine (M), or diclofenac (10M) failed to inhibit the excitatory effect of tramadol. However, phenoxybenzamine (1M) appreciably attenuated the excitatory effect of tramadol.
Conclusions: Tramadol produces substantial excitatory-ureteral activity by a mechanism that is still to be clarified and apparently not dependent on activation of opioid receptors, H1-receptors, muscarinic-receptors, or prostanoid synthesis and partly dependent on aminergic mechanisms

Reproductive factors and risk of breast cancer

Mahasin A. Altaha

Al- Anbar Medical Journal, 2013, Volume 11, Issue 1, Pages 17-26

Background: Breast cancer is the most common type of female cancer among Iraqi women. Some reproductive factors have been shown to be associated with an increase in breast cancer risk. There haven’t been any studies investigating the association between pregnancy outcome and breast cancer in Iraq.
Objectives: The aim of this study was to examine the possible associations between some reproductive factors as age of menarche, age at first delivery, parity and pregnancy outcome (i.e normal full term birth, abortion, premature delivery or multiple births) and risk of maternal breast cancer in AL-Anbar Governorate, west of Iraq.
Patients and methods: The study was conducted in the oncology clinic in AL-Ramadi General Hospital during the period from October 2011 to April 2012. The study consisted of 100 breast cancer cases confirmed on histopathology and 200 group- matched healthy controls. Bivariate analyses included odds ratio (OR); and 95% confidence interval (CI) for odds ratio were also performed.
Results: results showed that earlier age at menarche 30 years, and not having given birth were significantly associated with increased risk of breast cancer. With regards to birth outcome, full term birth was found to be associated with lower risk, the more the number of full term births, the more protection was found.
Premature deliveries < 8 months of gestation was found to be significantly associated with nearly three times risk compared to those with full term deliveries (O.R.=2.98, CI=1.60-5.56, p= 0.002), while premature deliveries > 8 months was not associated with risk, so as the effects of stillbirth. History of more than one abortion was found to slightly increase the breast cancer risk (O.R=1.24,CI= 0.70-2.18, p= 0.57). Having twin or multiple births were found to be protective against breast cancer (O.R=0.32, CI=0.12-0.86, p=0.019).
Conclusion: Risky reproductive factors for breast cancer included early age of menarche, late age at first full term birth, and nulliparity. More than one abortion seemed to slightly increase the risk, while on the other hand premature deliveries < 8 months significantly increased the risk of breast cancer. Pregnancy outcome in a form of full term birth, multiparty and twin births were protective against breast cancer

The Effect of Kisspeptin on Male Rat Reproductive System

Ziad H. Abd; Fakher Al-Ani; Yasir A. Hameed

Al- Anbar Medical Journal, 2013, Volume 11, Issue 1, Pages 27-36

Background: Kisspeptin (KP), a peptide secreted by the hypothalamic neurons, is a critical regulator of reproduction and puberty but its role in the regulation of gonadal maturation in sexually immature males is elusive.
Objectives: to investigate the effects of single dose of administration of KP on gonadotropins and testosterone release and maturation of immature rat male gonads.
Materials & methods: Kisspeptin-10 was administered intraperitoneally at different dosage concentrations (50 and 12.5 nmol) to 45 days old prepubertal male rats, as single dose. Plasma LH, FSH and testosterone concentrations were measured. Spermatogenesis was histologically studied.
Results: At the end of the treatments plasma LH increased significantly after 15 minutes, 6 hours and 24 hours. Testosterone concentration increased significantly after 15 minutes but decreased after 6 and 24 hours.
Histologically, there was an evident degeneration of seminiferous tubules showing tubular necrosis, multinucleated giant cell formation, intratubular vacuolization, widened lumen and deshaped germ cells. Marked microscopic changes characterized by enlarged intratubular spaces, degenerative tissues filling tubular lumen and disrupted germ cells were noticeable.
Conclusion: Pharmacological doses of kisspeptin-10 can cause induction of LH, FSH and testosterone and cause development of the spermatogonia but at high doses it causes testicular degeneration (dose dependent) in the prepubertal male rat

Advanced and conventional Molecular techniques in the diagnosis of Mycoplasma pneumoniae in patients with pneumoniae

Nidhal A.Mohammed; Mushtak T.S. Al-Ouqaili; Muntaha M.Hassan

Al- Anbar Medical Journal, 2013, Volume 11, Issue 1, Pages 37-46

Background:-M. pneumoniae is an important human pathogen that produces community-acquired respiratory tract infection. Diagnosis of M. pneumoniae infection is challenging and crucial for the timely initiation of the effective antibiotic therapy.
Objective: This study has been undertaken to detect M. pneumoniae in respiratory samples (throat swabs, throat wash and sputum) in patients with respiratory tract infection qualitatively by conventional polymerase chain reaction (PCR). Also, more advanced one, real time PCR was used to determine mycoplasmal target gene qualitatively and quantitatively.
Patients and methods: The study was performed on Seventy-five patients and thirty healthy subjects as control. Human genomic DNA was extracted and M. pneumoniae target gene (lipoprotein gene) was amplified using conventional PCR. Negative, positive controls and internal controls were involved in each experimental run. The amplified products were analyzed in 2% agarose gel and visualized using Red safe staining. In real time PCR, specific primer and probe mix depending on TaqMan® principle was used to detect P1 adhesion gene through FAM channel. A fluorogenic probe was included in the same reaction mixture which consists of a DNA probe labeled with a 5`-dye and a 3`-quencher. During PCR amplification. Data were analyzed using Smart-cycler software and M. pneumoniae DNA copy number was estimated from the cross point threshold relative to positive standard.
Results: Thirty five patients (45.5%) were positive by PCR and Thirty two (42.6 %) were positive by Real-time PCR. The highest rate of infection by using two molecular methods was of less than 20 years of age. The quantity of M. pneumoniae DNA target gene in positive Real-time PCR was ranged between 10-2000copies/µl.
Conclusion: The study concluded that both of molecular techniques conventional and real-time PCR are a rapid, reliable and ideal in diagnosis of M. pneumoniae using throat swabs, throat wash and sputum samples

Diclofenac-cefoxitin double-disk method is a novel tool for phenotypic detection of methicillin resistant Staphylococcus aureus: a preliminary report

Ammar Hekmat Auid; Majid A. K. Lafi; Saleem O.G. AL-Mawla

Al- Anbar Medical Journal, 2013, Volume 11, Issue 1, Pages 47-54

Background: the detection of methicillin resisatance is essential for both the institution of appropriate antimicrobial therapy and infection control measures. The development of largely divergent mecA genes by the new methicillin resistant Staphylococcus aureus (MRSA) made the present ‘gold-standard’ tests unable to determine whether they are MRSA or not. Therefore, there is an essential need to develop a new MRSA testing method.
Aim of Study: to demonstrate diclofenac (Dc) to be a very strong inducer of low expression methicillin resistance in MRSA.
Materials and Methods: standard disk diffusion method was performed for 26 Staphylococcus aureus isolates obtained from blood culture and wound swabs from patients admitted to Ramadi Teaching Hospital (from October, 2010 to March, 2011), against cefoxitin (FOX) 30µg disk, and MRSA screen test (Denka Seiken, Japan), as indicators to detect the presence of MRSA, and against selected β-lactam and non-β-lactam antimicrobial agents. Double disk tests (D-test) were performed to determine MLSB-inducible resistance mechanism and to assess the activity of Dc 50µg disk in approximation with selected antimicrobial agents.
Results: Both in complete agreement, FOX disk diffusion test and MRSA screen test revealed that 19/26 (73.1%) of the isolates appeared as MRSA, and 7/26 (26.9%) as methicillin susceptible Staphylococcus aureus (MSSA). In MRSA isolates only, Dc produced a paradoxical antagonistic effect upon combination with β-lactam drugs only, and this effect appeared in all the 19 MRSA isolates; while with non-β-lactam drugs, it potentiated their antistaphylococcal activity including inducible-MLSB isolates.
Conclusion: Dc is suggested to be a strong inducer of the expression of methicillin resistance. The use of Dc in detecting MRSA could be considered as a backup test with FOX to improve the accuracy of phenotypic detection of MRSA

Association Between Body Mass Index and Blood Pressure In Healthy Adults At Al-Ramadi City

Sami M. Awad

Al- Anbar Medical Journal, 2013, Volume 11, Issue 1, Pages 55-61

Objectives: To determine the association between body mass index and blood pressure among apparently healthy adults at Al-Ramadi City west of Iraq.
Methods: A Hospital-based cross sectional study of 250 apparently healthy adults was conducted during the period from the 1st of February to the 1st of October 2009 at the consultation Unit of Al-Ramadi Teaching Hospital. Tools of this study included self-administrated questionnaire, general physical examination, anthropometric and blood pressure measurement. Data were analyzed by using the statistical package for social science (SPSS program version -14). A p Results: A highly statistically significant association between body mass index (BMI) and increasing blood pressure (BP) was observed.
Conclusion: Obesity and overweight are among the several risk factors for the development of hypertension. Findings of this study support the recommendation of life style modification and weight reduction for obese or overweight subjects

Non-Hodgkin's Lymphoma: a Preliminary Morphometric Study

Aiad Abdullah Abdulrazak

Al- Anbar Medical Journal, 2013, Volume 11, Issue 1, Pages 62-68

Background: Assessment of nuclear morphology is crucial for the diagnosis of non-Hodgkin's lymphoma. However, it is often hampered by subjectivity and inter-obsever variation.
Objectives: This work is aimed at studying the usefulness of nuclear morphometry as an objective approach to the diagnosis of non-Hodgkin's lymphoma.
Material and Methods: Hematoxylin-Eosin stained sections from twenty-eight cases of non-Hodgkin's lymphoma was evaluated for nuclear size, area and perimeter by semi-automated image analysis system.
Results: The parameters related to nuclear morphology (nuclear size, area, & perimeter) of neoplastic lymphocytes were significantly higher in large cell lymphoma as compared to small cell, intermediate cell & Burkitt's lymphoma but, not for mixed cell lymphoma. This finding was further substantiated when calculating the overlap index.
Conclusion: This study supports the assumption that nuclear morphometry offers a more objective and reproducible diagnostic method for subcategorizing lymphoid tumors than is currently possible by conventional histopathological techniques

Beginning Steps in Construction of a Plasmid Free from Antibiotic Resistant Genes for DNA Vaccine

Evan L. Khaleef; Farhad Abdukarim

Al- Anbar Medical Journal, 2013, Volume 11, Issue 1, Pages 69-78

Objectives: Bacterial cell cultures containing antibiotic resistant genes represent a problem of growing concern. Spreading of bacterial genes encoding antibiotics resistance provides an environmental hazard, which is worsened by the release of antibiotics from the fermentation facility as well. This study has been undertaken to construct ,a new plasmid free from antibiotics to be used for DNA vaccine in the next future.
Subject and Methods: DNA vaccine has initiated a new era of vaccine research. Restriction enzyme and T4 DNA ligation from NEB were used for Restriction/Ligation of DNA and two PCR methods were used in this study long and short PCR. All plasmid and PCR products were analysed on 1% agarose gel.
Results: A plasmid free from antibiotic resistant genes was constructed from pBR322 by delete the bla gene by long PCR and tetr gene was deleted by direct repeat homologous recombination the final constructed plasmid is confirmed by gel electrophoresis in compare with two control, origin pBR322 and pBR322-∆amp in addition to specific lambda DNA marker.
Conclusion: It is concluded that the vector used as DNA vaccine which be free from antibiotic can play the same role as those contain antibiotic and eventually prevent horizontal separation of antibiotic resistant gene

Maxillary Arch Dimensions in an Iraqi Population Sample

Al- Anbar Medical Journal, 2013, Volume 11, Issue 1, Pages 79-84

Objectives: To determine the maxillary arch dimensions in an Iraqi (Salah Aldin city) sample aged (17-27) years with CL I(class one) normal occlusion and show the sex difference in this sample and compare these values of this group (males and females) combined with other studies in middle eastern population sample( Saudi and Egyptian population sample).
Materials and Methods: The observation concerning maxillary arch dimensions were taken from 80 study models (40males and 40 females) the measurement distances from canine to canine (C-C), molar to molar (M-M), molar to canine (M-C) and molar to incisor (M-I) according to Mack criteria . The measurements were made by means of vernier calipers with sharpened points to the nearest 0.05mm. Statistical analysis of the collected data was performed; the t .test was used when two groups were compared. level of significance was chosen (p<0.05,p Results: The greater mean values of inter cusp distances from canine to canine, molar to molar , molar to canine and molar to incisor were significantly higher in Iraqi males than Iraqi females , and this result is similar to result of sex difference in Saudi and Egyptian samples . While the comparison of the results of Iraqi and Saudi sample reveals no significant difference for Iraqi sample (both males and females )than for the Saudi sample (both males and females ) in all measurements except (C-C) distance which shows significant difference . While higher statistically significant differences in (C-C), (M-M) distances for Egyptian sample than Iraqi sample while (M-I) difference is greater in Iraqi sample than Egyptian sample.
Conclusion: The Iraqi maxillary arch dimension was greater in males than in females.There is a similarity between the Iraqi and Saudi maxillary arch dimensions, except a very little difference in (C-C) distance. The Egyptian maxillary arch dimensions (African group)was greater than that of the Iraqi sample (Asian group ) except in (M-C) distance which has no difference ,while (M-I) distance the difference is greater in Iraqi sample than Egyptian sample

The Value of Isolated Nipple Discharge a Retrospective Analysis of 46 Cases

Yahia Hameed Majeed

Al- Anbar Medical Journal, 2013, Volume 11, Issue 1, Pages 85-90

Background: Nipple discharge is one of presenting symptoms of breast disease. It accounts 6-10% from the total presenting diseases of the breast. It's horrible to the patient and dilemma to the surgeon if presenting alone.
Aim: To evaluate the significance of isolated nipple discharge.
Patients and methods: The data of 46 patients with isolated nipple discharge in medical city and Al-Jamiaa private hospital in Baghdad from 1995-2005. All assessed triply to exclude those with other breast finding other than discharge.Thier discharges were examined macro- and microscopically. All patients subjected to radical sub-areolar microduchectomy (Hadfield), and the histopathological results of specimens were reviewed.
Results: Macroscopically nipple discharge either bloody 21 cases or non-bloody 25 cases. Microscopically; 26 cases were RBCs+ ve, one of them reported as invasive ductal carcinoma, ductal papilloma was the most prevalent underlying lesion. The remaining RBCs-ve cases 20 there were 4 malignant cases, 2 cases ductal carcinoma insitu, 1 case lobular carcinoma insitu and 1 case invasive ductal carcinoma. Ductal papilloma was also the most prevalent underlying lesion.
Conclusion: Nipple discharge is an important sign of underlying breast disease whether bloody or not. Not all non-bloody discharges are RBC free. In the absence of the organic lesion in the breast it is important to analyze the discharge cytological

Pelviureteric Junction Obstruction in Partial Duplex System Involving Both Moieties: A Case Report

Azzawi M. Hadi Aljumaily

Al- Anbar Medical Journal, 2013, Volume 11, Issue 1, Pages 91-93

The most common congenital abnormality of the urinary tract is a duplex kidney. Pelviureteric junction obstruction (PUJO) is a rare association that can affect the lower moiety of incomplete duplex kidneys. We report a case of PUJO of both upper and lower moiety in a partial duplex kidney. We describe the imaging appearances of this rare association and the operative procedure we used to reconstruct this rare anomaly