2016 Volume 9, Issue 1
The Effects of Schoolbags on the Health of Students Review Article
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s choolbags used by students has become the most popular means of carrying belongings to and from school all over the world. The aim of this study is to review the literature and to ascertain the recommended average weight of schoolbags in comparison to child Body Weight (BW), to describe the correct way of schoolbag carrying and to determine risk factors related to carriage of schoolbags in an attempt to suggest the alternatives to avoid or at least to reduce these drawbacks. The majority of reports indicated that schoolbag greater than the recommended weight (10% of student BW) for long period of time might affect the musculoskeletal alignment which will cause back pain, neck pain, and shoulder pain in addition to deformities in the stature. Recent literature focused on schoolbag weight, the manner and duration of carriage, the age and gender of the student which could affect the shoulders, cervical and thoraco-lumber spines of students. A general guideline of 10% BW was initially proposed by a Germans (Voll and Klimt) in 1977. Many of studies later on continued to recommend and emphasize that the schoolbag load should not exceed this limit. The best way to carry schoolbag is on both shoulders with well-padded straps and hip belts for proper distribution of the load. The duration of carriage is also an important factor influencing cervical and shoulder posture and could contribute to and maintain musculoskeletal symptoms. Student age was found to be significantly associated with developing musculoskeletal disorders, especially among adolescent children (11-14 years). Gender was another significant predictor with girls showing more symptoms than boys of similar age. Back pain is the most frequent musculoskeletal problem and shoulder pain was the second most common symptom among children. Preventive measures such as limiting carrying load and correcting way of carrying are multi-faceted and need to be implemented in cooperation between different authorities including the students and their parents, the Ministry of Education and media in order to achieve these goals.
No Tie Technique Using Harmonic Scalpel for Thyroidectomy Versus Conventional Technique (A Prospective Study)
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background: The pioneers of thyroid surgery, Theodor Kocher and Theodor Billroth, developed an acceptable technique of standardized thyroid surgery in the nineteenth century. It includes three basic principles: identification and ligation of the feeding vessels, identification and preservation of the laryngeal nerves and identification and preservation of the parathyroid glands. The basic surgical instruments have not significantly changed, the main innovations are new methods of coagulation and vascular section. Aim: to compare the outcomes of total thyroidectomy and lobectomy, utilizing the conventional hemostatic technique (CH) and harmonic scalpel technique (HS). Patients and Methods: This study was carried at Al-Hussein medical city. In one group the tie and ligature technique was applied and the new harmonic scalpel technique was applied to the other group. The study variables are: operative time, post-operative drainage volume, recurrent laryngeal nerve (RLN) status and total serum calcium level in total thyroidectomy group. Student’s t test was used to compare quantitative variables, chi square test was to compare qualitative variables. Results: Seventy patients were included in this study, 40 patients had total thyroidectomy, and 30 patients underwent lobectomy. The mean operative time, in the total thyroidectomy group, was 83.4±13.2 minutes versus 60.3±5.3 minutes in the CH and HS respectively. And it was statistically significant. In the lobectomy group, the mean operative Time was 47.8±7.3 minute versus 38.8±6.8 minute in the CH and HS respectively. It was statistically significant. Post-operative drainage, in the total thyroidectomy group, was 128.6 ± 11.1 ml versus 98.1± 10.3 ml in the CH and HS group respectively. In the lobectomy group, it was 116.4±21.1 ml versus 62.8±8.6 ml in the CH and HS group respectively. And both are highly significant. Regarding RLN palsy, in the total thyroidectomy group, 2 patients out of 20 with CH versus 3 out of 20 with HS, sustained RLN palsy but statistically was non-significant. In the lobectomy group, 2 patients out of 14 with CH versus zero out of 16 patients with HS sustained RLN palsy also was non-significant. Regarding hypocalcaemia, in the total thyroidectomy group, 4 patients out of 20 with CH versus 3 patients out of 20 in the HS group developed post-operative hypocalcaemia and was statistically non-significant. Conclusion: Harmonic scalpel is a relatively safe, effective hemostatic tool in thyroid surgery. Complications are no more than that of conventional hemostatic technique.
Intraoperative Comparison between Spinal and General Anaesthesia for Lumbar Laminectomy Regarding Effectiveness and Hemodynamic Stability in Karbala
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background: General anaestheia is the most frequently used method For spinal surgery. Neuraxial blocks have proved most useful in lower abdominal, inguinal, urogenital, rectal, and lower extremity surgery. Lumbar spinal surgery may also be performed under spinal anaestheia. Aim: To assess the notion that spinal anaestheia can be both safe and effective in the treatment of patients undergoing lumbar spinal surgeries. Methods: The study was performed in Al-Imam Al-Hussein medical city, Karbala, Iraq from April 2010 to April 2014, 60 patients in whom either spinal anaestheia SA or general anaestheia GA was induced to perform a lumbar laminectomy. Patients were matched for anaestheia-related class, age, gender and preoperative vital sign. Thirty patients in each group both groups were well matched. Results: The heart rate (HR) and blood pressure (NIBP) was higher in SA during induction, but they were higher in GA during surgery and recovery time. Recovery time was longer in GA group, patient and surgeon were more satisfy with GA p-value <0.05. Conclusion: Spinal anaestheia is a suitable alternative to general anaestheia for lumbar disc surgery, but need cooperative patient. Recommendation: Spinal anaestheia for spinal surgery is good choice for cooperative patient it’s better to avoid if surgical time might be prolonged or in risky patient.
Prevalence & characteristics of Myocardial Bridging in Patients Subjected to Computed Tomography Coronary Angiography in Iraq.
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b ackground: Myocardial bridge occurs when one of the coronary arteries tunnels through the myocardium rather than its normal course at the epicardial fat, so it will be compressed during systole. Myocardial bridging was first recognized at autopsy more than 200 years ago, firstly reported in depth in 1951, and was recognized angiographically in 1960. Computed Tomography Coronary Angiography “CTCA” has been accepted as a reliable noninvasive imaging modality for the diagnosis of MB Aim of the study: studying the prevalence & characteristic of myocardial bridge among patients Subjected to Computed Tomography Coronary Angiography “CTCA” in Iraq Subject & methods: The study was conducted on 154 patients examined by CTCA , 110 (72%) was male & 44(28%) was female , between January 2013 till December 2014. distribution of MB patients among age, sex, were identified, types of MB, Bridging characteristics ,Coarse of the bridging within the muscle , Length of the segment of the bridging, Site of the bridging at the main coronary arteries LAD, LCX, RCA, The location of myocardial bridges in the LAD was classified according to segmental involvement as proximal, middle and distal , Associated atherosclerotic among MB patients was estimated. Result: This study show that myocardial bridging is common congenital anomalies with total prevalence “41.55% “ , more commonly seen in male “70% of patient with MB“ than female “ 30% of patient with MB , with age distribution of 52+-11.4 y, the most frequently involved artery is the LAD (59 patient :92%) & the most frequently involved segment is the mid segment of the LAD “84.37% “, with variable length of the involved segment “(42 +/-17.8 ) mm ,the superficial type is more frequent (56.25%) than the deep (43.75%) & there is increase occurrence of atherosclerosis at the pre bridging segment (94.7%) & less at the post bridging segment (5.26%), while is not observed at the bridging segment itself. Conclusion: MB is common in Iraqi population; CTCA is useful for detection & characterization of MB & associated atheroscerltic changes
Correlation between Time Elapsed after Maxillary Teeth Extraction and Maxillary Sinus Pneumatization
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b ackground: Pneumatization is an activity that occur physiologically in all paranasal sinuses during the growing period, causing them to increase in volume. Pneumatization of the sinus after extractions can have various treatment-planning implications, such as reduction of the alveolar bone height available for implants, orthodontic miniscrew or complication in preprosthetic surgery. Aim of the study: To find the correlation between rate of pneumatization of maxillary sinus and time after extraction of the related teeth. Subjects, material and methods: A total of 96 panoramic radiograph used to measure the supero-inferior differences of the sinus floor position by using interorbital line and 2 zygomatic lines as a reference lines after one to more than 10 years of the unilateral extraction of one of the maxillary second premolar, first molar or second molar tooth of 48 experimental subjects to make a comparison with the contralateral 48 control subjects with bilateral present mentioned teeth. Results: 48 control subjects show no statistically significant mean difference between the one side and the adjusted contralateral side. There was statistically significant increase in the side of the missing tooth compared to that of the contralateral side. The site of the missing tooth is associated with an average increase in distance of 2.53mm from the comparable 0.22mm in the control subjects, and this change was statistically significant. There is a moderate strong positive linear correlation coefficient between time interval and maxillary sinus pneumatization r=0.45 P<0.001. Conclusion & discussion: The pneumatization of the maxillary sinus is related to the time interval since extraction. The longer the time interval the more maxillary sinus pneumatization.
Community Knowledge and Attitudes towards Pulmonary Tuberculosis in Kirkuk
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background: Tuberculosis is one of the primary public health problems in developing countries. Knowledge about the disease has been known to increase the risk of spreading the bacteria and the risk of developing the disease. Objectives: The objective of this study was to assess the level of Tuberculosis knowledge, attitudes among population in Kirkuk city. Subjects and Method: A community based cross-sectional study using structured questionnaire, 400 respondents were asked questions regarding cause, symptoms, method of transmission of pulmonary TB and their attitude to person infected with pulmonary Tuberculosis. Results: Most of respondents had heard of pulmonary Tuberculosis with males having better (though not significant) knowledge than females. Although attitude toward TB did not influence caring for sick relatives or friends, it impeded social interactions and marriage prospects with infected persons within the community Conclusion: Knowledge and attitude toward pulmonary Tuberculosis was generally good in this community. Efforts should be intensified by health authorities in the local government to raise awareness and knowledge of the disease, so as to improve social perception and early recognition of infection.
A study of clinical characteristics and psychosocial stressors in patients with conversion disorder
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background: Conversion disorder is the term used in the Diagnostic and Statistical Manual of Mental disorders-Fourth edition classification system (DSM-IV). It was coined by Sigmund Freud. Objectives: To study and stratify the clinical presentation and psychosocial stressors of patients with conversion disorder. Method: The sample is composed of 182 patients (52 males and 130 females) referred from emergency department to psychiatry outpatient clinic. DSM-IV criteria were used to diagnose conversion disorder. The Social Readjustment Rating Scale by Holmes and Rahe which ranks the effects of life events was used in our study. Results: (70.3%) of the patients presented with psychogenic non epileptic seizures. Of the referred cases, 76.9% have had previous history of the same condition and 31.9% had previous referral to psychiatrist. There was significant association between score interpretation of the Social Readjustment Rating Scale by Holmes and Rahe and age, gender, occupation, marital status and previous admission for the same condition. Conclusion: Episodes of conversion disorders are triggered by psychosocial stressors the severity of which does not seem to correlate with the risk of relapse. The highest incidence of conversion episodes were detected in married, unemployed young females with lower levels of education. The prognosis of those patients improves with early identification and proper psychiatric assessment and management.
Impact of Excess Androgenic Activity on Non-Fasting Serum Lipid Profile in Reproductive Age Women with Type 2 Diabetes Mellitus
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background: Type 2 diabetes mellitus (T2DM) is an endocrinopathy that affects people of different ages. It is among the components of metabolic syndrome which has broad health implications. Obesity, insulin resistance and hyperandrogenism coexist in T2DM, and could have independent and interactive effects on dyslipidemia manifested mostly by elevated low-density lipoprotein cholesterol (LDLc), triglyceride (TG) levels and decreased high-density lipoprotein cholesterol (HDLc). Aim of the study was to confirm the relationship between non-fasting TG, testosterone (Ts) and sex hormone binding globulin (SHBG) levels in reproductive age women with T2DM. Materials and Methods: Serum non-fasting lipid profile and sex hormone levels were measured in 40 female patients with T2DM and 35 normoglycemic women without a known family history of diabetes mellitus as a control group. Enzymatic colorimetric methods were used to measure the non-fasting lipids and blood glucose, while Eliza technique was used to measure testosterone (Ts) and sex hormone binding globulin (SHBG) by DRG-ELISA kit. Results & Discussion: There are significant elevations in triglycerides (TG) and atherogenic index (AI), with highly significant reduction in HDL-C, p˂ 0.001; in the patient group (women with T2DM) as compared to their control group .There were no significant differences in the mean total cholesterol (TC) and low density lipoprotein-cholesterol (LDL-C). As concerning sex hormones, there was a significant reduction in SHBG concentrations (p˂ 0.01) in T2DM women in relation to their normal glycemic control women. Serum total Ts levels showed no marked difference between the two groups, however it showed a significant correlation with the TG (p< 0.05) and AI (p <0.05) in the T2DM women. The free androgenic index (FAI) was significantly higher in the T2DM group and showed a significant correlation with serum TG. Conclusion: These results confirm the association of low SHBG with elevation in androgenic activity and non-fasting TG in the diabetic women with expectation of high risk of cardiovascular disease.
Relationship between Toxoplasma gondii and Autoimmune Disease in Aborted Women in Najaf Province
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b ackground:Autoimmune diseases are chronic conditions initiated by the loss of immunological tolerance to self-antigens. The pathogenic hypothesis comprises a complex interaction between genetic, environmental and hormonal factors. Aim of this study to assess the association between toxoplasmosis and some autoimmune diseases. Methods: A case-control study was conducted to estimate the association between toxoplasmosis and some of autoimmune disease including diabetes mellitus, rheumatoid arthritis and systemic lupus erythematosus. The present study was carried out on 48aborted women, and 21non-aborted women, all of these cases were limited to females only in the reproductive age (16-50 years).Toxo-IgM and Toxo-IgG antibodies were detected with (ELISA) (Human/ Germany) in both groups, and measure blood sugar, ACCP, and ANF. Results: The infections with toxoplasmosis were 5(17.9%) and 23(82.1%) among those with diabetes mellitus and rheumatoid arthritis disease respectively. However, none of the 8 women with SLE had toxoplasmosis, Furthermore; the results revealed that toxoplasmosis positive women were about 4.4 folds more likely to have RA. (OR= 4.4, P≤ 0.01). Conclusion: This research concludes that the primary or secondary infections with Toxoplasma gondii can mimicry immune response and make shift in the immune response to induce autoimmune disease.
Some Virulence Factors Genes and Phylogenic Groups of Uropathogenic Escherichia Coli (UPEC) Isolated from Karbala Patients
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background: Uropathogenic Escherichia coli (UPEC) is most important causative agent of urinary tract infection (UTI). This disease is still big health problem among human population in spite of scientific progress. Aims: aims of this study were to investigate the isolates of UPEC in patients with UTI, characterize the virulence factors and phylogenic groups among clinical isolates. Materials and Methods: A total of 150 urine specimens were collected from patients with UTI after establishing the diagnosis via investigation and clinical diagnosis in Al-Hussein Hospital, Gynecology and Obstetrics Hospital, and Children Hospital in Karbala province during the period from November 2013 to April 2014. Thirteen stool samples from apparently healthy individuals as control group were included. All E. coli isolates were identified by standard methods. Molecular diagnosis and characterization for virulence and phylogenic genes were detected by Multiplex PCR technique in medical researches laboratory of medical college at Karbala University. Results and Discussion: This study showed that 56/150 patients (37.3%) had UTI due to UPEC. The isolated UPEC were examined for the presence of the adhesion genes (Papc, Afa and Sfa) and the phylogeny groups’ genes by Multiplex PCR assays. The primers encoding virulence genes were tested against to all the 56 UPEC and 13 stool isolates. It was found that 27(48.21%) urine isolates carried just one virulence factor, of them 16(28.57%) isolates carrying papc, 2(3.57%) isolates carrying afa and 9(16.07%) isolates carrying sfa. No isolates out of 56 had carried all the three genes. However, no virulence factor was found in 24 (42.85%) isolates. Pap gene was found mostly in 7 isolates among patients aged (1-10 years) and (21-30 years); while, the prevalence of sfa gene was found in 7 isolates (50%) among patients aged (31-40 years); however, two isolates have afa gene it was in one isolate in each age group (1-10 years) and (41-50 years). The percentage of phylogenic groups of UPEC isolates belonging to B2 followed by D, A and B1, were 39.28%, 33.92%, 16.07% and 10.71% respectively; while in control group the results were A (53.84%), B2 (23.07%), B1 (15.38%) and D (7.69%). Conclusions: Its̓ concluded that the genes of virulence factors of UPEC isolates in patients with UTI were higher than in healthy persons. Significantly, E. coli strains responsible for UTI were far more likely to be members of phylogenic groups B2 or D than A or B1.
Co-localization of EBV and Expression of P16- Cyclin-Dependent Kinase inhibitor Protein in Tissues from Patients with Non- Hodgkin's Lymphoma
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b ackground: EBV has been classified as a group 1 carcinogen associated with a variety of lymphoid and epithelial cancers. EBV was evidenced as a monogenic virus from its ability to transform normal human B cells, resulting in immortalization of the infected cells. A tumor suppressor protein, P16, is a cyclin-dependent kinase inhibitor plays a critical molecular role in cell senescence, regulation of the apoptosis pathway and G1 cell cycle arrest. Aim of the study: To analyze the concordant frequency and impact of P16 protein expression and EBV infection on tissues from a group of patients with Non- Hodgkin's Lymphoma (NHL). Patients and methods: Forty-five (45) formalin-fixed, paraffin- embedded tissues from lymph nodes biopsies were enrolled in this study; (30) lymph nodes biopsies were related to patients with NHL and (15) lymph nodes autopsies have included as apparently normal control group. Detection of EBV was done by ultra-sensitive version of in situ hybridization (ISH) method whereas immunohistochemical (IHC) system was used to demonstrate the protein expression of P16 tumor suppressor gene. Results: Detection of EBV -ISH reactions in tissues with NHL was observed in 17 out of 30 (56.7%), while in the tissues from lymph nodes autopsies was detected in 6.7% (1 out of 15).Positive P16- IHC reactions were observed in 14 out of 30 NHL cases (47.1%). No P16 positive – IHC reaction was detected in healthy lymph node tissues in the control group. The differences between the percentages of EBV and P16 detection in NHL tissues and control tissues group were statistically highly significant (P value = < 0.0001). Conclusions: The significant protein expression of P16 tumor suppressor gene as well as EBV infection in NHL in our results could indicate that cell cycle dysregulation and EBV-related transformation are important events in the pathogenesis of subset of NHL.
Immunophenotyping of Mature B-Cell Neoplasms in Correlation with Morphological Diagnosis
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background: Mature B-cell neoplasms include a number of disease entities arising from mature B lymphocytes which involve primarily the blood, bone marrow (BM) and lymphoid organs such as the lymph nodes and spleen. Although there are difficulties in separating CLL from some NHL, the distinction is important because prognostic and therapeutic differences exist. Immunophenotyping (IPT) has become an essential tool to confirm the diagnosis and to separate CLL from other lymphoid malignancies. Objectives: To express the difference between the IPT& morphology with morphology alone to reach definite diagnosis in mature B- cell neoplasm. Methods: BM biopsies of fifty five adult patients with CLL and leukemic phase of NHL were collected from December 2010 to April 2011; fifty of them were retrospectively while five of them were prospectively collected. Results: In this study, Twenty six out of 29 CLL patients were confirmed as CLL by IPT while the rest three cases diagnosed as NHL rather than CLL and 25 out of 26 NHL cases were confirmed by IPT and only one case diagnosed as CLL. Conclusions: This study revealed that the IPT has important diagnostic role in the subclassification of mature B-cell neoplasms also revealed that the IPT technique in conjunction with morphology have more precise role than morphology alone in the diagnosis of mature B-cell neoplasms.
Relationship between Epistaxis and Hypertension
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background: Epistaxis is a common symptom of diverse conditions which may present as mild recurrent bleeds or severe life threatening rhinological emergency. Children and adolescent are more often afflicted with minor episodes of anterior epistaxis, whereas the incidence of severe posterior epistaxis is greater in those who are more than 50 years old. Hypertension has been considered to be a major cause of spontaneous epistaxis for a long time. However, particularly in the recent medical literatures, the relationship between hypertension and epistaxis appears to be more controversial. Objectives: To evaluate the relationship between hypertension and epistaxis and to compare the prevalence of the epistaxis in hypertensive patients with normotensive patients. Methods: A prospective study was carried out on 101 hypertensive patients (group A) and 152 normotensive patients (group B) who served as a control group at Department of Medicine and ENT, Al-Hussian Teaching Hospital, Karbala during the period January to July 2015. Data from epistaxis patients for both groups were collected. Results: Out of total 101 hypertensive patients, 61 (60%) were males and 40 (40%) were females (M: F=1.5:1). The age range was 33 to 86 years with a mean age of 58 years. Twenty-seven out of 101 hypertensive patients were found to have epistaxis. The control group (group B) were 152 normotensive patients; 104 male and 48 female (M: F=2.2:1), and only 28 participants have a history of epistaxis. The prevalence of epistaxis was not significantly higher among patients with hypertension compared to those without hypertension. Conclusions: We demonstrated that epistaxis was unlikely associated with hypertension, and that epistaxis was not initiated by high BP. However, epistaxis was more difficult to control in hypertensive patients.
Clinicopathological Profile of Patients with Unilateral Sinonasal Masses in Karbala
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b ackground: A variety of non-neoplastic and neoplastic conditions involving the nasal cavity, paranasal sinuses, and nasopharynx. Most patients present with complaints of nasal obstruction. Other symptoms include nasal discharge, epistaxis, and disturbances of smell, oral symptoms, facial swelling, orbital symptoms, and ear symptoms. The presence of unilateral symptoms or pathology is regarded with caution as sinonasal neoplasms which may also present during their early stages with subtle symptoms that mimic an inflammatory pathology. Objectives: The aim of the study was to analyze the histopathologic diagnosis of patients with unilateral nasal mass and identify their different clinical presentations. Methods: A cross sectional prospective study was carried out on 34 consecutive patients with unilateral sinonasal mass at Al-Hussein Teaching Hospital and Maythem Al-Tammar Private Hospital, Karbala between April to August 2015 focusing on patient’s age, sex, and complaints. . Clinical examinations and proper investigations were carried out for all patients. Biopsy was taken from all cases for histopathologic examination to confirm diagnosis. Results: Out of total 34 patients with unilateral sinonasal masses 25 (73.5%) were males and 9 (26.5%) were females (M: F=2.8:1). The age range was 7 to 60 years with a mean age of 29.2 years. Twenty two patients were found to have non-neoplastic unilateral conditions (64.7%), while 12 patients had neoplastic unilateral conditions (35.3%). Inflammatory nasal polyp was the most common condition in non-neoplastic group (59.9%). Inverted papilloma was the commonest benign neoplastic condition (17.7%), 3 cases of non-Hodgkin’s lymphomas (8.9%) represents the commonest malignant neoplasms among malignant neoplastic group and single case of adenoid cystic carcinoma. Conclusions: Sinonasal masses have various differential diagnoses that otolaryngologists have to consider this variability in diagnosis and treatment. Nasal obstruction is the most common symptom while epistaxis and extranasal symptoms like facial pain, dental and orbital complaints were found to be higher in the neoplastic conditions. The clinician must have a high index of suspicion to rule out a neoplastic etiology in all cases of unilateral nasal mass.