Table of content

Iraqi Academic Scientific Journal

المجلة العراقية للاختصاصات الطبية

ISSN: 16088360
Publisher: The Iraqi Borad for Medical Specialization
Faculty:
Language: English

This journal is Open Access

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E-mail:IPMJ2000@yahoo.com

Table of content: 2010 volume:9 issue:3

Article
Hypertension in Haemodialysis

Authors: Jawad K. Manuti
Pages: 225-228
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ABSTRACT: BACKGROUND: Relevant factors involved in the pathogenesis of hypertension among dialysis patients include sodium and water retention, dialysate composition and prescription, increased activity of vasoconstrictive systems(sympathetic nervous system, rennin-angiotensin system, endothelin and vasopressin), decrease activity of vasodilatory systems(nitric oxide, kinins), increased intracellular calcium, increased arterial stiffness, sleep apnea, hyperparathyroidism, erythropoietin and renovascular disease OBJECTIVE: The objective of this study is to assess the prevalence of hypertension among uremic patients undergoing haemodialysis and to assess difference of blood pressure reading before and after dialysis. PATIENTS AND METHODS: 140 patients with chronic renal failure ´ renal failure on regular haemodialysis. blood pressure was measured by doctors before dialysis, within 2 hour of dialysis , after dialysis and after 48 hours of dialysis. we averaged six routine predialysis systolic and diastolic blood pressure. The same was carried out for postdialysis. RESULTS: Patients with preheamodialysis (office BP) >130/85 mmHg are considered as hypertensive in chronic renal failure, who made up of 74% of the study population. 40% patients were on monotherapy antihypertensive drug. 65% are taking calcium channel blocker, angiotensin converting enzyme inhibitor 38%, angiotensin П receptor blockers 26% and beta blocker 20%. Preheamodialysis blood pressure(Office BP) overestimated BP values in relation to 48 h postdialysis CONCLUSION: Significant difference was shown between predialysis office blood pressure and 48 hour postdialysis in the recognition of hypertension in heamodialysis patients. the prevalence of hypertension in heamodialysis patients is high (74%). most of the patients used combination of antihypertensive drugs, calcium channel blocker commonly used 65%.


Article
Assessments of Predominance of Cardiac Autonomic Neuropathy in Iraqi Diabetic Subjects

Authors: Ghalib A. Al-Sharefi
Pages: 229-234
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ABSTRACTS: BACKGROUND: Autonomic nervous system is well known to be affected by endocrine diseases and metabolic disorders ,hyperglycemia plays an integral role in this aspect which might alter both sympathetic and parasympathetic components. OBJECTIVE: The study was designed to assess the cardiac autonomic neuropathy in Iraqi diabetic subjects and to determine which division will be predominent (sympathetic or parasympathetic). Settings Department of Physiology in the Medical College of AL Mustansyriah University and the Section of Neurophysiology in Al Yarmouk Teaching Hospital. PATIENTS AND METHODS: Sixty subjects with Type 1 diabetes mellitus and sixty with Type 2 diabetes mellitus were enrolled in this study and their studied parameters were compared to sixty healthy individuals free from glucose intolerance assured by normal Oral Glucose Tolerance Test(OGTT) were regarded as a control group .Cardiovascular autonomic tests for all subjects ( healthy and diabetics) were done by using Ewing's battery reflex tests. RESULTS: The results revealed the presence of significant difference between diabetic groups (type 1 & type 2) and control group regarding autonomic reflex tests including blood pressure response to standing and hand grip test (p>0.05) in type 1 DM and blood pressure response to standing (p>0.01) in type 2 DM. In this study 68.33% of diabetic subjects showed abnormal response to one or more of the performed tests. Also sympathetic involvement was found to be more common; (38.33%) for postural hypotension and (46.66%) for diastolic response to sustained hand grip testing while the parasympathetic division showed (32.75%) for valsalva maneuver and (31.66%) for beat to beat heart rate variation testing and (18.33%) for heart rate response to standing. CONCLUSION: Diabetes mellitus affects cardiac autonomic system adversely with predominance to sympathetic division more than the parasympathetic component and this affection is aided by the duration of diabetes. So better glycemic control can delay the occurrence of cardiac complications associated with diabetes mellitus and in turn may improve life expectancy in diabetic subjects.


Article
The Use of Peritoneal Flap in The Transabdominal Repair of Vesicovaginal Fistula

Authors: Hayder Mahdi AL-Aridy
Pages: 235-243
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ABSTRACT: BACKGROUND: Vesicovaginal fistula (VVF) represents a significant morbidity in female Urology. Although surgical success is achieved in the majority of cases, a 4 to 35% failure rate occurs when a transvesical or transvaginal approach is used. OBJECTIVE: The aim of the present study is to describe our experience and effectiveness of transabdominal repair of vesicovaginal fistula with peritoneal flap interposition. PATIENTS AND METHODS: A total of 18 patients with VVF (16 primary, 2 recurrent) were repaired transabdominally with peritoneal flap interposition at Al-Najaf teaching hospital , Iraq ,during the period from March 2007 to January 2010.Approaching the bladder transperitoneally with bivalving the bladder which separated from vagina to allow tension free closure in separate layers with interposition of peritoneal flap. The outcome was classified into sealed fistula (cured) and recurrent fistula(failed) and was carried out for all patients by thorough clinical assessment 4 weeks after removal of the catheter. RESULTS: The mean age was (39.33±10.19) years (range 25-62) and the parity ranged from 1 to 13 (mean 5.38±3.46) .(10) patients (55.55%) had VVF due to obstetric causes.(7) patients (38.88%) had VVF due to gynecologic causes.(1) patients (5.55%) had VVF due to Iatrogenic causes.The size of the fistula ranged from 1 cm to 12 cm (mean 3.94±2.65). The vesicovaginal fistula was successfully corrected in all patients at the first attempt. No significant bladder dysfunction or decrease in bladder capacity was seen after repair. CONCLUSION: A peritoneal flap for transabdominal repair of vesicovaginal fistula is safe and achieves excellent functional results.Although a high success rate of repair,we should focus attention on strategies of prevention.


Article
Brilliant Blue- Non Mercuric Schaudinn′s Fixative Solutions Wet Mount for Identification of Intestinal Parasites in Stool Specimens

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ABSTRACT: BACKGROUND: Definitive diagnosis of the intestinal parasites requires the demonstration of the organisms or eggs in feces or tissues. Stool specimens should be preserved , stained and microscopically examined. METHODS: Copper sulfate schaudinns fixative ( CuSO4SF ) solution and zinc sulfate schaudinns fixative ( ZnSO4SF ) solution were prepared, 2 sets of 5 concentrations (serially diluted ) were prepared first set Brilliant blue food color powder (B) was dissolved in CuSO4SF solution ( B-CuSO4SF ) solution second set Brilliant blue food color powder was dissolved in ZnSO4SF solution ( B-ZnSO4SF ) solution Merthiolate-iodine-formalin ( MIF ) preservative and staining solution (control solution) was prepared.  During one year 85 positive stool samples were collected from patients complaining gastro- intestinal tract disorder.  Stool-CuSO4SF suspension, stool-ZnSO4SF suspension and stool-MIF suspension were prpared from each stool sample.  Eleven slides were prepared from each stool sample and examined microscopically by wet mount technique,5 slides were prepared from each concentration, on a slide one drop from B-CuSO4SF and one drop from stool- CuSO4SF suspension were mixed. Another 5 slides were prepared from each concentration, on a slide one drop of B-ZnSO4SF and one drop from stool -ZnSO4SF suspension were mixed. One wet mount smear was prepared from one drop of stool-MIF suspension ( control test ). RESULTS:  Both solutions B-CuSO4SF and B-ZnSO4SF were showed similar results, these two solutions were very efficient in preserving and staining trophozoites and cysts of intestinal protozoa, helminth eggs and non parasitic findings in the wet smear of stool specimen during 24h.  The most appropriate concentration for two solutions were 0.2%wt/vol B-CuSO4SF and 0.4%wt/vol B-ZnSO4SF  During one year B-CuSO4SF and B-ZnSO4SF were very efficient in staining of the intestinal protozoa and helminth eggs. CONCLUSION: Both 0.2%wt/vol B-CuSO4SF and 0.4%wt/vol B-ZnSO4SF solutions may be considered as an efficient one step rapid, safe and economical stain of wet mount stool smear for using in the identification of the intestinal parasites


Article
Estimation of Immunoglobulin (IgG and IgM) in Hepatitis B Virus Infected Patients and Individuals Vaccinated with Recombinant HB Vaccine

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ABSTRACT: BACKGROUND: Hepatitis B virus (HBV) infection is a major public health problem. Successful clearance of the virus depends on a complex interaction between the virus and the host immune response. OBJECTIVE: The purpose of this study was to assessment of some immunoglobulins (IgG and IgM) in hepatitis patients and vaccinated groups compared with healthy control. METHODS: Study groups were classified into patient group 35 (15 acute (AC) and 20 chronic (CH)) and 35 vaccinated group (20 responder (RD) and 15 Non-responder (NRD)) and 18 healthy non vaccinated control group (HN). This study extended through a period from May to November 2007. Blood samples were taken from patients and hospitals staffs in Nanakaly, Erbil and Rizgary Teaching Hospital/ Erbil/ Iraq to detection of IgG and IgM level in serum by immunoturbidimetric test. RESULTS: The mean serum IgG level significantly increased in CH patients (p<0.05) compared to AH and HN control groups, in contrast IgM level increased high significant (p<0.001) in AH than CH and HN groups. No significantly differences in serum immunoglobulins (IgG and IgM) between vaccinated individuals and HN group (p>0.05). CONCLUSION: Present study indicate that serum IgG level was higher in CH patients whereas IgM level increased in AH. No significant differences in their levels were observed between vaccinated individuals and HN group.

Keywords

hepatitis --- immunoglobulin --- chronic --- acute --- vaccine


Article
Cephalosporins Susceptibility Test in Urinary Tract Infection

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ABSTRACT: BACKGROUND: This study was conducted at the Al-Kindy Teaching Hospital to determine the resistance patterns to cephalosporins of members of the family Enterobacteriaceae isolated from urinary tract infections (UTIs). A total of 270 urine specimens were collected from February, 2008 to May, 2008. OBJECTIVE: Determination the Resistance patterns to cephalosporins in Enterobacteriaceae isolated from urinary tract infection. METHODS: Urine specimens were processed for culture, and susceptibility testing using Kirby-Bauer method. The minimum inhibitory concentration (MIC) was determined by twofold dilution. RESULT: Escherichia coli was found to be the most organism, followed by Klebsiella spp. The results of susceptibility of isolates under study to different cephalosporins were moderately or highly resistant to many of the test agents. The observations on the minimum inhibitory concentrations (MICs) and minimum bactericidal concentrations (MBCs) for the cephalosporins explained the high level of resistance to cephalothin and cefaclor, and a moderate level of resistance to cefotaxime, ceftazidime and cefixime. CONCLUSION: The increasing MIC of cephalosporins, especially third generation, indicates decreasing susceptibility of these organisms to these types of β-lactam agents due to the production of extended spectrum β-lactamases (ESBLs).


Article
Prostate Specific Antigen in Polycystic Ovary Syndrome

Authors: Sanaa M. Ali Hadi --- Ansam Al- Bayatti --- Nuhal Jebri
Pages: 270-273
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ABSTRACT: BACKGROUND: Polycystic ovary syndrome (PCOS) is the most common cause of hyperandrogenism, and anovulatory infertility; it affects 5-10 % of females at their reproductive age. Prostate specific antigen is a glycoprotein that is secreted from the prostate in males and from paraurethral glands and breast in female. OBJECTIVE: To evaluated the total and free prostate specific antigen levels in female with PCOS, and find out its relation with FSH, LH, Prolactin and testosterone (F,T). METHODS: Eight patients with PCOS diagnosed based on three criteria * High LH: FSH ratio; LH luteinizing hormone to FSH follicle stimulating hormone is 2:1 or more particularly in the early phase of menstrual cycle (3-6) day. * Ultrasound reveals polycystic ovaries * Biomedical hyperandrogenism. ; Elevated androgens particularly free testosterone. Forty normal fertile females served as a control group in this study . Blood samples were taken from all individuals from 3-6 day of menstrual cycle to measure total and free prostate specific antigen, total and free testosterone ( by enzyme linked immunosorbent assay) and FSH,LH, Prolactin (by Immunoradiometric assay). RESULTS: Patients with PCOS and controls differed significantly in all parameters studied, except FSH (P >0.05). LH and LH: FSH ratio were significantly elevated in PCOS group compared to normal control group (11.9±5.4 vs. 7.0±0.6) and (2.3±1.1 vs. 1.2±0.1) respectively. Total and free testosterone were significantly elevated in patient with PCOS compared to normal control group (50±9.6 vs 24 ±3.4 ) and (8.9 ±1.0 vs 1.9±0.4) respectively . Total and free PSA significantly elevated in patient with PCOS compared to normal control group (1.2±0.4 vs 0.1±0.02) and (0.04±0.01 vs 0.01±0.003) respectively. Positive correlation between T-PSA, F-PSA and T-testo, F –testo CONCLUSION: Total and free serum prostate specific antigen levels are higher in patient with PCOS. Serum PSA measurement might be marker of hyperandrogenism in females suffering from PCOS


Article
Histopathological Interpretation of Abnormal Uterine Bleeding After the Age of 40 Year

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ABSTRACT: BACKGROUND: To delineat the frequancy and pattern of uterine lesions which result in abnormal uterine bleeding (AUB)after the age of 40 years. OBJECTIVE: To delineat the frequancy and pattern of uterine lesions which result in abnormal uterine bleeding (AUB after the age of 40 years) and to compare the result with other similar studies METHOD: Histopathological examination of the tissues obtained by curettage and/or hysterectomy play an important role in the diagnosis of the lesions which cause AUB.. RESULTS: Organic intrauterine lesions was found in 69 (19%) of the cases. These included chronic endometritis (7.7%), endometrial polyp (6%), malignancy (3.9%) and submucous leiomyoma (1.4%) .On the other hand, the commonest histopathological finding in patient with AUB due to dysfunctional cause was endometrial hyperplasia which was found in (30.3%) of the cases, (27%) were simple endometrial type (cystic glandular hyperplasia). Postmenopausal bleeding is found in 76 cases (21%). Atrophic endometrium was the commonest finding of postmenopausal bleeding, which represented (34.2%). Endometrial adenocarcinoma was found in 3.3%. Eighty-two cases underwent hysterectomy after initial curetting due to persistent uterine bleeding, the endometrial lesions of (79) patients were confirmed at hysterectomy making the diagnostic accuracy of D and C(96.3%). Other uterine lesions were found at hysterectomy such as adenomyosis and leiomyoma. CONCLUSION: Dysfunctional uterine bleeding was the predominant cause of AUB in women above ( 40 ) years of age.

Keywords

AUB --- curettage --- endometrium


Article
Tonsillectomy By Dissection Under Local Anesthesia(Indication-Operative- Procedure –Complication -15 Years Practice)

Authors: Yousif E Chalabi
Pages: 283-287
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ABSTRACT: BACGROUND: Although tonsillectomy is one of the most frequent surgical procedure practiced its indication and operative procedure remains controversial. There is an increased economic pressure to be done as an outpatient procedure . Hemorrhage is main complication other rare complication is asthmatic attacks precipitation in allergic patients. OBJECTIVE: To determine the indication. Operative procedure.Complication namely hemorrhage and allergic aggravation METHODS: Aretrospective review of T’S under L.A done for 962 patients from june1993-august2008 in Baquba and Sulaiymani teaching hospital partially because of G.Adrug shortage during sanction or because of G.A contra-indication absolutely or relatively .precise block anesthesia of lesser palatine and glossopharyngeal sensory nerve supply to tonsil is practiced with removal of tonsil by dissection RESULTS: Most patients operated on because of recurrent acute tonsillitis (926) of these 20 patients with nasal allergy 4patients of them with bronchial asthma, (12)patients with associated cardiac or renal problem, (16)patients with UAO or sleep apnea,(4)patients with enlarged suspected malignancy, (4)patients with peritonsillar abscess, (50)patients developed exaggerated gage reflex but not hindering the operation , (12)patients developed primary bleeding, (2)patients secondary bleeding. None of allergic patients developed asthma during the practice period. CONCLUSION: T’S by L.A have a place in surgical practice especially in allergic patients.Allergic aggravation and asthmatic precipitation may be due to G.A and not T’S per se.The operation is of shorter duration and hospitalization than under G.A. Peroperative and secondary bleeding are less than G.A and of less pain severity post-operatively than under G.A.Exaggerated gage reflex not hindering the operation


Article
Human Chorionic Gonadotropin in Treatment of Preterm Labour

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ABSTRACT: BACKGROUND: Preterm labour is a major healthcare problem throughout the world, it is a major cause of perinatal morbidity and mortality, that is not significantly altered by the current drug therapies, most of which are associated with significant maternal or fetal side effects. OBJECTIVE: To evaluate the role of human chorionic gonadotrophin (HCG ) in the treatment of preterm labour. METHODS: Fifty-seven women with preterm labour were enrolled in this clinical trial at Al- Yarmouk Teaching Hospital/ department of Obstetrics and Gynaecology – Baghdad /Iraq during the period from April, 1st 2006 till November, 30th 2006, and were assigned to receive a single intramuscular injection of 5000 units of HCG followed by a drip of 10000 units of HCG in 500 ml 5% dextrose over 6 hours. 30 women continued the study and the mean prolongation of the pregnancy was calculated for all of them. RESULTS: The mean prolongation of pregnancy was 32.97 ± 17.6 days and it was highest among gestational ages of 29-30 weeks ( 43.3± 19.85 days ), with the mean gestational age at birth was 35.7 ± 2.8 weeks. All babies born to these women had weight appropriate for their gestational age at birth with a mean birth weight of 2.7 ± 0.64 kg and 60% of babies weighed > 2.5 Kg at birth. CONCLUSION: It was shown through this trial that human chorionic gonadotropin was effective in exhibiting potent tocolysis and prolonging pregnancy in preterm labour without causing adverse effects to the mothers or their babies. This can make a major contribution to the management of this common obstetrical complication.

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HCG --- preterm labour --- treatment


Article
Semen Quality of Infertile Couples--Comparison Between Smokers and Non-Smokers

Authors: Ammar Fadil Abid
Pages: 293-296
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ABSTRACT: BACKGROUND: The effect of cigarette smoking on spermatogenesis is unclear. Previous studies suggest a deleterious effect of cigarette smoking on semen on semen quality ,but their results have not been consistent. OBJECTIVE: To compare the various semen parameters of infertile cigarette smokers with infertile non-smokers, to study the effect of cigarette smoking on semen quality. METHODS: Semen samples of 66 cigarette smokers and 70 non-smokers infertile patients were included in the study. As far as possible; other factors which might influence semen quality were eliminated. Seminal parameters, when taken together, indicated the presence or absence of the three main semen variables: asthenospermia (A), oligospermia (O), and normospermia (N). Smokers were categorized as light, moderate and heavy smokers. Semen samples were examined for Asthenospermia and oligospermia, according to World Health Organization guidelines. RESULTS: In our study, 25 non-smokers had normospermia (N) with their semen parameters falling within the normal ranges. In contrast, samples from 16 smokers qualified as N. This finding underscores the fact that smoking certainly has an adverse influence on the semen quality, as concluded in several other studies. Asthenospermia (A) was the most dominant semen variable contributing to the semen quality of smokers (n = 34) as well as non-smokers (n = 31). Statistical analysis using Pearson chi-squared and t-test found no statistically significant effect of cigarette smoking on sperm density; motility or morphologic features of sperm were detected. CONCLUSION: Our study shows a limited effect of smoking on conventional sperm parameters.


Article
Transurethral Microwave Thermotherapy (TUMT) for Benign Prostatic Hyperplasia; Our Experience

Authors: Yousuf M. Al-Hallaq
Pages: 297-299
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ABSTRACT: BACKGROUND: Minimally invasive office – based treatments for benign prostatic hyperplasia (BPH) are challenging the traditional surgical and medical management options for symptomatic BPH. OBJECTIVE: The aim of this study is to assess the efficacy of transurethral microwave therapy (TUMT) on spontaneous voiding, maximum flow rate and residual urine volume in patients with otherwise poor general health and BPH. METHODS: Thirty (30) patients with associated comorbid diseases and retention of urine (acute and chronic) due to BPH were subjected for TUMT as an outpatient procedure, from January 2002 to November 2003. Follow up was performed 10 days post TUMT, and then monthly until 3 months clinically and by assessing, spontaneous voiding, maximal flow rate and residual urine volume. RESULTS: Out of 30 treated patients, 5 were able to void spontaneously (without catheter) at the end of 12 weeks following TUMT. There was a little improvement of maximum urinary flow rate and residual urine volume at the end of the same period. CONCLUSION: TUMT is an alternative choice for the treatment of patients with BPH and chronic medical illnesses or those refusing surgery. However low energy protocol TUMT is not an effective treatment mode for patients with urinary retention due to BPH


Article
A Study of 100 Cases of Stomas Performed in Child’s Central Teaching Hospital in Baghdad

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ABSTRACT: BACKGROUND: Colostomy is an artificial opening made in the large bowel to divert faeces and flatus to exterior, where it can be collected in an external appliance. As a method of treating intestinal obstruction, colostomies date back to the later part of the eighteenth century, and some of the first survivors of this procedure were children with imperforate anus. OBJECTIVE: To identify the common indications and complications of stoma formation in pediatric age group below two years old. PATIENTS AND METHODS: A total number of (100) temporary colostomies and ileostomies (96 colostomies and 6 ileostomies) were preformed for (100) neonates, infants and children below two years of age in the pediatric surgical department of Child’s Central Teaching Hospital in Baghdad in the period from January 2005 to January 2007. RESULTS: Most of the colostomies and ileostomies (52%) were done in the neonatal period and mainly for imperforate anus (57.6%) and Hirschsprung’s disease (23.8%). Colostomy prolapse was the commonest complication and occurred in twenty patients 20% .the right transverse loop colostomy was the commonest stoma used in our patients and had the higher rate of complications. Prolapse ands skin excoriation were the most common complications in our study. CONCLUSION: Hirschsprung’s disease and imperforate anus were the most common indications of stoma formation in pediatric age group. Prolapse, skin excoriation and wound sepsis were the most common complications after creation of stoma.


Article
Liver Assessment in Patients with Osteoarthritis Taking Non Steroidal Anti Inflammatory Drugs Mainly (Diclofenac Acid) Within Two to Six Weeks of Treatment

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ABSTRACT: BACKGROUND: Non Steroidal Anti-Inflammatory drugs (NSAIDs) are used to treat musculoskeletal disorders, inflammation and to control pain. Virtually all (NSAIDs) are capable of producing liver injury ranging from mild reversible elevation of liver enzymes to severe hepatic failure. OBJECTIVE: To estimate the hepatic risk associated with the use of some NSAIDs. SUBJECT AND METHOD: 80 osteoarthritic patients were on diclofenac acid (voltarin) tablets 75 mg, 60 of them were female and 20 were male, laboratory estimation of serum alanine aminotransferase (ALT), serum aspartate aminotransferase (AST), serum alkaline phosphatase activity and total serum bilirubin (TSB) were done. For comparison age and sex matched 96 apparently healthy persons serve as controls. RESULTS: 27 (33.75 %) of the diclofenac treated patients had some impairment of liver function tests, 66.6 % of the liver injury found in patients aged more than 50 years and 88.8 % had occurred in females. hepatocelluar injury characterize most NSAIDs induced hepatotoxicity. CONCLUSION: The frequency of Drug induced liver injury (DILI) in diclofenac treated patients is about 33.75%.DILI is more common in females and old age.


Article
Low Birth Weight in Western Iraq

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ABSTRACT: BACKGROUND: In Iraq, several reports documented an increase in the prevalence of low birth weight (LBW) in the last 3 decades. OBJECTIVE: This study was carried out to report on the rate of LBW in western Iraq during the period of widespread violence. METHODS: All singleton live births in Al-Ramadi Maternity and Paediatrics hospital during the period of 1st April to 1st Oct. 2006, were included in the study. All the neonates were checked for birth weight and the expanded parelled was used to assess gestational age. Multiple logistic regression was used to estimate odd ratio for LBW. RESULTS: A total of 400 singleton livebirth were included in the study. Over all 31% of were LBW, and 67% of them were preterm. Maternal age, parties, education, lack of antenatal care and history of LBW and prematurity were risk factors. CONCLUSION: LBW and preterm birth neonates are still highly prevalent in Iraq and reflect the effect of sanctions, Gulf wars and widespread violence

Keywords

LBW --- IUGR --- birth weight --- western Iraq --- civil war


Article
Options of the Treatment in Steroid Resistant Nephrotic Syndrome in Children in Central Child Teaching Hospital-Baghdad

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ABSTRACT: BACKGROUND: The therapy of steroid resistant nephrotic syndrome (SRNS) is still a matter of controversy. OBJECTIVE: To assess the options of treatment in SRNS PATIENT AND METHOD: A retrospective study to 50 patients randomly selected in the Central Child Teaching Hospital during study period from Jan. 2006 to July 2008. The patients age were between 6 months.-18 years. All patients who had failed to achieve an improvement in proteinuria after minimum of 4 weeks (up to 8 weeks) of prednisolone (PDN) in a dosage 2 mg/kg/day were taken. Only the patients with idiopathic nephrotic syndrome (45 patients) were involved in the study but the patients with secondary nephrotic syndrome and congenital neprosis were excluded from the study. Each patient were individualized to the type of pathology and to the type of medication used. RESULTS: Forty five patients were included in the study, the age range between 6 months.-18 years. Twenty eight patients were male and 17 were female, M: F ratio 1.64: 1. Regarding the type of pathology, 20 patients with focal segmental glomerulosclerosis (FSGS), 11 patients with minimal change nephrotic syndrome (MCNS), 8 patients with diffuse mesangial proliferation (DMP) and 6 patients were unknown biopsy (not down biopsy). The drugs that used were methyl prednisolone (MP) in 17 patients, Every other day steroid (EODS) in 10 patients, cyclosporineA (CsA) plus EODS in 16 patients (10 patients as first option and 6 patients as second option), cyclophosphamide (CYS) used in 8 patients (6 patients as first option and 2 patients as second option) and chlorambucil were used in 2 patients only. The response was higher in patients who received EODS (50%), followed by the patients who received CsA plus EODS (25%) then the patients who received MP(23.5%) and the patients who received CYS(12.5%) and chlorambucil(zero%). The response to treatment was higher in females than males, 11 out of 28 males (39.28%) responded to treatment while 7 of 17 female (41.17%) responded to treatment. The patients with early presentation responded to treatment higher than those with late presentation, so 12 of 19 patients (63.15%) presented early while 10 of 26 patients (38.46%) presented late. According to histopathology, the patients with unknown etiology had higher rate of response, 3 out of 6 patients (50%) responded to treatment followed by 7 of 20 (35%) patients with FSGS, then 2 of 8 (25%) patients with DMP, then 2 of 11 (18.18%) patients with MCNS. CONCLUSION: The drugs used are the common drugs and EODS is preferable type of medication used in SRNS


Article
A Review of 100 Cases of Colonic Injuries Admitted to Baghdad Teaching Hospital According to ACS Grading System

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ABSTRACT: BACKGROUND: In Iraq nearly 95% of colonic injuries are caused by penetrating trauma (gun shot, blast injuries, stab injuries, or iatrogenic trauma), blunt injuries are rare & commonly result from road traffic accidents or fall from height. While in the rest of the world, penetrating trauma accounts for 80-90% of cases. This higher rate of penetrating trauma in Iraq is due to the high rate of terrorism attacks with low & high velocity missiles. OBJECTIVE: The aim is to study cases with colonic injuries according to ACS(American College of Surgeons) grading system, the surgical management applied & the postoperative outcome of each grade. PATIENTS AND METHODS: This prospective study comprises (100) patients with documented colonic injuries admitted to the surgical wards at Baghdad Teaching Hospital spanning the years 2006 to 2008. The parameters used in this study include: age, gender, mechanism of injury, part of the colon involved by injury, the grade of the injury, other associated organ injuries, the method chosen to manage the injury & the outcome (uneventful recovery, postoperative morbidity & death). RESULTS: Colonic injuries were caused by bullet injuries in 50% of cases, sigmoid colon was the most common involved part (32%), 64% of cases were of grade 2 ACS , the most common associated organ injury was small intestine (60%),colonic injuries were primarily sutured in 48% of cases, while other 48% of cases ended with colostomy. Morbidity postoperatively were recorded in 32% of cases, most frequently with grade 2 & in cases treated by colostomy. Postoperative Death was recorded in 14 % of cases. CONCLUSION: According to our study, ACS grading system proves to be highly beneficial to be applied in the coarse of management of colonic injuries.


Article
Lung Diffusing Capacity for Carbon Monoxide (DLco-SB): the Influence of Cigarette Smoking

Authors: Najeeb Hassan Mohammed
Pages: 328-334
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ABSTRACT: BACKGROUND: Most tests of lung function used in the evaluation and follow-up of the pulmonary effect of smoking reflect airway function alone such as standard spirometry. Whereas, the best established test that reflect alveolar function is the single-breath carbon monoxide diffusing capacity (DLco-SB) especially when this is expressed per liter of alveolar volume (DLco/VA). Accordingly, to study the effect of smoking on both airway and alveolar functions, it is necessary to use DLco/VA test in addition to standard spirometry. OBJECTIVE: The present study was designed to evaluate the effect of cigarette smoking on lung diffusion, to correlate the effect of cigarette smoking and smoking cessation on lung diffusion and to find out whether the effect of cigarette smoking on lung diffusion is reversible. SUBJECTS AND METHODS: The effect of cigarette smoking on spirometric indicators of ventilatory function (FVC, FEV1%, PEFR) and on lung diffusing capacity for carbon monoxide (DLco-SB/VA) was evaluated on two occasions 6 months apart in 94 middle-aged, asymptomatic, male subjects, 56 smokers and 38 nonsmokers. RESULTS: All subjects were within the normal predicted spirometric and lung diffusion values (80-120%). The values of FVC, FEV1, FEV1/FVC% and PEFR averaged more than 94% in never smokers (n = 38, mean age 43.57 years), 85% predicted in smokers (n = 56, mean age 42.54 years). However, the mean rate of decrease in spirometric and lung diffusion values (DLco/VA) between smoker and non-smokers were significant (p<0.05). fourteen subjects (14) who initially were smokers became sustained ex-smokers within six months of the first measurement, however, comparing the mean values of these parameters between the two groups reveals statistically significant differences (p<0.05); since that the values of DLco and DLco/VA in ex-smokers were significantly greater than those of current smokers and approached the values of those who had never smoked. In ex-smokers the mean values of DLco/VA rose, averaging 90% predicted at the first assessment but 97% predicted six months later. CONCLUSION: The values of FVC, FEV1, FEV1/FVC%, PEFR and Lung diffusing capacity for carbon monoxide (DLco/VA) were lower in smokers than in never smokers. Ex-smokers had spirometric and lung diffusion values similar to those of never smokers even when spirometric values and DLco/VA were known to have been reduced while they were smoking.

Keywords

dLco-SB --- spirometry --- smoking


Article
Effects of Oral Contraceptives Intake On the Gingiva

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ABSTRACT: BACKGROUND: The use of contraceptive medication has been shown to increase gingival inflammatory reaction to local irritants. OBJECTIVE: To determine the effect of oral contraceptive pills and the duration of drug intake on the plaque index, gingival index and probing depth. METHODS: A total of 30 women of the age group 19-40 years attending a primary health care center in AL-Ramadi city were selected and permitted to start taking contraceptive pills. Three visits were arranged of three months interval between the visits. Plaque index, gingival index &probing depth were measured at the three visits. RESULTS: The results revealed a significant difference in the mean plaque index & the mean gingival index among the three visits. Regarding the probing depth, 23.3% of women had pocket depth of 4 & 5mm and this percentage was the same for the three visits. CONCLUSION: Results indicates that women taking contraceptive pills had increasing mean of plaque & gingival indices with increasing the duration of drug intake. Probing depth was found the same through the three visits


Article
Atypical Presentaion of Abruptio Placentae, A Case Report

Authors: Yosra Tahir Jarjees
Pages: 342-344
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Abstract

ABSTRACT: Abruptio placentae is a severe pregnancy complication that occurs in about 1% of gestations. This pregnancy complication has been found to increase maternal and fetal morbidity and mortality considerably. The purpose of presenting this case report is to show that abruptio placentae can be presented in a different way apart from the classical presentation, and to show the association between Rh-isoimmunization and abruption placentae. The way to reach the diagnosis and how to manage the case has been also discussed thoroughly.

Table of content: volume:9 issue:3