Table of content

Journal of the Faculty of Medicine

مجلة كلية الطب

ISSN: 00419419
Publisher: Baghdad University
Faculty: Medicine
Language: English

This journal is Open Access

About

Journal of the Faculty of Medicine – University of Baghdad

A peer- reviewed journal published Quarterly by the college of medicine –Baghdad University

ISSN: 0041-9419

E-ISSN 2410-8057

The Journal interested in publication of clinical and basic medical research.


The first issue of this Journal was published under the name of (Journal of the Royal Iraqi Medical College) in April /1936, approved by the council of the College as a general journal dealing with the news of the college and few scientific articles to encourage the teaching staff for research publication. The journal was published randomly and ceased during World War II due to financial difficulties.
In 1946 Prof. Dr. Hashim Al Witri, the college dean, assigned republication of the journal and urged the teaching staff to participate and publish their research in the journal. Despite his effort the journal remained irregular in publication. In 1959 Prof. Dr. Faisal Al-Sabih became the Editor in Chief of the journal when he returned from the United Kingdom and appointed on the teaching staff, restructured the journal and changed its name to (The Journal of the Faculty of Medicine) and used new scientific system for publication of articles.
The first issue of the new series started in June 1959. The journal continued to be published on a regular basis since then without interruption in (four issues during the year). The journal became registered the international number (ISSN) in 2000 and entered in many important international indexes.
After 2003 the journal continued despite the difficulties involved in every aspect of the country and by the beginning of 2004 the journal progressed through a series of changes to reach a level that can be recognized internationally.
After 2010 the journal became published electronically of the same edited issues.
Recently the journal became recognized by the (Index Copernicus) and publicised internationaly.

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Contact info

e-mail:iqjmc@comed.uobaghdad.edu.iq
mobile:+96407709826825

Table of content: 2007 volume:49 issue:1

Article
An analytic study of 200 cases of head injuries admitted to teaching Hospital in Najaf.

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Back ground: This is a prospective study of Head injury in Najaf. Aim: to study the causes & out come & way of transferring the rat to the hospital & best way to investigate them. Patients & methods:A prospective analytical study of 200 cases of Head injury patients, who were admitted to Saddam Teaching Hospital , in Najaf between 18 t" of November 1996 and 1st of September 1998. Results: All age groups were included in this study, male to female ratio was 4:1 and the highest incidence was seen at the age group below 14 years. The two most common causes of head injury were road traffic accident (RTA)(51 %) and assault (22%),of RTA pedestrians accounted for (87.25%). RTA accounted of (80%) in those with severe head injury. The highest incidence of head injuries in both male and female was between 2pm and 6pm. All patients brought to hospital by personal means, most of them reached the hospital within the first hour of injury. 115 patients (57.5%) were minor head injuries {Glasgow coma scale (11-15)}. Skull x-ray was taken for 185 patients, it was positive for fracture in 48 patients (24%) and negative in 137 (68.5%). There is significant number of patients with negative skull X-ray who need not to be X- rayed. The commonest associated injuries were limb fractures 35% followed by injuries of abdominal viscera 11%. The incidence of operative treatment (10%). The final outcome on discharge was complete recovery in 156 patients (78%) residual neurological deficits in 18 patients (9%), and death in 20 patients (10%), and 6 patients discharged against medical advice. The common cause of head injuries in those who died was RTA 85%& we give recommendation regarding traffic roads & culture of society & policy of investigation. Key words :Road Traffic Accident (RTA). Glasgow come scale (GCS), Computed Tomograghy (CT scan). In traventricular Hemorrhage (IVH) Disseminated intravascular coagulation (DIC) Cerebrospinal fluid (CSF).

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Article
Colostomy closure in pediatric age group A comparative study betweenSingle and double layer anestomosis

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This prospective study involved one hundred patients with colostomies admitted at the Central Pediatric Teaching Hospital for colostomy closure over the period of two years (Jan.2000-Jan2002).
Patients were divided in to two groups according to the technique of colostomy closure. In the first group, the closure was done by single layer of interrupted non-absorbable suture material; in the second group closure was done by double layer suturing technique.
All patients were prepared by the same conventional method including fluid diet for three days followed by two days washing enemas before operation with antimicrobial prophylaxis agents. Of these one hundred patients;(48) presented as cases of Hirschsprung`s disease, (50) were cases of ano-rectal malformations, and (2) were cases of traumatic colonic perforation. According to the type of the colostomy; there were (62) loop colostomy, and (38) double-barreled colostomy.
According to the site of the colostomy; there were (84) patients with right transverse colostomy, (2) with left descending colostomy, (12) with sigmoidostomy, and (2) with cecostomy. Sixteen patients developed complications following colostomy closure; these were (wound infection, fecal fistula, small bowel obstruction, and other systemic infections).
We advise single layer bowel anastomosis for the following reasons:
1-operative time (anesthetic time) theoretically shorter with single layer closure.
2-less tissue handling (less trauma) with single layer closure.
3-less narrowing effect (as less suture material) on the already small bowel lumen. Too many sutures and too many knots leading to comprise blood supply with double layer closure.4-more cost benefit with single layer closure.

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Article
Relieving Symptoms of Chronic Sinusitis in Children

Authors: Hussein M. Hassan
Pages: 13-16
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Background: To determine the efficacy of adenoidectomy in relieving symptoms of chronic sinusitis in children. Patients and methods :A prospective study carried out on 35 patients who underwent adenoidectomy or Adeno-tonsillectomy between May 2004 and October 2005.The patient ages ranged from 3 to 12 years. Five patients were unavailable for follow-up and did not complete the study so they are excluded from. The pre-operative symptoms were Rhinorrohea, Nasal congestion, Headache, Postnasal drainage, Cough, Halitosis and Irritability. Also recorded was Mouth breathing, Fever and Frequent antibiotic use. Telephone interviews with the patient's caregivers were conducted to collect information following the surgery regarding the presence of the same symptoms as well as an estimate of overall improvement. Follow-up ranged from 5 months to 1 year. Results :The most frequently reported symptoms before surgery were Rhinorrhoea, Nasal congestion, Mouth breathing, and Frequent antibiotic use. (26, 28, 24, 30 patients respectively). These numbers decreased following surgery to (11, 12, 6, 24 patients respectively) Complete or near complete symptom resolution was reported in 18 (60%) patients. Some improvement was reported in 6 (20%) patients. Minimal or no improvement was reported in another 6 (20%) patients. Conclusion In the majority of cases, symptoms of chronic sinusitis in children are relieved by adenoidectomy.


Article
Distribution Of T.B. Among Women And Pediatric Age Group

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Bakground: A prospective study was designed to find out the prevalence of different types of T.B. among women and children. Methods: A total of 390 patients aged from less than one year up to more than 65 years who attended T.B. center in Kirkuk city from beginning to end of 2005, were included in the study. A detail clinical and laboratory examination were carried out to confirm the diagnosis. Results: The rate of infection in females (46.15%) was lower than males (53.84%). In pediatric age groups, the highest rate was among the age 12-14 (2.05%) and the lowest was among >1-2 years and 9-11 years (0.76%). Inactive pulmonary T.B. was highest among the pediatric age group. Conclusion: It is concluded that the rate of T.B. was high in both females and pediatric age group in Kirkuk province. Inactive T.B. was highest among pediatric age group from 12-14 years.

Keywords

T.B. --- women --- children --- Kirkuk


Article
Relation between Behavioral Factors, Malnutrition and Persistent

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Background A high prevalence of Behaviors which is related to persistent diarrhea and the prevalence of moderate to sever malnutrition in patients with persistent diarrhea in children. Objectives To asses the prevalence of negative behaviors that causes the persistent diarrhea and to asses the prevalence of malnutrition among children with persistent diarrhea and to compare prevalence of malnutrition due to persistent diarrhea to that of national figures. Patients and Methods This study was carried out at the Central Teaching Hospital for Children in Baghdad, a total number of 200 cases of persistent diarrhea (lasting more than 14 days)"with no more than 48 hour normal bowel motions in this period" in children less than 2 years of age. The period of the study was one year from the 1st of January 1999 to the thirty-one of December 1999. Information was taken from patient's companions usually the mothers and the patients were selected at Inpatient, out patient and Emergency departments in a randomized way. Results. The study showed that the most common age group of persistent diarrhea was the 2nd half of the first year constituting (47%) (94/200) of patients with persistent diarrhea. Patients whose mothers were illiterate constituted a high proportion (48%) (96/200). Patients on bottle or mixed feeding constituted (77%) (144/200). A high prevalence of some behaviors which is related to persistent diarrhea was noticed like allowing the children to pick up food spilled on the floor and eat it (65%) (130/200), stopping or altering feeding during episodes of diarrhea (78%) (156/200), mothers neglecting washing hands or their babies hands before feeding their children (74%) (148/200) and (66%) (132/200) respectively, failure to introduce solid food in 1st year of life (72.3%) (94/ 130) and failure to eat adult type of food in 2nd year of life (65.7%) (46/ 70). The prevalence of moderate to sever malnutrition at the three age groups was significantly higher in children with persistent diarrhea in present study compared to general population figures reported by polio immunization national day (PIND) survey at 1999 in Iraq, marasmus was significantly more common in 2nd half of the 1st year of life and the prevalence of kwashiorkor was significantly higher (15.8%) (11/70) among the older age group (2nd year of life) Conclusion. The most common age group who developed persistent diarrhea was the second half of the first year of life. The negative behaviors of the mothers had a significant effect on the occurrence of persistent diarrhea in children and the development of malnutrition diseases like marsmus and kwashiorkor


Article
Causes of Vomiting in Hospitalized Children

Authors: Fairs M. Frankul*
Pages: 27-31
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Background: vomiting is a very common symptom of disease in childhood, it occurs both in gastrointestinal and non-gastrointestinal diseases. Objectives: Our aim of the study was to find out the causes of vomiting in different age group, the improper management of vomiting in daily practice and to emphasis on the usefulness of imaging study in the diagnosis. Methods: A prospective study was carried out on patients presented with vomiting admitted to Children Welfare Teaching Hospital from the first of Dec. 2001 to the end of April 2002 .The age ranged between early neonatal periods to 12 years of age. Reults: A total of 100 child were included in this study,(65) male (35) female male to female ratio was1.86:1. Surgical causes of the gastrointestinal tract was the most common cause of vomiting (50 %) in the neonatal period, while infectious cause formed 78.3% & 48.4% during infancy and childhood respectively. Imaging studies was carried out on 54 patients and helped to reach a final diagnosis in 21(38,9% ) patients. In this study green color vomiting was found to relate mainly (64.7%) to the intestinal obstruction with a (p) value >0.05. Conclusion: There was no benefit of antiemetic drugs in the treatment of vomiting, Imaging studies were helpful in reaching the correct diagnosis of vomiting in some cases, green color vomiting should make pediatrician suspicious of intestinal obstruction.

Keywords

children --- Vomiting


Article
Analytic Study Of Congenital Malformations In Four

Authors: Numan Nafie Hameed
Pages: 32-36
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Background: Congenital malformations are responsible for a considerable proportion of perinatal, neonatal and infant mortality in many Eastern Mediterranean countries. So this study aims to find out the incidence, types and probable risk factors of these malformations in Baghdad. Patients and methods: one hundred cases of congenital malformations were studied out of 8090 neonates born in 4 hospitals in Baghdad province over 5 months in 2002 (preterm, term) .The incidence , types and risk factors were analysed . Results: the incidence of congenital malformations was 12.36/ 1000 live births, with the central nervous system malformations being the commonest. There is increased risk in consanguinous marriages 27 (27%), mothers not attending antenatal care 25 (25%), mothers of low gravidity 60 (60%), and mothers not taking folic acid during pregnancy (86.7%). Conclusion: Consanguineous marriages and mothers not taking folic acid during pregnancy are important risk factors for the occurrence of congenital malformations .So I recommend genetic counseling especially for consanguineous marriages, and giving all pregnant women folic acid before and during pregnancy. A multicentre study will give more broad idea about the incidence , types ,and risk factors in our country


Article
Predictive values of risk factors in management of diabetic foot

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Background: Outcome of management of patients with diabetic foot is difficult to predict. Assessment of variables in history , examination and investigations were analyzed with outcome of management and whether can be assigned as prognostic factors . Methods: prospective study of 300 patients with diabetic foot in Baghdad teaching hospital during the period from April 2000 to March 2004,certain criteria was taken in history and examination, these were investigated and treated either by conservative procedure or amputation. Results: most common age group was 50-59 years ( 33.3%). The male to female ratio was 2:1. Conservative debridement was performed in ( 60%) of patients while amputation was employed in (40%). amputation was performed in 604 in patient above 60 years and in(75%) of patients who had diabetic foot lesions for > 2 weeks,and in 90% of smokers for 10 years or more. Amputation was needed in (71%) in those who had history of previous ulceration and 72.5% of patients who had positive history of previous amputation. Amputation was needed in (88%) of those who had their temperature >38°C. in (91%) of patients who had diabetic foot lesion of Wagner grade>III and 91%. patients with X-ray findings of osteomyelitis. Conclusions: Highly significant association was found between amputation with following variable , smokers > 10 years, patients with a temperature of > 38°C, Hypertension > 140/90 mmHg Wagner grade > III, white blood cell count of > 20,000/cc and positive foot X-ray findings. Slight significant association of amputation and the following variables: Age >60 years, duration of foot lesion >2 weeks, history of previous amputation, previous ulceration, negative pedal pulses, deformed feet and patients who had impaired normal vision.


Article
Exudative Diabetic Maculopathy Treated By Frequancy Doubled Nd: Yag Laser (532nm)

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Background: Diabetic maculopathy means involvement of the macula by edema and exudates or ischemia which is the most common cause of visual impairment in diabetic patients, particularly those with type 2diabetes. Objective: The literatures are rich in publications of these regards, nevertheless the works in general were not systematic, not enough details regarding procedures and dose parameters in using laser for treatment are mentioned. "In the present work, an attempt to build a systematic procedure regarding dose parameters, application parameters and laser safety." Methods: A frequency doubled Nd: YAG laser was used to treat all eyes included in this study with diabetic maculopathy. Forty eyes of twenty five non insulin dependent diabetic Iraqi patients were evaluated, sixteen males and nine females. Their ages were 42- 76 years, all of them from patients attending ophthalmic out-patient department in the medical city. Results: Maculopathy regressed in 38/40 of the treated eyes, unchanged in 2/40 eyes and no one was deteriorated. Visual acuity improved in 6/40 of the treated eyes by at least two lines of Snellen's chart while it stabilized in other 34/40. Conclusion: Exudative diabetic maculopathy is responsible for reduction in vision and even legal blindness in many patients. Close regular follow up and early laser treatment of eyes with maculopathy is significant in stabilization of vision and reducing the rate of visual loss.


Article
Haematologic Parameters In Acute Promyelocytic Leukemia Patients Treated With ALL Trans- Retinoic acid

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Background: Acute Promyelocytic Leukemia (APL) is commonly associated with disseminated intravascular coagulation (DIC) and early correction of coagulopathy is of vital importance. All Trans-Retinoic Acid (ATRA) is considered to be the drug of choice in the treatment of APL. Objective: The work was conducted to 1- Identify patients with APL who show laboratory evidence of DIC. J Fac Med Baghdad Vol. 49, No. 1, 2007 Received: June 2006 Accepted: Nov. 2006 2- Study the serial changes in haemostatic parameters in APL patients treated with ATRA and to compare their results with those treated with conventional chemotherapy without ATRA. Subjective and methods: In this prospective study (from October 2003 to October 2005), 44 newly diagnosed, untreated APL patients were included. ATRA plus chemotherapy – treated patients were 24 while 17 patients were treated with chemotherapy other than ATRA. For each patient, a full clinical evaluation was done and hematological investigations were accomplished at time of diagnosis and repeated on day 3 and 7 of therapy. Diagnosis of DIC was based on finding a positive D- dimer test with hypofibrinogenaemia with or without pathologically prolonged (PT and/or APTT). Results: In 44 newly diagnosed, untreated APL patients studied, the age range between 6-81 years with a median of 27 years. Male to female ratio was 1.3:1. Before treatment all patients had anemia, thrombocytopenia, and elevated level of D – dimer. DIC was present in all patients at time of diagnosis. All parameters that showed abnormal level at time of diagnosis had returned to normality within one week in ATRA treated group, indicating that DIC has essentially resolved. By contrast, those parameters remained abnormal even on day 7 in the chemotherapy treated group. Indicating that DIC was on going. Conclusion: ATRA therapy in APL patients is associated with rapid improvement of coagulopathy therefore , it is justified to be used from day one of the treatment. _________________________________________________________________


Article
Proportion and Determinants of Uncontrolled Hypertension among Treated

Authors: Faris Al-Lami
Pages: 56-63
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Background: Heart failure is a common clinical syndrome with a high morbidity and mortality, despite advances in medical treatment. Death from dangerous ventricular arrhythmias is frequently implicated.
Patients, materials & methods: Eighty patients with heart failure (HF) (fitting the criteria of heart failure) who were admitted to the medical city teaching hospital during a period of 8 months, were studied for incidence of nonsustained ventricular tachycardia (N.S.V.T.) (detected by Holter monitoring) and its association with the severity of left ventricular dysfunction (measured by ejection fraction), ventricular size (measured by left ventricular end diastolic dimension), and other factors .
Results: It was found that out of 80 patients with H.F, 20 patients (25%) have N.S.V.T. N.S.V.T was found to be significantly associated with the severity of H.F. and left ventricular dimension. Hypertension (HT) remains poorly controlled even in the developed countries in spite of the improvement in management. Many studies found that about 70% of people with HT remain uncontrolled. The aim of this study is to determine the proportion, and determinants of uncontrolled HT (UHT) among treated hypertensive patients. A random sample of 214 known hypertensive patients, on regular treatment for a minimum of one year was included. The mean of three blood pressure (BP) readings measured two weeks apart was considered. Controlled BP was defined as systolic BP≤140mmHg, and diastolic BP≤90 mmHg. A questionnaire was used to collect data on certain demographic variables (age, gender, marital status, educational status, crowding index), smoking habit, salt, and alcohol intake, number of used antihypertensive drugs, frequency of BP checking, co morbid illnesses, and certain anthropometric measurements. The proportion of UHT is 68%. Although the proportion of UHT was higher among older age patients, males, currently married, college graduate, those using three antihypertensive drugs, patients with no dietary salt restriction, or no co morbid illnesses, but these factors were not proved to be statistically significant. Current smoking, Body Mass Index (BMI) ≥25 Kg/m2(reflecting overweight/ Obesity), and frequency of BP checking were statistically significant predictors of UHT.

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Article
Nonsustained Ventricular Tachycardia in Heart Failure

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Background: Heart failure is a common clinical syndrome with a high morbidity and mortality, despite advances in medical treatment. Death from dangerous ventricular arrhythmias is frequently implicated. Patients, materials & methods: Eighty patients with heart failure (HF) (fitting the criteria of heart failure) who were admitted to the medical city teaching hospital during a period of 8 months, were studied for incidence of nonsustained ventricular tachycardia (N.S.V.T.) (detected by Holter monitoring) and its association with the severity of left ventricular dysfunction (measured by ejection fraction), ventricular size (measured by left ventricular end diastolic dimension), and other factors . J Fac Med Baghdad Vol. 49, No. 1, 2007 Received: April 2006 Accepted: June 2006 Results: It was found that out of 80 patients with H.F, 20 patients (25%) have N.S.V.T. N.S.V.T was found to be significantly associated with the severity of H.F. and left ventricular dimension. The arrhythmia was found to be strongly related with hypokalemia. The incidence of N.S.V.T. is less in patients receiving beta-blockers in their treatment regimen. Conclusion: Nonsustained ventricular tachycardia is a common finding in heart failure and is related to the severity of heart failure and other factors related to the disease and its treatment

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Article
Electromyographic Changes in Thyrotoxicosis

Authors: Khalid I. Mussa,;
Pages: 69-72
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Objectives: To document electromyographic changes in thyrotoxic patients, and to categorize the type of myopathic process in thyrotoxicosis.
Design: This case control study was designed to show the electromyographic changes in thyrotoxic patients and to compare these findings with that of normal aged matched controls to show the significance of these changes in thyrotoxic patients. Student’s test was applied on the results and P value was extracted.
Subjects: Subjects in this study were chosen according to certain criteria depending mainly on their blood level of thyroid hormone (T3, and T4) and TSH. All of them are thyrotoxic patients, their ages range between 15 to 45 years. They were 25 patients (15 female and 10 males). Another 25 subjects were chosen as normal controls they were of the same age and sex, patient with features of myopathy or neuropathy from diseases other than thyrotoxicosis were excluded carefully from studied patients and the normal controls.
Results: EMG finding in thyrotoxic patients was as follows: No spontaneous activities in the proximal muscles (deltoid and in rectus femoris muscles). The amplitude of the motor unit action potentials was ranging between (200-800 microv) with a mean of (488.8 +/- 159.3microv.) in the deltoid muscle, while the amplitude of the action potential In rectus femoris muscle in thyrotoxic patients was ranging between (350-900 microv.). In abductor pollicis brevis muscle the action potential amplitude in thyrotoxic patients was ranging between (500-2150 microv.), there was significant difference between thyrotoxic patients and normal controls. The duration of the motor unit potential in thyrotoxic patients was ranging between (7—11.5 msec.) with a mean of (8.51+/- 1,24 msec) in the deltoid muscle, slightly higher figures in rectus femoris muscle, this indicates significant difference in the duration of action potential between patients and normal controls. The other parameters of EMG study all indicate a myopathic process involving proximal muscles in 76% of thyrotoxic patients and a neuropathic process involving distal muscles in 28% of thyrotoxic patients.
Conclusions:
1-thyrotoxicosis involves proximal muscles more than distal muscles.
2-myopathic process in thyrotoxicosis can be observed clearly in EMG study of the proximal muscles.
3-EMG findings in thyrotoxic myopathy includes, short duration polyphasic potentials, with early recruitment full interference pattern.
4-Distal muscles in thyrotoxic patients may show EMG findings of a rather neuropathic process.


Article
Pain In Patients With Multipe Sclerosis

Authors: Mo'taz Fayrouz Abd --- Khalid I. Mussa*.)
Pages: 73-76
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Background: pain is frequently listed among initial symptoms of MS or an occurring in the course of the disease.
Patients and Methods: one hundred thirty MS patients diagnosed according to Macdonald's criteria compared with 115 matched age and sex control were interviewed about pain Neuropathic, somatic and headache.
Results: Neuropathic pain was significantly higher in MS than control group, while LLD and ARP were of no significance difference between two groups. For somatic pain there was significant increase in MS.
Conclusion: pain is common in MS especially LLD. There is no significant difference between pain subtypes and duration of disease and FS, EDSS.


Article
Brain abscess in Iraq during a 10 years period: Part 1. Epidemiology, aetiology and clinical picture

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Background: This study comprises two parts. "['his part deals with epidemiology, aetiology and clinical features of brain abscess during a 10 years period, while the second will deal with diagnostic investigation, management and final outcome of brain abscess Methods: The case records of patients with brain abscess admitted to the neurosurgical specialties hospital in Baghdad over a 10 years period extending from 1" Jan. 1993 to 31S ` Dec. 2002, inclusive were reviewed. Data obtained included demographic and clinical data. Results: A total of 78 cases (1.2% of total admission) of brain abscess were admitted. Their age ranged from one month to 68 years. The most common' aetiological (actor was cyanotic heart disease, with the congenital anomaly being unrepaired in all cases. Remote infection foci other than heart represent minority. Half of the cases had a rapid onset and fluminant progression. The presenting features of the patients older than one year were raised intracranial pressure, and focal neurological deficit and infection. J Fac Med Baghdad Vol. 49, No. 1, 2007 Received: May2006 Accepted: Sep. 2006 Conclusion: Maintaining a high index of clinical suspicions in patients having one of the infection sources together with neurological signs should be emphasized. '.

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Article
Clinical And Angiographic Characteristics Of Left Main CoronaryArtery Disease, A Retrospective Study

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Background : Left main coronary artery (LMCA) disease represents important and serious portion of coronary artery disease(CAD).
Aim: The aim of this study is to estimate the incidence of LMCA disease among patients with CAD undergoing coronary artery angiography and to evaluate clinical characteristics of patients with LMCA disease.
Methods: The study involved review of clinical notes and coronary angiography of 1020 patients with CAD in Ibin Al Bitar hospital for cardiac surgery between April and September 2004.This review included evaluation of electrocardiogram (ECG), echocardiogram(ECHO),
ECG exercise test (EET) and coronary angiography.
Results: Among 56 patients proved to have left main coronary artery (LMCA) disease,40 patients had complete data available which were studied.
Mean age of patients with LMCA disease was 60 ± 8.07 years, 82% of them were males, 62% were smokers, 40% were diabetics and 55% were hypertensive.
In this group 62.5% of patients with LMCA disease presented as acute coronary syndrome (ACS) and 37.5% as chronic stable angina (CSA),normal left ventricular (LV) function was found in 75% of patients and 40% have normal electrocardiogram (ECG).
Patients with LMCA disease who have distal involvement represent 75%,15% have diffusely diseased LMCA, right coronary artery (RCA) was involved in 80% of patients and those with RCA involvement were more commonly presented with ACS (78%), while those without RCA involvement presented more as CSA.
Those patients who underwent ECG exercise test had poor functional Capacity, with mean exercise duration of 3.7 ± 2.3 minutes and mean metabolic equivalents (METs) of 4.5 ± 2.46.
The tests were positive in 76.9% of patients inconclusive in the rest but no negative tests were recorded.
No significant differences were observed between those patients with ACS and those with CSA in regard to patients' characteristics.
Conclusion: LMCA disease is not uncommon among those with CAD, it occurs in patients with multiple cardiovascular risk factors. Patients with LMCA disease usually have poor functional capacity and their ETTs are commonly positive and of high risk score. Involvements of right coronary artery (RCA) in addition to LMCA render the patients more unstable.


Article
The Anticipated Hazards Due to Errors In Using Laser In Medicine & Recommendationms for the Safe Use Of Medical Laser Systems in Iraqi Hospitaals

Authors: Azzaam S. Farrohaa --- Khaleel I. Hajim
Pages: 86-88
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• Causes of Laser Hazard I - Inherent Hazards to Laser Beam Direct or reflected laser beams have consequential health effects range from minor skin burn to irreversible eye injuries. The hazards depend on the power output and wavelength of the used laser and depend on the exposure time and MPE. ti & 2) A- Eye Hazards Point light source cause more damage to eyes than large sources, because point sources concentrate into a very small point on the retina with a high power density. So direct laser beam or specular reflected laser beam cause more damage than diffusely reflected laser beam.

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Article
CT Evaluation of Liver Hydatid Disease

Authors: May Khalid Ameen
Pages: 89-94
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Background: To elucidate distinctive CT imaging features that allows a diagnosis of hepatic hydatidosis. Patients and methods : The computed tomographic (CT) findings of 58 patients with sonographically detected cystic liver lesions were prospectively analyzed. These patients were followed up until a final diagnosis was reached. Results : By CT scanning we correctly localized and diagnosed 81 hepatic hydatid cysts in 50 patients. These were all proved by surgery or endoscopic retrograde cholangio-pancreatography (ERCP). Stage III and II hydatid cysts were the commonest types (29 % and 25 % respectively ). 52 % of the cysts were 5-10 cm at presentation. At CT, we identified some ancillary imaging features that help in the diagnosis of unilocular type I hepatic echinococcal cysts. Conclusion : Although no imaging feature can provide a definitive diagnosis of a unilocular type I hepatic echinococcal cyst, some ancillary imaging features may help in differentiating them from a non parasitic simple liver cysts. Types II, III, & V hydatid cysts, on the other hand, have characteristic imaging features that allow their confidant diagnosis.

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Article
Ultrasound Evaluation of Suspected Appendicitis

Authors: May Khalid Ameen
Pages: 95-100
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Background To evaluate the sensitivity, specificity, accuracy, positive predictive value (PPV), and negative predictive value (NPV) of ultrasonographic and doppler US findings in the diagnosis of acute appendicitis. Method : A total of 115 cases of clinically suspected appendicitis were prospectively examined by grey scale US and doppler US. Five patients were excluded from the study because of difficulty to perform the graded compression technique. In the other 115 patients who were included in the study population , US appendiceal and periappendiceal signs, as well as doppler US findings were evaluated. Definitive diagnosis was established at surgery and histopathological examination in 62 patients (59 patients with appendicitis & 3 patients with alternative final diagnosis), and at clinical follow up in 48 patients. Results : The prevalence of appendicitis in this study was 54%. The appendix was identified in 80 (73 %) of the 110 patients , which included 55 (93 %) of 59 patients with appendicitis & 25 949 %) of 51 patients without appendicitis. The most accurate appendiceal finding for appendicitis was a diameter of ≥ 6 mm & non compressibility, which both had an accuracy of 96 %. The lack of visualization of the appendix had a NPV of 87 % , while the visualization of a normal appendix with a diameter of < 6 mm had a NPV of 96 %. Inflammatory periappendiceal fat changes had a sensitivity of 92 % , PPV of 83 %, & a NPV of 89 %. Hyperaemia in the appendiceal wall, although had a low sensitivity (53%), it had both high specificity (92 %) & high PPV (94 %). The other findings had both low PPV & NPV. Conclusion : A non compressible appendix with a threshold outer diameter of 6 mm under compression is the most accurate US finding for appendicitis; with high sensitivity, specificity, PPV, & NPV.

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Article
Progesterone Therapy Administered 24 hours Before Embryo Transfer in ICSI Cycle Improves Embryo Implantation and Pregnancy in Women With Luteal Phase Defect.

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Background: Ovulation induction by human menopausal gonadotrophin (HMG) results in temporal luteal phase defect. Luteal support therapies are required to support embryo implantation in stimulated cycle especially in luteal phase defect infertile women. Objective: The objective of the present study was to investigate the clinical significance of progesterone, aspirin and HCG on human embryo implantation in women with luteal phase defect following ICSI and embryo transfer (ET). Patients and Methods: The female patients were divided into six groups depending on the type of the luteal support protocols (LSP). Group 1 (No= 54), received 10 mg oral progesterone (P), group 2 (No= 35) received P plus HCG, group 3 (No= 59) received P plus HCG plus oral aspirin, group 4 (No= 47) received vaginal P administered 24 hours before embryo transfer plus oral aspirin, group 5 (No= 40) received vaginal P administered 12 hours after embryo transfer plus oral aspirin and group 6 (No= 46) received intramuscular P plus oral aspirin. The LSP were continued for at least 12 weeks, when the B- HCG test was positive, (tested two weeks after embryo transfer). Results: Statistical analysis of the clinical data showed no significant differences between the LSP in regard to patient's age, body mass index (B/M2), basal FSH/LH ratio and estradiol concentration at the day of HCG injection. The ICSI rate, percentages of embryos developed in vitro, and the numbers of the transferable quality embryos were similar in all groups (P>0.05). The pregnancy rate was significantly higher (P < 0.05), in group 4 compared to other groups (38.66% versus 24.51%(G 1), 22.53% (G 2), 28.66% (G 3), 25% (G 5), 21.60% (G 6). The percentages of viable fetal sac development per patient were 31.49 (17/54), in G 1, 42.86 (15/35), in G 2, 49.16 (29/59), in G 3, 59.58 (28/47), in G 4, 32.50 (13/40), in G 5, and 34.79 (16/46), G 6. The percent of viable gestation sac was significantly higher in group 4 compared to other groups (P < 0.05). Conclusions: The administration of 400 mg /day vaginal progesterone 24 hours before ET and 100 mg/day aspirin five days after ET results in significant improvements in pregnancy and embryo implantation rates and development of viable fetuses in luteal phase defect infertile women undergoing ICSI-ET.


Article
Correlation between the conventional, routine histological grading of transitional cell carcinoma of the urinary bladder and morphometric analysis

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Background: Transitional cell carcinoma of the urinary bladder is one of the important malignancies in both sex groups .It is considered as a heterogenous neoplasm with different biological behavior, in which the majority are early non invasive with tendency for recurrence and some may progress to invasive tumor. An important clinicopathological features are ,the tumor stage and histological grade which are used as prognostic parameters of the tumor and play an important role in therapy. Due to the subjectivity of the histological grading , the reproducibility was low . Many studies showed the value of quantitative analysis of the tumor as an important method in determining the recurrence of the tumor and muscular invasion, some other studies showed the value of nuclear measurement as a prognostic tool for bladder carcinoma. Aim of the study: To evaluate the benefit of nuclear image analysis as an objective method for grading of transitional cell carcinoma of the urinary bladder and compare it with the subjective routine histological grading. Material and method: Sixty two cases of transitional cell carcinoma of the urinary bladder, histologically diagnosed and graded according to WHO grading system ,were selected . In each case 8-10 HPF were examined &10-20consecutive cells were studied, also we measured the largest 10 nuclei for each case separately by a computerized image analysis system at x400 magnification. Nuclear area and roundness were determined. Statistical analysis was performed using the analysis of variance and Tukey’s test (HSD). Results: There was no statistical difference in the mean value of nuclear roundness between the three grades (P<0.05), while there was a statistical difference between grade I&III of their mean nuclear area (MNA) &MNA of the largest 10 nuclei (P<0.05). No such difference was found between grade I&II or grade II&III (P<0.05). Conclusion: Morphometric analysis should be based on the selection of special areas and not by random measurement as done on routine histological grading.


Article
The Role Of IL-4 And IL-8 In The Itiology Of Tinea Versicolor In Group Of Iraqi Patients

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Background: Tinea versicolor is a common dermatological problem ,world wide distribution , caused by a dimorphic fungus called Malassezia furfur ,it live normally on skin as a commensal . Many factors play a role in the etiology of TV among these could be the disturbed immune system which may be related to the ability of TV alter the immune system by a process called Immunomodulation leading to subsequent infection. Immuno-inflammatory activity mediated by different cytokines could have a role in the etiology of TV. Objective: To evaluate the serum level of the inflammatory cytokines ,IL-4andIL-8,in patients with TV as compared to immunocompramized patients and healthy groups. Patients and methods: This study enrolled 50 total patients, 15 of them were as patients control group who were immunocompramized with evident skin lesion ,to be compared serologically with 15 patients who had TV and normal immunity, the control group composed of20 healthy volunteers. Using ELISA test technique the following tests were done :detection of IL-4 and IL-8 in the sera of all groups. Results and discussion: The statistical differences in the rate of detectable IL-4 level between TV and healthy control p< 0.001,while the difference was a highly significant between the healthy control and immunocompramized patients with TV,P<0.00338.The difference between two diseased groups was(p< 0.219)which is non significant , when p<0. 05 was considered significant. IL-8 the results of our study showed a significant difference between the healthy control and the patients with tinea versicolor, p-value was( 0.05). In this study there was a nice findings by which the difference between the healthy control and the immunocompramized patients was highly significant as ,p<0.005. Conclusion :The genus Malassezia is an immunological paradox. In some circumstances, it acts as an adjuvant, activates the complement cascade, and elicits both cellular and humoral immune responses in healthy individuals, among which IL8 and IL-4 were notably increased . In contrast, it also seems to have the ability not only to evade the immune system but actually to suppress the response directed against


Article
Association between Interleukin-5 & Body Mass Index among Iraqi Asthmatic Patients

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Background: Asthma is an allergic hypersensitivity disease in which many mediators play a role in its pathogenecity. One of these etiological agents is the mediators such as Interleukin-5 (IL-5). The aim of this study to demonstrate the association between IL-5 and obesity in asthma development. Materials & Methods: One hundred and four sera samples for asthma cases have been studied in comparison with 41 non-asthmatic bronchitis as a patient controls beside 30 apparently healthy controls. Cytokine has been estimated using ELISA method in correlation with Body Mass Index (BMI). Results: This study revealed a significant correlation between IL-5 concentration and BMI (P<0.05), particularly among females. Conclusion: There is certain correlation between obesity and asthma accompanied by IL-5. Key

Keywords

Asthma --- IL-5 --- ELISA --- BMI.


Article
Some Immunological Evaluations of Propolis in Albino Male Mice

Authors: Ali H. Ad'hiah
Pages: 121-125
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Propolis is a complex resinous bee product that has a wide range of biological activities. In the present investigation, two oral doses (10 and 20 mg/kg/day) of propolis (ethanol extract) were evaluated immunologically in albino male mice (80 animals) through three types of experiments. In the first, the propolis was tested alone, while in the second and third experiments, propolis was given before and after the immune suppressive drug MMC (pre- and post treatments, respectively). The three experiments were paralleled with three negative controls, in which the propolis was replaced with distilled water. In the first experiment, the dose 10 mg/kg of propolis enhanced the parameters investigated, and a significant increase was observed in the total count of leucocytes (10.7 vs. 7.8 x 103 cells/cu.mm.blood), lymphocytes (7.0 vs. 5.3 x 103 cells/cu.mm.blood), neutrophils (2.9 vs. 2.1 x 103 cells/cu.mm.blood), monocytes (0.5 vs. 0.3 x 103 cells/cu.mm.blood) and eosinophils (0.3 vs. 0.1 x 103 cells/cu.mm. blood), PI (15.2 vs. 10.8%), PFC (72 vs. 38%), AR (0.84 vs. 0.57 mm) and DTH (0.68 vs. 0.40) as compared to negative controls. Much more enhancements were observed in the dose 20 mg/kg. In the second and third experiments, a similar picture was drawn in the interaction of propolis (pre- and posttreatments) with MMC, in which the propolis extract was able to modulate the immune suppressive effect of MMC, and this was dependent on the type of treatment and dose, and again, the dose 20 mg/kg was more effective in this respect. Key words and Abbreviations: Arthus reaction (AR), Delayed type hypersensitivity reaction (DTH), Mitomycin C (MMC), Phagocytic index (PI), Plaque forming cells (PFC), Propolis and Sheep red blood cells (SRBC).


Article
Acetaminophen Mimics the Action of Salbutamol in Relaxing Gravid Human Uterus - In - Vitro

Authors: Mahdi I. Hilmy
Pages: 126-129
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Management of preterp'labour generally treated by salbutamol even with some expected disturbing - maternal pulmonary oedema , respiratory distress and cardiovascular side effects and neonatal low-sized and cellularity of thymus and lymph nodes . This demands finding a substitute free of these side effects . Initially, acetaminophen was tested on rats uterine horns and on pregnant rats and reported an effective relaxation of the uterine horns and profound delay in parturition . These results jestified an in-vitro study on strips of gravid human uterus ruptured during difficult labour. Acetaminophen (50 mg) reduced tension by 50% which was comparable decrease in tension when 5 gg of salbutamol was added. Profound drop in tension when adjunct use of both drugs, while repeated three doses of 50 mg acetoaminophen were added separately resulted in corresponding drops in tesion down to below resting level . These findings encouraged future clinical trials on threatened women with abortion since the use of acetaminophen in the usual dosage is effective tocolytic agent without any maternal side effect but with mild possible neonatal lung congestion as a result of transient narrowing of ductus arteriosis especially in advanced gestation age.


Article
Doxycycline In Pityriasis Rosea: Placebo- Controlled Clinical Trial

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Background: Pityriasis rosea is an acute, self-limiting skin disease, probably of infective origin. Doxycycline is a broad-spectrum antibiotic, and most probably has an immunomodulator and an anti-inflammatory effect. Objective: To assess the efficacy of doxycycline in the treatment of pityriasis rosea in patients evaluated between January 2001 and May 2002. Patients and methods: This was a placebo-controlled clinical trial. One hundred and twenty patients with pityriasis rosea were included in the study; all of them were above 12 years of age. They had been divided into 2 groups, the treatment group consisted of 60 patients and received doxycycline capsule. 100,mg orally for 14 days and the placebo group consisted of 60 patients and received glucose capsules for 14 days, all the patients were followed up clinically for 4 weeks after treatment, the responses were categorized into excellent, partial and no response. Results: forty-six patients from the treatment group completed the study. Excellent response was achieved in 30 patients (65%), partial response in 15 patients (33.5%) and no response in I patient (1.5%). Forty patients from the placebo group completed the study. Excellent response was achieved in 4 patients (10%), partial response in 20 (50%) and no response in 16 patients (40%). The results were statistically significant. Conclusions: we concluded that doxycycline was effective in the treatment of pityriasis rosea, with very few adverse effects.


Article
Photo – Histometry A Modified Computer Assisted Morphometric Measurement Program

Authors: Zaid A AL-Madfai --- Huda M AL- Kateeb*
Pages: 135-137
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A promotion to a previous computer programmed technique "Photo-Micro Estimation Program" was carried out to compute the exact dimensions of cell and cell fraction in photographs of histological sections. "Visual Basic 6" was used as a language for building of the antecedent application forms. With the aid of a slide micrometer, pixels were substituted for micrometer (μm). The new procedure was termed "Photo-histometry program". To test the suitability of this program, eight photographs of histological sections were selected randomly to be tested. Results were contrasted with those calculated by using ocular lens (calibrated by a slide micrometer). Estimation of RBC diameter (well known, =7-8 μm) was the second step in assessing the adequateness of this new program. Results revealed that this program was simple, fast, adequate and accurate. It was better than the calibrated ocular lens in being more precise (it enumerates up to the fractions of a micrometer)


Article
Isolation of some microorganisms from Iraqi patients with chronic maxillary sinusitis.

Authors: Suhaila M. Al-Salloum --- Sarmad M. Zeiny
Pages: 138-143
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Background: Maxillary sinusitis is one of the most common infections of humans. Sinusitis can be defined as an inflammation of the membrane lining of any sinus, especially one of the paranasal sinuses. Objective: To determine the causative microorganisms of chronic maxillary sinusitis. Patients: Forty five chronic sinusitis patients were involved in the present study. Methods: Sampling method were sinus specimens (aspiration or injection aspiration). Results: Haemophilus species, Streptococcus pneumoniae (S.pneumoniae) and Moraxella catarrhalis (M.catarrhalis) were the most frequent isolates; in addition Penicillium and Cladosporium species were isolated from some chronic sinusitis patients. Conclusion: Chronic sinusitis could be caused by either bacterial species or by fungal species; most bacterial isolates were Haemophilus species followed by S.pneumoniae and M.catarrhalis. The incidences of chronic sinusitis were more at patients age (20-29 years) old groups.


Article
Herbal activation of mammary gland; a comparative

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Seventy five adult virgin female Norway rats (60 experimental and 15 controls) were used to evaluate the effect of seeds of three herbs (Fennel, Cumin and Garden cress) on their mammary glands. Experimental animals were fed with these herbs (each type of herb seeds was given to twenty experimental rats) for fourteen days. Rats were sacrificed and mammary gland sections were obtained, stained then morphometrically assessed. Serum prolactin level was performed too. Results revealed that Garden cress seeds are the strongest lactogenic agent among the three. Both Fennel and Cumin seeds were shown to be very weak galactagogues.


Article
Aflatoxin B1-Induced Kidney Damage in Rats

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Background: Aflatoxin B1 (AFB1) is a widely distributed mycotoxin in nature. Several investigations have shown its biological effects on different organs and in different animal species. However, the effects of AFB1 on the rat kidney have not been much elucidated histologically. Objective: This study aims to demonstrate the effects of AFB1 contaminated diet on the rat kidney from the histological and morphometric aspects. Method: Twelve mature albino rats were divided equally into a control group fed with usual diet and a treated group which was daily fed with diet contaminated with 20 mg AFB1/kg of body weight for 30 days. Semithin sections from renal cortex were stained with methylene blue and examined by light microscopy. Corpuscular changes were also detected morphometrically in terms of the ratio between the area of Bowman’s capsule and the area of its contained glomerulus (B/G ratio). Results: The treated group showed a marked increase in body weight. Histologically, there was evidence of acute tubular necrosis and increase in urinary space. Morphometrically, there was a diffuse significant increase in the B/G ratio compared to the control. Conclusion: Gain in weight can be attributed to fluid retention that accompanies the ensuing renal damage. The dietary dose of AFB1 (20 mg/kg of body weight) for 30 days was sufficient to produce acute tubular necrosis. The corpuscular changes indicated by the increase in the B/G ratio can be attributed to compensatory hypertrophy.

Keywords

Aflatoxin --- Kidney --- Rat --- Morphometry


Article
Observations on the ultrastructure of a rat mammary gland treated with harmal and borage

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Background : It had been indentified by histological, histochemical and morphometrical studies that peganum harmala is a mammogenic herb and borage officinalis is a lactogenic one . To complete our investigation about these two herbs , we performed electron microscopical study . Materials and methods : Rats were grouped according to their physiological status into three groups . Each group was subdivided in to three subgroups : one control and two experimental . The two experimental group were treated daily; the 1st one with an aqueous extract of peganum harmala seeds and the 2nd with an aqueous extract of borage officinalis flowers . After two weeks of treatment , mammary glands were employed for electron microscopical study . Results : In virgin rats , the epithelial and myoepithelial cells were partially differentiated when harmal was given and completely differentiated when borage was given . In pregnant rats , harmal and borage optimize mammary parenchymal growth and induce lactation when these herbs were given. In lactating rats ,these herbs exhibited a picture similar to control lactating group but the budding of lipid droplets and the swelling of secretary vesicles were markedly increased . Conclusion: Both harmal and borage stimulate the release of prolactin and induce galactogenesis during pregnancy and promote it during lactation . Key Words : Mammary gland , Electron microscope , Harmal , Borage


Article
Effect of chlorpromazine on intact and irradiated aliquot

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Bagkground:Chlorpromazine is widely used in human medicine in the therapy of schizophrenia, organic psychosis and the manic phase of manic depressive illness. It expressed a selective cytotoxicity and the results of genotoxicity were positive. Objectives: This study is designed to explore the effect of chlorpromazine on irradiated and non irradiated calf thymus double strands DNA (ctdsDNA) molecule. Methods: Aliquots of irradiated (subjected to UVB light) and non-radiated ctdsDNA samples were incubatyed with different concentrations of chlorpromazine. Further series of experiments studied the simultaneous effects of chlorpromazine and UVB light on aliquots of ctdsDNA, The changes in optic densities of ctdsDNA aliquots were mointered and recorded bu UVspectrophotometer at 260 nm. Results: Chlorpromazine exerts dual effects on non-radiated ctdsDNA aliquots represented by hyperchromasia and hypochromasia in regard to its concentration. It potentiates the effect of UVB radiation on ctdsDNA molecules. Its effect is differed in respect to the radiation status. Conclusion: chlorpromazine exerts several effects on aliquot ctdsDNA samples which are related to the nature of DNA molecule as well as to the concentration of chlorpromazine.Also chlorpromazine potentiates the hyperchromasic effect of UVB radiation on aliquot ctdsDNA samples but it produces completely damage of DNA molecule when the aliquot ctdsDNA samples irradiated in presence of chlorpromazine.

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Article
Effect of Continuous Darkness on Immune Response (In vivo Assay)

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Background: Reports denote that changes in day length enhance or suppress components of immune function in several mammalian species. The aim of present experimental study is directed to test the hypothesis deals with the effect of photoperiods on some immune limbs responsiveness. Materials and Methods: Twenty six male and female BALB/C mice, 5-7 weeks old, 14- 18gm weight divided into two groups, test groups (n.=8 mice for each sex) and control groups (n.=5 for each sex). Test groups were kept in a dark room for a month, while control groups were kept in a room where the photoperiod was day light: darkness 12:12hr. All studied groups immunized with o.2ml (10% sheep red blood cells) on day 4 and 8 of the last 12 days of the experiment. The weight of all animals were measured at the beginning and the end of the experiment. Arthus reaction, delayed type hypersensitivity and serum antibody titer were assessed on day 11 and 12 of program. J Fac Med Baghdad Vol. 49, No. 1, 2007 Received: May 2006 Accepted: Oct. 2006 Results: Significant increased (P<0.005) in body weight, index level of Arthus reaction, delayed type hypersensitivity and serum antibody titer in the test groups in comparison with the control groups. Conclusion: Data are consistent with the hypothesis that immune parameters are enhanced in short photoperiods or continuous darkness. Keywords: Photoperiod, immune response

Table of content: volume:49 issue:1