Table of content

Mustansiriya Medical Journal

مجلة المستنصرية الطبية

ISSN: 20701128 22274081
Publisher: Al-Mustansyriah University
Faculty: Medicine
Language: English

This journal is Open Access

About

Mustansiriya Medical Journal MMJ, a semi-annual peer-reviewed journal, is the official Journal of the College of Medicine, Al-Mustansiriya University. The journal was first published during the academic year 2001 - 2002 as the "Journal of Basic Medical Sciences" . Later on, an in order to expand the scope of publication and attract more scientific articles, the editorial board decided in late 2007 to switch the name from “ The Journal of Basic Medical Sciences” to “Mustansiriya Medical Journal”, the official Journal of the Faculty of Medicine at the University of Mustansiriya. The first issue with this new name was published in May 2008.

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Contact info

Iraq, Baghdad, College of Medicine, Al-Mustansiriya University, P.o.Box: 14132
Tel: 5413485
Fax: 5410584
email: mmj.mcom@yahoo.com

Table of content: 2009 volume:8 issue:1

Article
Novel Insulin & Better Glycemic Control in Type 2 Diabetics

Authors: Hazim A. Abdulwahab
Pages: 8-12
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Abstract

Background Recently a new premixed insulin analogue has been introduced with good results achieved in different parts of the world particularly regarding good glycemic control and safety. Objective This clinical study was conducted to evaluate the effectiveness and safety of introducing new insulin (biphasic insulin aspart 70/30)for the treatment of type 2 diabetic patients. Methods This prospective follow up study included 68 type 2 diabetic patients who has been randomly selected from those attending the National Diabetes Centre (NDC)of Almustansiria University during the period between 1st of oct.2004 to 31st of march 2005.Each patient had been followed for an average period of 6 months. Detailed history had been recorded and thorough physical examination has been performed for each patient. Readings of fasting and postprandial plasma glucose (FPG,PPPG), HbA1c,body mass index (BMI), and the frequency of hypoglycemic attacks had been recorded at the baseline ,interim, and the final visit which had been separated by 3 months between each other. At the baseline visit , each patient has been instructed how to use insulin pen properly and biphasic insulin aspart 70/30 had been supplied to the patients included in this study freely. Statistical analysis using students t-test had been used to assess the difference between different means using a p value of less than 0.05 as the level of statistical significance. Results This study showed that there was significant difference between the mean human insulin dose used before the study(48.3u/day) and the mean premixed insulin Aspart (36.88u/day) P value less than 0.05.The use of insulin analogue was associated with significant reduction in FPG (130.5mg/Dl in the last visit ,compared with 216mg/Dl in the 1st visit )P value less than 0.001,and the PPPG (160.2mg/Dl compared with 280mg/Dl in the 1st and last visit respectively)P value less than 0.001, and the mean HbA1c (7.1% compared with 9.41%)P value less than 0.001.There was no significant difference between the 1st and last visit recordings of BMI (27.9Kg/m2 compared with 28.1Kg/m2 respectively )P value more than 0.05 ,and in the average incidence of mild hypoglycemic episodes (1.01 compared with 0.42 episode respectively)P value more than 0.05. Conclusion This study showed that the use of this type of insulin analogue for type2DM lead to marked and statistically significant improvement in the glycemic control ,mainly in the PPPG. In addition the use of this type of insulin was associated with only mild elevation in the BMI and slight lowering in the incidence of hypoglycemic episodes ,both non-significant statistically.


Article
Extrahepatic Biliary Tract Injuries

Authors: Gasan Al-Quzweeny
Pages: 13-16
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Abstract

Background Extra hepatic biliary tract (EBT) injuries are injuries that involve the gall bladder (GB), the common hepatic (CHD) and the common bile ducts (CBD). They are rarely encountered during external abdominal traumas. They are serious and associated with high morbidity and mortality when the ductal system is involved and because of the associated visceral and vascular injuries and thus they need special care to be diagnosed early, and managed properly. Objectives: To study the incidence, clinical presentation, management, and complications of extrahepatic biliary tract injuries. Methods Retrospective review was done for all the patients who had laparotomy for their abdominal traumas during a year at Al Yarmouk Teaching Hospital with special emphasis on extrahepatic biliary tract injuries. Results Nearly 700 people had severe abdominal injuries necessitating an explorative laparotomy for their management. Out of this number only 8 definite extrahepatic biliary tract injuries were discovered. 6 of them had cholecystectomy and 2 had biliary ductal injuries for which drainage was the major step in their management. 4 cases were labeled to have missed EBT injuries. Conclusion Extrahepatic biliary injuries are rare coincidences on exploring traumatized abdomen. They are serious injuries associated with high morbidity and mortality when the ductal system is involved and are usually accompanied by severe other visceral injuries. Their management should be done by the most senior surgeon and if possible in a well equipped center.

Keywords

extra‐hepatic --- biliary --- injuries --- Iraq


Article
Compliance of Diabetic patients

Authors: Riyadh K Lafta
Pages: 17-22
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Abstract

Background Diabetes is likely to be the fifth leading cause of death. Global excess mortality attributable to diabetes is estimated at 2.9 million deaths which is equivalent to 5.2% of world all-cause mortality. Compliance with medical advice is essential for controlling the disease; it is affected by many factors related to the patient, the disease, the physician and the family. Objective To assess the level of diabetic patients’ compliance with diet, drugs and visits, and to assess its effect on the disease control through certain indicators. Methods A total of 300 diabetic patients from different age categories, both males and females, were included in this study. The patients are usually either self-referral or referred from other hospitals, primary health care centers, governmental general practice clinics or private clinics. A questionnaire form was constructed to collect data about the demographic characteristics of the patients, about diet and medications. Files of the patients were reviewed to have an idea about their compliance. Results Compliance with diet was medium in half of the patients, while with drugs; it was good in 60.3%, and 38.7% had good compliance to visits. The best compliance with diet (38.2%) was seen in the age group 40-49 year while the least (19.2%) was in the age group (30-39)[ (χ²=2.65, P>0.05), 37.4% of the patients who are using oral hypoglycaemic agents, and 36.7% of those using insulin had good compliance with diet (χ²=7.10, P<0.05). Conclusion We can conclude from this study that the diabetic patients (represented by the study sample) have poor compliance with diet and visits, the duration of the disease was the most common variable found to predict compliance.

Keywords

Diabetic --- compliance --- Iraq


Article
Haemorrhoidectomy: a Comparative Study of Open & Closed Methods

Authors: Hamid I. Jasim
Pages: 23-26
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Abstract

Background: Haemorrhoidectomy is an operation for third and fourth degree hemorrhoids Aim: To compare the closed (Ferguson) and open (Milligan-Morgan) methods. Methods: A prospective study, eighty patients admitted with hemorrhoids were randomly allocated to either open or closed methods. Results: Mean operative time was shorter in the open method. Analgesic requirement were less in the closed method. Healing time was shorter in the closed method. Conclusions: The closed technique is associated with less pain during early post- operative period and faster healing.

Keywords

Haemorrhoids --- open --- closed --- pain --- healing time.


Article
Hand Deformities in Patients with Rheumatoid Arthritis

Authors: R. R. Merza
Pages: 27-32
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Abstract

Objective To estimate the types of hand deformities in patients with rheumatoid arthritis (RA). Methods: A group of 100 patients who had been admitted to the department of rheumatology and rehabilitation center in Sulaimany general hospital and those who had been attended to the rheumatology and rehabilitation center between June 2006 and January 2007 were included in this study.86% were females and 14% were males . Patients who had undergone articular surgery and patients below 16 years had been excluded. Results Hand deformities recorded in 47% of cases. The frequency of deformities was as follow; swan neck deformity (48.90%), boutonniere deformity (43.04%), Z deformity(59.5%), ulnar deviation of the metacarpophalangeal joints (MCPJ) (78.7%), radial deviation of the wrist (91.48%), subluxation of the wrist (27.6%), and subluxation of the MCPJ(36.17%).There was a significant correlation between disease duration and development of deformities,other factors that had been studied but had no effect on the development of deformities were rheumatoid factor positivity ;occupation of the patients ;effect of weather;and geographical distribution of the patients. Conclusion Rheumatoid arthritis is an important disease that affects the hands and cause deformities. Understanding these deformities is necessary for the proper management of these patients. This study is representative for RA related hand deformities and factors that contribute to their development.


Article
Leptin in Goitrous patients

Authors: Feryal Hashim Rada
Pages: 33-35
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Abstract

Objective To evaluate the relationship between serum Leptin levels and metabolic syndrome, in (obese, non-obese) control subjects, untreated hypothyroid and hyperthyroid patients. Methods A study was made on 63 goitrous patients and 25 control subjects. Body mass index (BMI) was calculated. Serum T3, T4, TSH were measured by RIA method, serum lipid profile was measured by spectrophotometric method, serum Leptin was measured by ELISA method. Results The mean serum Leptin level was significantly higher in obese than in non-obese control subjects (29.1 vs. 5.8 ngm / ml) and higher in hypothyroid patients (27.9 ngm /ml), and lowest levels in hyperthyroid patients (3.4 ngm /ml). Conclusion Leptin reduce body weight by decreasing food intake (appetite), fat deposition and increasing energy expenditure. Serum Leptin is highly correlated with the body mass index (BMI), other indices of adiposity (lipid profile) in normal obese human and hypothyroid patients.


Article
Colorectal cancer in a group of Iraqi patients

Authors: Sabeha Moosa Al‐Bayati
Pages: 36-39
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Abstract

Background Colorectal cancer is the second most common internal malignancy and the second leading cause of cancer death (after lung cancer).The condition becomes increasingly common after the age of 50.Because it is a common problem in certain areas of the world and because its insidious nature of onset that sometimes is too late when diagnosed, keeping high index of suspicion with developing screening tests that are reliable and easily performed are vital in diagnosis. Objective: To highlight some of the demographic, laboratory, and histopathological criteria of colorectal cancer in a group of Iraqi patients. Methods This study is a descriptive cross sectional study that had enrolled 30 patients with colorectal cancer. The patients included in this study had been selected from those patients who had attended the endoscopic unit / department of medicine at Al-Yarmouk teaching hospital during the period between the 1st of September 2006 to the 1st of September 2007. Patients diagnosed to have colorectal cancer by colonoscopy, and biopsy samples were taken for histopathological study, and blood samples were taken for carcinoembryonic antigen. Results This study revealed that 80% of the patients were older than 50 years of age with a male: female ratio of 2.75:1.63.33% of the patients were smokers. The study revealed that the presentation of the disease is usually insidious with abdominal pain, change in bowel habit and haematochezia and melena seen in 83.34% of the patients. 66.67% of the tumors were located in the rectosigmoid.All the tumors were adenocarcinoma. Carcinoembryonic antigen was +ve in 60% of the patients. Conclusion Colorectal cancer is more common in old male patients with smoking habit.


Article
Faecal (Lower Enterocutaneous) Fistula after Colonic Surgery (Analysis of Its Occurrence & Recurrence)

Authors: Haytham Hazim
Pages: 40-45
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Abstract

Background One of the major complications of colonic resections is anastomotic leak that may convert in some cases into permanent faecal fistula, presented with discharge of faecal material from the site of the wound or drain. Objective: To know the incidence of faecal fistula after colonic surgery, and to analyse the associated factors that enhance or reduce its formation and its recurrence. Method A prospective study of one hundred and thirty seven patients who were undergone colonic surgery in the period from Jan.1996 to Jun.2005. Those patients were followed up for at least one month after the operation of the anastomosis of the colon. The operations were done for different pathologies or lesions. All of the operations in this study were elective with bowel preparation, while 126 patients (92%) had previous colostomy because of an urgent operation in the past. Results It had been found that the majority of the operations on the colon were closure of the colostomy (92%), especially that due to missile injuries (75.5%). Anastomotic leak appeared in 14 cases (10.2%) of the total operations, ten of them closed spontaneously with conservative treatment and the remaining 4 cases (2.9% of the total) transformed into faecal fistulae. All of these fistulae were in the patients originally injured by high energy missiles. Re-operation for those four patients, after bowel preparation, included excision of the fistula with resection of the affected segment of the colon and reanastomosis. The fistula disappeared in three of them but recurred in the fourth. Conclusions Although mortality reduced markedly in elective colonic operation, by the modern surgery, faecal fistula still remains a challenge to the surgeons. Bowel preparation, prophylactic antibiotics, good vascularity of the ends of the colon, proper approximation of the ends of the colon without tension, delicate suturing, prevention of perioperative hypotension, and good nutrition of the patient; all are prophylactic measures against formation of the fistula. Once the fistula was formed, then simple suture closure of the fistula alone is not beneficial, preferably resection of the affected segment of the colon is indicated.


Article
Isolation & Partial Purification of Testosterone Receptors in Benign & Malignant Prostatic Tumors

Authors: Omar F. Abdul‐Rasheed
Pages: 46-52
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Abstract

Background A gel filtration technique has been used for the isolation and purification of soluble testosterone receptors from benign and malignant prostatic tumors. Two types of testosterone receptors from benign and malignant prostatic tumors were eluted from the sephadex G-200 column. This work was carried out to characterize and quantify human nuclear androgen receptors from benign and malignant prostatic tumors. Methods The study involved twenty five patients with benign prostatic hyperplasia (BPH) and thirteen patients with prostatic adenocarcinoma (PCA) attending Al-Kadhimiya teaching hospital from the period of November 2005 till july 2006. Results The purification folds of two benign separated receptors (BI & BII) were 11.588 and 19.582 fold respectively whereas for the two malignant separated receptors (MI & MII) were 24.280 and 29.111 fold respectively.The choice of most appropriate conditions of the binding of 125I-testosterone with its receptors were also carried out.The concentrations of binding sites and the equilibrium dissociation constants for the binding between 125I-testosterone and its purified receptors have been determined using Scatchrad analysis and the specificity of the binding has been examined. The concentrations of two benign separated receptors (BI & BII) were 0.931 and 1.140 pmole/mg protein respectively whereas separated malignant receptors (MI & MII) have 1.056 and 2.163 pmole/mg protein respectively at 37ºC. Conclusions Gel filtration technique and Scatchard analysis confirmed the presence of two types of testosterone receptors in each tumor type. The first eluted receptor (I) has a relatively higher molecular weight with a lower affinity constant for testosterone binding than the other(II).


Article
The Significance of Estimation of Anti- Apoptotic Protein in Acute Leukemia Cases

Authors: Waseem Fadhil Al‐Tememi
Pages: 53-58
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Background Apoptosis is a terminal cell fate that eliminates physiological unneeded or dangerous cells. The Bcl-2 oncoprotein encodes a mitochondrial protein that blocks apoptosis. High levels of Bcl-2 protein are found in different malignancies including acute leukemias and it is thought to be directly involved in the emergence of drug resistance by disrupting &/or delaying apoptotic program and promoting tumor survival. Objectives To analyze the significance of any variation in the level of Bcl-2 expression according to disease progress (from time of diagnosis to time of remission or resistance) in cases with acute leukemia, and whether to consider this variation as a prognostic marker. Methods: Through a prospective study, 25 samples of bone marrow aspirates were taken from different patients who attended the hematology unit of Baghdad teaching hospital in the medical city from December 2005 to July 2006, who proved to have acute leukemia in its different types or subtypes(ALL and AML) & at a variable phases of the disease course. Monoclonal antibody targeted against Bcl-2 oncoprotein via immunocytochemistry staining techniques of these aspirates was performed in order to define the level of Bcl-2 protein carrying cells & looking for any differences in this expression in relation to disease progress or treatment hoping to translate these findings in terms of prognosis. Results Despite the heterogenous expression of Bcl-2 protein carrying cells in each case(0-500 cells out of 500 cells)of AML or ALL , it was found to be in positive correlation with the density of blast cell percentage in the marrow(r=0.515,p=0.008) unlike the relation with total leucocyte count (r=0.364,p=0.074). Conclusion: A good clinical clue to intractable resistant course of the disease at diagnosis is verified in this study when very high level of Bcl-2 protein carrying cells was found. This finding may have a useful clinical application through the recommendation to change therapeutic strategy, at time of diagnosis, to more aggressive protocols, which is agreed by others. There was no chance to study the application of high level of Bcl-2 protein in terms of long-term survival due to short follow up.


Article
Hyperprolactinaemia: when MRI is indicated?

Authors: Wasan I. Majeed
Pages: 59-64
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Abstract

Design This prospective study was carried out at the magnetic resonance imaging (MRI) unit at the department of diagnostic imaging of Al-Kadhmiya Teaching Hospital over a period of 26 months. Objective: To establish a strategy for the use of MRI of the pituitary region in patients with hyperprolactinaemia based on the possibility of finding a pathology in the pituitary region as a cause of hyperprolactinaemia with respect to serum prolactin (PRL) as well as the analysis of serum PRL in relation to the size of adenoma in the pre & post medical treatment evaluation to determine the need for MRI in the follow up in patients with pituitary adenoma. Subjects & Methods We selected 69 women recently found to have clinical & biochemical evidence of hyperprolactinaemia with serum PRL exceeding the double the upper normal level of the control. MRI of the pituitary region & serum PRL were assessed at the initial presentation for all patients & after the institution of bromocriptine (BRC) treatment for 28 patients who were shown to have either micro or macroadenomas at the initial MRI. The diameter of the adenoma served as a predictor for its size & was considered for correlation with serum PRL level at the follow up period of 3 , 6 & 12 months of treatment. Results At the initial MRI, 27 patients had microadenomas (39.1%), 12 patients had macroadenomas (17.4%), 9 patients had empty sella turcica (13.1%), and 21 patients (30.4%) had no obvious abnormality in the pituitary region The analysis of individual serum PRL level to establish a cut-off point of serum PRL above which all cases were positive for a pathology in the pituitary region on MR imaging, revealed a cut-off value = 84.6 ng/ml. A strong correlation has been found between the size of adenoma and serum PRL level at the initial presentation as well as at the follow up assessment that revealed a parallel reduction in adenoma diameter & serum PRL level. Conclusion MRI of the pituitary region is justifiable in women with hyper-prolactinaemia when serum PRL level is approximately two & a half folds of the upper normal level where its likely to reveal an abnormality , but it should not be used routinely for the follow up of patients on treatment as the assessment of serum PRL level will suffice as a predictor of tumor shrinkage unless there is no response to medical treatment or the patient developed new symptoms that suggest increase in the size of the adenoma or involvement of the surrounding structures.


Article
Transverse Myelitis: Story of Fifteen Years of Dependence on Mechanical Ventilation

Authors: Basim.S. Al‐Mgoter
Pages: 65-66
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Abstract

This is a story of a patient with 27 years old; he had spent 12 years of his life enjoying a good health and living as a lovely child among his family, his father, mother and other brothers and sisters. Wail Hadi Hassan was looking forward to a life filled with happiness and hope and suddenly he found himself inside the hospital, he was admitted to the hospital and since that time he couldn`t leave.

Keywords

Table of content: volume:8 issue:1