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IRAQI JOURNAL OF MEDICAL SCIENCES

المجلة العراقية للعلوم الطبية

ISSN: 16816579
Publisher: Al-Nahrain University
Faculty: Medicine
Language: English

This journal is Open Access

About

Iraqi Journal of Medical Sciences
Aims and Scope
Iraqi Journal of Medical Sciences is published by College of Medicine, Al-Nahrain University. It is a quarterly multidisciplinary medical journal since 2000 . High quality papers written in English, dealing with aspects of clinical, academic or investigative medicine or research will be welcomed. Emphasis is placed on matters relating to medicine in Iraq in particular and the Middle East in general, though articles are welcomed from anywhere in the world.
Iraqi Journal of Medical Sciences publishes original articles, case reports, and letters to the editor, editorials, investigative medicine, and review articles. They include forensic medicine, history of medicine, medical ethics, and religious aspects of medicine, and other selected topics.
عنوان المجلة :
College of Medicine
Baghdad, Iraq
Tel and Fax: + 964-1-5224368
P. O. Box 14222, Baghdad, Iraq.
E-mail: iraqijms@colmed-alnahrain.edu.iq

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iraqi_jms_alnahrain@yahoo.com

iraqijms@colmed-alnahrain.edu.iq

http://www.colmed-alnahrain.edu.iq

Table of content: 2005 volume:4 issue:2

Article
EDITORIAL: MEDICAL PRACTICE: IS THE TEXTBOOK ALWAYS RIGHT?

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Article
MOTOR INNERVATION OF THE SHORT MUSCLES OF THE THUMB: ANATOMIC AND CLINICAL IMPLICATIONS
لتعصيب الحركي للعضلات القصيرة في ابهام اليد: المضامين التشريحية والسريرية

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Background: The motor innervation of the thumb muscles though important for the hand surgeon, yet it is still a subject of debate since median and ulnar nerves play variable roles. Objectives: To describe the innervation of the short muscles of the thumb and the possible presence of a 1st palmar interosseous muscle. To correlate the variations of innervation to prognostic values in nerve diseases and injuries. Methods: A dissection of 15 adult embalmed hands was performed. An EMG study on 42 hands of healthy volunteers was done in which the compound muscle action potential and the interference pattern were studied by sampling separate muscles. Results: In (86.6%) of the dissections the muscular branch of the median nerve was the first branch in the palm. A median-ulnar anastomosis was found in (53.3%) of the dissected hands, demonstrated at different levels. In spite of special attention to reveal a first palmar interosseous muscle, it was not detected as a separate entity. In the EMG study, innervation showed considerable variations. Adductor pollicis did not receive pure median innervation, it received the ulnar nerve in (90.5%) of the cases. Abductor pollicis brevis did not show a pure ulnar supply, it was mainly supplied by median nerve (66.7%). The highest percentage (66.7%) of a mixed innervation was shown in opponens pollicis. Conclusions: The palmar median-ulnar anastomosis at different levels makes it vulnerable in surgical interventions. The absence of significant laterality in the mode of innervation of specific muscles may help the prognosis of the affected hand from an EMG study done on the contralateral side. The conventional EMG method does not specify the exact innervation of each muscle. From the prognostic point of view if the method used in this study is applied conventionally, the severity of the injury can be expressed in terms of muscles involved. Many muscles received mixed innervation and will retain their function on the long run. Key words: thenar muscles, motor innervation, EMG


Article
HISTOLOGICAL CHANGES IN PLACENTA OF PATIENTS WITH PRE ECLAMPSIA
التغيرات النسجيه الحاصله في مشيمة المصابات بمقدمة الارتعاج

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Background: Preeclampsia is a major disease of human reproduction, with 10% of human births being affected, mainly a systemic endothelial disease causing activation of platelets and diffuse ischemic disorders. Objectives: The study aims to demonstrate the histological changes in placenta of women suffering from hypertensive disease. Methods: Placental samples were obtained from 15 healthy uncomplicated pregnancies and 35 pregnancies complicated by intrauterine growth restriction due to sever preeclampsia. Samples were prepared and examined by light microscope. Results: Variable changes have been observed in different patients, including degeneration of most of endothelial cells, degeneration of major trophoblast cells, hyalinization and fibrotic trophoblast cells in some patient sections and fatty infiltration within trophoblast cells in other patient sections. Conclusion: The primary cause of preeclampsia is a disturbed growth of trophoblast cells with the degeneration of major endothelial cells. Key words: Preeclampsia, Placenta, histological changes.


Article
ISOLATION AND PURIFICATION OF MYELOPEROXIDASE FROM HUMAN POLYMORPHONEUCLEAR-CELLS (PMN)
عزل و تنمية المايلوبيروكسيديز من الخلايا متعددة الانوية في الانسان

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Background: Myeloperoxidase (MPO) oxidoreductase, EC.1.11.1.7 stored in granules of neutrophils ingest microorganisms by generating of reactive oxidants. Objective: Isolation and Purification of (MPO) from polymorphonuclear cells. Methods: The enzyme was purified from polymorphonuclear blood cells by Ion exchange chromatography by CMC and gel filtration Sephacryl S.200 column and SDS electrophoresis. Results: Polymorphonuclear cell (PMN) were isolated from human blood; cell extract was prepared by homogenizetion of cell pellets in 0.34 M sucrose. Human (PMN) Myeloperoxidase (MPO) has been purified to homogeneity by two- steps procedure, which included CM-cellulose ion exchange chromatography and Sephacyl S- 200 column at purification fold and recovery of 1.281 and 43.94% respectively. The final product was homogeneous when examined by SDS -polyacrylamide gel electrophoresis. The molecular weight of the enzyme is 80,000 daltons as determined by SDS- PAGE and 88,000 daltons by Sephacyl S-200. Conclusion: The purification of MPO with accepted yield may open new approaches for its using in the medical application as preparing of monclonal antibodies and diagnostic kits for detection of antimyeloperxidase that are required for some inflammatory diseases Keywords: Polymorphonulear cells; Myeloperoxidase


Article
ROLE OF TOTAL AND LIPID -BOUND SIALIC ACID IN DISCRIMINATIG ACTIVITES OF RHEUMTOID ARTHRIRIS PATIENTS
دور حامض السايليك الكلي و الدهن المرتبط بحامض السايليك للتمييز بين فاعليات مرضى التهاب المفاصل الرثوى

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Background: It is known that total serum sialic acid (TSA) and lipid bound sialic acid (LSA) levels may be altered by different types of disease included Rheumatoid Arthritis (RA) and inflammatory disease, therefore the evaluation of these compounds in serum patients with RA may elucidate the relationship between its levels and disease activity. Aim: This study was designed to evaluate the clinical application of serum total sialic acid (TSA) and lipid bound sialic acid (LSA) levels in patients with RA, considering the disease activity and compare the levels with a normal group. Method: The study was carried out on ninety-seven healthy and sick adults. Fifty-four (37 female, 17 male) patients with RA disease. Of them 29 patients (21female, 8 male) had low disease activity [age range 32-65 years] and twenty-five patients (16 female, 9 male) had high disease activity [age range 22-52 years]. They were compared with 43 healthy persons [age range 19-64 years]. Colorimetric methods were used for determination TSA and LSA in serum samples. Results: Total sialic acid and lipid bound sialic acid levels in serum patients with RA show significantly increased when compared to normal group, and more increased in patients with high activity disease. Conclusions: Based on our results, serum TSA and LSA level would be used as a good marker for discriminating between activities of RA disease. Key words: Rheumatoid Arthritis, sialic acid, and lipid bound sialic acid.


Article
THE ROLE OF CERVICAL SCREENING IN EARLY DETECTION OF CERVICAL LESIONS
دور تقصي لطاخات عنق الرحم في التشخيص المبكر للافات

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Background: Papanicolaou (pap) smear is the most effective cancer prevention screening tool ever devised. Objective: To study the prevalence of cervical inflammatory, premalignant and malignant lesions and to identify factors related to the prevalence of those lesions. Methods: A cross sectional study was conducted over 3 months period on 302 women attending a Gynecology and Obstetrics outpatient clinic. A detailed history was recruited and pap smear was performed after taking patient consent. Results: Among the total of 300 satisfactory pap smears, pathological changes were found in 209 (67.7%) while the rest 91 (30.3%) did not show any abnormality. More than one type of pathology were found in some cervical smears. The prevalence of different pathological changes revealed by cytological diagnosis of 302 pap smear were: Non-specific cervicitis 188(62.7%), Squamous metaplasia 23 (7.7%), Moniliasis 11 (3.7%), Squamous dysplasia (mild and moderate) 7 (2.3%), trichomouns vaginalis 4(1.3%), HPV infection 4(1.3%), IUCD changes 4(1.3%) and 2 smears (0.7%) were unsatisfactory and excluded from the study. Conclusions: The prevalence of pre-carcerous and carcerous cervical lesions are low and comparable to other studies. Low educational level and improper genital and sexual hygienic practices are associated with inflammatory smears, and they are common findings among women with pre-carcerous lesions. History of prior genital infection, using contraception, abortion and curettage are associated with cervicitis. Keywords: pap smear, cervical cancer, cervicitis


Article
TRACE ELEMENTS AND HEMATOLOGICAL CHANGES IN THALASSAEMIA MAJOR AND MINOR
تقييم نسبة المعادن الضئيلة و متغيرات الدم المختلفة عند مرضى الثالاسيميا بنوعيه الرئيسي و النوعي

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Background: The Thalassaemias are hereditary hemolytic anaemia due to genetic defect in the DNA or in the messenger RNA. Many studies on B-thalassaemia (major and minor) have reported variation in the level of the trace elements zinc, Copper and Magnesium. These variations may play a role in cellular abnormalities, which characterize this disorder. Thus, these trace elements have been used as indices for following up these patients. Objective: To assess the level of serum Cu, Zn and Mg in thalassaemic patients (major and minor) and to investigate different hematological parameters as well as serum ferritin in those patients. Methods: 72 patients with B-thalassaemia major (Th. M.), 17 patients with B- thalassaemia minor (Th.Mn.) and 30 healthy age matched subjects who served as control. Trace elements, Hb, PCV, MCH and MCHC and serum ferritin were estimated. Results: A significant decrease in Hb concentration and MCHC was found in Th.M. compared to control group whereas a significant increase in MCV, MCH and MCHC was found in Th.M. compared to Th.Mn. In addition, MCV, MCH and MCHC were significantly reduced in Th.Mn. compared to control, while PCV level was significantly higher when compared to Th.M. patients and control group. Serum Cu and Zn in Th.M. were significantly increased when compared to control group while serum Mg in Th.M. was significantly reduced when compared to healthy control but not in Th.Mn. In Th.Mn., serum Cu was significantly increase when compared to control and to Th.M. patients. Serum ferritin was significantly high in B-thalassaemia major and minor when compared to control. In addition, it was significantly high in Th. M. compared to Th.Mn. Furthermore, only serum Zn and Mg showed a significant positive correlation with PCV in B-Th.M. patients. Conclusion: Serum Cu and ferritin were high in B-Th.M. and Th.Mn., serum Mg was low and serum Zn was high in B-Th.M. Since serum Zn and Mg were closely related to PCV, therefore the therapeutic value of Mg and Zn supplementation should be tested in those patients. Keywords: Trace Elements, Thalassaemia Major and Minor, Hematological Changes


Article
ASPIRATION CYTOLOGY OF OVARIAN CYSTS AND CYSTIC NEOPLASM: A STUDY OF 39 ASPIRATES
الفحص الخلوي بالرشف بالابرة الدقيقة للاكياس و الاورام الكيسية للمبيض ، دراسة (39) حالة.

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Background: Fine needle aspiration cytology has been widely applied in the diagnosis of ovarian cysts and cystic neoplasms, it offers the advantages of rapid diagnosis, minimal trauma to the patient and low cost, yielding relatively acceptable diagnostic sensitivity and specificity. Objective: To evaluate the sensitivity and specificity of aspiration cytology in the diagnosis of ovarian cystic lesions. Methods: 39 female patients with clinico-radiological diagnosis of ovarian cysts and cystic neoplasm underwent ultrasonic guided aspiration cytology in the period from January 2000 to June 2003 at Al-Kadhimiya Teaching Hospital. Results: Thirty-nine female patients with an age range of 21-48 years underwent ultrasonic guided aspiration cytology of an ovarian cystic lesion. There were thirteen female patients with non neoplastic cysts while twenty six female patients had neoplastic cystic lesion with various histogenesis including (surface epithelial and germ cell type) predominantly benign tumors, while three cases revealed malignant serous cystadenocarcinoma. The over all sensitivity around 37.5% considering the inadequate cytological smears as a false negative result and specificity of 100%. Conclusion: Fine needle aspiration cytology in the evaluation of ovarian cysts and cystic neoplastic lesions in safe, reliable and rapid diagnostic procedure yielding relatively acceptable sensitivity and specificity. Key word: FNAC, ovarian cystic lesions


Article
THE SIGNIFICANCE OF LIPOPROTEIN DEPOSITION IN THE RETINA OF PREGNANT WOMEN AS A MARKER OF PREECLAMPSIA, IUGR AND OTHER RELATED MATERNAL AND FETAL COMPLICATIONS
القيمة التنبئية للترسبات الصلدة في قعر العين للحوامل في الأشهر الثلاث الأخيرة من الحمل كمؤشر لارتفاع ضغط الدم و تباطؤ نموا الجنين و المضاعفات الأخرى

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Background: Preeclampsia is a disorder characterized by three main clinical features, these are hypertension, edema and proteinuria. Fibrin deposition in various tissues can be easily demonstrated by microscopical examination, however this requires a biopsy. Fortunately, the eye is the mirror of the body. Objective: To detect the deposition of fibrin in the eyes of pregnant women within the first two weeks of the third trimester before the women become preeclamptic, through simple ophthalmoscopy Methods: 42 primigravida pregnant women were chosen as a study group, which include those women in whom hard exudate (Lipoprotein deposition) was detected at 28-30 weeks of gestation in their retina through simple ophthalmoscopy examination. While another control group of 46 women were selected in whom examination of the eye for hard exudate was negative. Both groups were followed routinely in the third trimester and screened for any complication, which may develop. Results: The incidence of preeclampsia, oligohydramnios, placenta abruption was significantly higher in the study group than in the control group, 45.23% vs 13.04, 28.57% vs 2.17 % and 16.66 % vs 2.17 % respectively. While the incidence of IUGR and perinatal death was still higher in the study group than in the control group 28.57 % vs 2.17 % and 9.52 % vs 0.00 %. Conclusion: Simple ophthalmoscopic examination of the pregnant women eyes for the presence of hard exudate (Lipoprotein deposition) may be useful in sorting high-risk women for preeclampsia and its related complications. Key words ; Preeclampsia, hard exudate, retina, lipoprotein


Article
TITANIUM MINIPLATE OSTEOSYNTHESIS OF MANDIBULAR FRACTURES
تثبيت كسور الفك الاسفل بواسطة الصفائح التيتانيومية العظمية المصغرة

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Background: The treatment of mandibular fractures (#s) had traditionally involved re-establishment of occlusion by Intermaxillary Fixation (IMF). In order to eliminate the morbidity associated with IMF. IMF has associated morbidity such as weight loss, interference with oral hygiene measures and patient discomfort. Increasingly over the three past decades, oral and maxillofacial surgeons have developed techniques of treating mandibular fractures using internal fixation. The routine use of miniplats in oral and maxillofacial surgery has gained popularity since Champy reporded modification of the original technique of Michelet. Objective: Evaluation of titanium miniplate osteosynthesis in treatment of mandibular fractures and comparison of the out come, advantages, disadvantages and complications between intra oral and extra oral approach for the application of titanium miniplates. Methods: This study was performed prospectively on 24 patients with 28 isolated mandibular fractures and treated by open reduction and titanium miniplate osteosynthesis. Ten patients had intra oral approach and fourteen patients had extra oral approach. Result: The overall complication rate was 25%. In the group, in which extra oral approach was used, the complication rate was 21.4% (3patients): 2 patients with facial scarring and 1 patient with malocclusion. In the group, in which intra oral approach was used, the complication rate was 30% (3 patients): 1 patient with paraesthesia of the lip, 1 patient with postoperative infection and 1 patient with root injury. Conclusion: Miniplate osteosynthesis gives acceptable result, and it can be recommended as a routine method for treatment of all mandibular #s. Intra oral approach is advantageous to, and gives comparable results with extra oral approach. Experience in the technique is an important factor in the outcome. Key words: Trauma-Mandibular fracture-Miniplate osteosynthesis


Article
THE INCIDENCE OF SCROTAL VARICOCELE AS FOUND IN INFERTILE PATIENTS BY CLINICAL EXAMINATION, B-MODE AND COLOR DOPPLER ULTRASOUND
حدوث دوالي الخصية في الرجال العقيمين كما وجد بالفحص السريري ، و فحص الموجات فوق الصوتية الاعتيادي و الدوبلر الملون

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Background: Considerable attention has been made for improving the diagnosis of varicocele none invasively by color Doppler ultrasound due to the association between it and male sub fertility and the potential for enhanced fertility after varicocelectomy. The color Doppler ultrasound diagnostic criteria for varicocele were; a. Dilatation of pampiniform plexus more than 2mm. b. Retrograde flow in the upright position regardless the size of pampiniform plexus. Objectives: To assess the value of color Doppler ultrasound compared to clinical examination and B.mode ultrasound in diagnosis of scrotal varicocele. Methods: A cross sectional study was done on one hundred infertile or hypo fertile patients with clinical suspicion of varicocele who were examined by B. mode and color Doppler US for confirmation or exclusion of the diagnosis or to exclude recurrence after varicocelectomy. Results: Color Doppler US including B.mode facility increased the incidence of false negative clinical cases by 22% which is very significant and was important to correct the diagnosis of false positive clinical cases in 6% of patients , they were highly valuable in confirming the clinical suspicion of varicocele in 62%.Color Doppler US was highly essential to detect subclinical cases in 5% and detecting recurrence after varicocelectomy in 37% of postoperative cases. Conclusion: Color Doppler Ultrasound became the standard reference non-invasive imaging modality for diagnosis of scrotal varicocele and following patients after varicocelectomy. Keywords: Varicocele, B.mode ultrasound, Color Doppler imaging (CDI).


Article
PREVALENCE OF PARKINSON’S DISEASE IN AL-KADHIMIYA DISTRICT (BAGHDAD CITY): COMMUNITY-BASED STUDY
شيوع مرض باركنسن في منطقة الكاظمية من مدينة بغداد

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Background: Parkinson's disease is a chronic neurodegerative disorder affects mostly people above 40ys. Studying its prevalence is crucial for health public planning especially as worldwide communities are getting older. There are some worldwide variations in the estimated prevalence rates and the figures are unknown in our country. Objective: To estimate the prevalence of Parkinson's disease in Al-Kadhiymia district. Methods: Community-based study was conducted as cross-sectional survey on random sample of the population of the district. Suspected cases of Parkinson's disease identified during home visits were referred to the neurological department at the University Hospital of Iraqi Medical College in order to confirm the diagnosis of the senior neurologist. Diagnosis is made by identifying at least two cardinal features of the disease (resting tremor, bradykinesia, rigidity and postural instability) in the absence of signs of secondary parkinsonism. Results: 25 cases of Parkinson’s disease collected from a random sample of 22,988 individuals (13 were males, 23 were females. 6 lived in rural areas and 19 in urban). Three cases (12%) were newly diagnosed. Tremor was the predominant symptom of onset (80%). 19 cases had bilateral involvement of the disease, in spite of the unilateral onset of all cases. The crude prevalence rate was 108.75 per 105 population. Age adjusted prevalence rates showed constant increase with age. Gender-adjusted prevalence rates were calculated for male 114/105 populations and for 103/105 population. Residency-adjusted prevalence rates were 114,3 and 94,3 per 105 population for urban and rural living respectively. Conclusion: Prevalence rate of Parkinson’s disease is just lower than the figures in Europe and North America, but higher than those of Africa and China. It increases constantly with increasing age. There was no significant gender or rural difference in the prevalence rates. The prevalence figure can be applied to the population of Baghdad City because of the similar population structure and characteristics to those of Al-Kadhimiya district. Key words: Parkinson disease, prevalence, Baghdad, Cross sectional study


Article
AN EVALUATION OF HAEMOGLOBIN DETERMINATION USING SODIUM LAURYL SULFATE
تقييم قياس الهيموغلوبين باستخدام طريقة الصوديوم لوريل سولفيت

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Introduction: Various methods for the quantitative determination of Hb have been developed during the last decade, based on chemical and physical principles of Hb, gasometry or spectrophotometry. Methods: Spectrophotometric measurement of Hb as HiCN was carried out by the ICSH recommended reference method and by cyanide free (sodium lauryl sulfate) reagent. Measurements were carried out in 347 venous blood collected into K2EDTA anticoagulant. Normal samples were obtained from volunteers and other samples were obtained from patient specimens in routine diagnostic service. The latter included Leukaemia with high WBC count, Lipaemia, Cord blood, other abnormalities (uraemia, jaundice thalassemia minor and major) and methaemoglobinemia. The Hb value then determined by using HiCN method and SLS method. Results: Maximum absorbance is at 535 nm, the conversion time of Hb to SLS-Hb was rapid of less than 15 seconds. The freshly prepared SLS-Hb was stabile in the first 120 minutes after dilution. Haemoglobin converts almost instantaneously and there is a direct relationship of absorbance to Hb concentration over awid range of measurements (r = 0.999). Conclusion: its reliability is equal to that of HiCN method with routine blood specimens, but slightly more reliable than HiCN method when there is interference by lipaemia. There is no significant difference in measurements on samples containing HbF (r = 0.995). It measures methamoglobin with correlation coefficient (r) of 0.999. It has a major advantage in that the reagent is non-hazardous compound. Keywords: Haemoglobin, Sodium lauryl sulphate


Article
PITUITARY ADENOMA: RETROSPECTIVE STUDY AND ANALYSIS OF FACTORS THAT AFFECT THE OUTCOME OF SURGICAL TREATMENT
دراسة سريرية, و تحليل للعوامل المؤثرة في نتائج العلاج الجراحي لأورام الغدة النخامية

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Background: Pituitary adenomas are benign epithelial tumors, representing about 10% of intracranial tumors. They present as visual or hormonal disturbances or both. Attention to details in the treatment of theses benign tumors can’t be overemphasized in order to achieve best results. Objective: The aim of this work is to review the clinical and radiological features of these relatively common tumors, and identify factors that affect the outcome of surgical treatment and recurrence. Methods: This study was carried out retrospectively by reviewing the medical records of all patients with pituitary adenomas treated in the period of four years, and collecting clinical, radiological, laboratory, and surgical data. Follow up of 1-4 years was obtained on all patients. Results: There were 55 patients (31 male and 24 female) the median age was 37 year. The main presenting symptoms were visual deterioration in 49%, symptoms of endocrine disturbance in 35.3%, headache in14.5%, behavioural changes in 1.8% and seizure in 1.8%. The most common hormonal disturbance was hyperprolactinemia (32.7%). Lateral skull x-ray showed grade III sellar enlargement with erosion of the dorsum sellae in 87.2%. Brain CT scan showed isodense mass in 76% of cases, with suprasellar extension in 82.6% and contrast enhancement in 85.7%. The operative approaches were right subfrontal craniotomy in 83.6% and tarns-sphenoidal (sub labial) approach in 16.3%. Intracapsular (subtotal) removal was achieved in 70.9%, while capsular (total) removal was achieved in 29.1%. Tumour recurred in 3 patients; two of them had postoperative radiotherapy and all had originally aggressive tumors.. There were 2 cases of post radiation glioma. Conclusion: The results of the study were similar to those published. Pituitary adenoma is usually benign relatively avascular soft in consistency with characteristic clinical and radiological features. Unless associated with advanced optic atrophy with visual loss there is dramatic improvement of optic nerve function following surgery. Transient diabetes insipidus is the commonest postoperative complication mainly following trans-sphenoidal approach. The only factor that enhances recurrence is tumour aggressiveness. Postoperative radiotherapy is only indicated for aggressive invasive pituitary adenoma. Key words: Pituitary, Adenoma, Outcome.


Article
THE COPING STYLES OF ADOLESCENTS WITH TYPE 1 DIABETES MELLITUS
اساليب التغلب على المشاكل و المصاعب لدى المراهقيـن المصابين بداء السكر نوع 1

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Background: The importance of developmental prospective in understanding the variability in diabetic adolescent's coping efforts is underscored in Iraq. Objective: This work was carried out to assess the association between the coping styles and higher level of perceived diabetes related worries. Methods: 160 adolescents with type 1 diabetes were enrolled in this study from different diabetes centers in Baghdad city for the period 1st June to 21st Dec. 2000. Each participant interviewed individually. Full information including age, sex, and duration of diabetes, sport activity and visits to diabetic clinics and a diabetic related worries subscales were used. Coping styles (active and aggressive coping styles) were assessed by selected subscales. The influences of coping styles and other variables on diabetic related worries were examined by stepwise regression analysis. Results: Higher perception of diabetic related worry was significantly associated with active coping, aggressive coping, emotional support and sex. Age and visits to diabetic clinics were not associated with higher perceived diabetic related worry. Conclusion: The finding demonstrated the importance of coping behavior to perceived diabetic worries, which in turn affects the metabolic control. Key words: diabetic adolescents, coping styles, Iraq


Article
SUBJECTIVE AND QUANTITATIVE EVALUATION OF BONE MARROW TREPHINE BIOPSY IN IDIOPATHIC MYELOFIBROSIS
ألتقييم الشخصياتي و الكمي لخزع نقي العظم في مرض تليف نقي العظم الابتدائي

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Background: Idiopathic Myelofibrosis (IMF) is one of the myeloproliferative disorders in which various degrees of bone marrow fibrosis constitute the cardinal pathogenetic criteria for the disease therefore the study of bone marrow trephine biopsy is a major step in diagnosis . Objectives: Are reticulin and iron stain are essential for the diagnosis and staging of idiopathic myelofibrosis Methods: Trephine biopsies of 30 patients with IMF were reevaluated and the paraffin blocks were further sectioned, stained for H & E and reticulin and Perl’s reaction. The patients were classified into four groups according to Cologne criteria for which both subjective and quantitative evaluations of trephine biopsies were performed. Results: Both qualitative and quantitative evaluation was performed on trephine biopsies. The most consistent finding with progression of diseases was megakaryocytic and granulocytic proliferation with preponderance of megakaryocytes. The study also proves that most patients showed an increase in the number of hemopoietic cells, reticulin fibers, trabecular bone width, osteoblastic index, blood vessels, and a reduction in the iron stores. Conclusion: A thorough assessment of bone marrow biopsy including adequate tissue sampling stained for reticulin and iron stain are essential for the diagnosis and staging of idiopathic myelofibrosis. Keywords: Idiopathic myelofibrosis, trephine biopsy, subjective, quantitative

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