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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: 2006 volume:5 issue:1

Article
EDITORIAL: THOUGHTS ON EXAMINATION OF MEDICAL STUDENTS

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Abstract

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Article
SURGICAL ANATOMY OF THE SUPERIOR EPIGASTRIC ARTERY
التشريح الجراحي للشريان الشرسوفي العلوي

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Background: The superior epigastric artery and its preservation during surgical procedures are now gaining more importance. Anatomical studies regarding variations in the epigastric vessels have not been conclusively reported. More emphasis was directed towards the inferior epigastric artery on the expense of its superior counterpart. Objective: To illustrate the gross anatomy of the superior epigastric artery with special emphasis on laparoscopic cholecystectomy entry sites in order to map a safety zone. Method: Fifteen embalmed cadavers were dissected. Complications pertaining to the superior epigastric artery were reviewed in 90 patients who underwent laparoscopic cholecystectomy. Results: Gross arterial communication between the superior and inferior epigastric arteries was observed in (33%) of the cadavers where it was located above the umbilicus. In the epigastric region, the main stem of the superior epigastric artery was located within a longitude not extending laterally away from 5 cm off the midline. The inferior epigastric artery was commonly larger than the superior. In only one cadaver (7%) the caliber of the superior epigastric artery was comparable to that of the inferior. In (4.4%) of the cholecystectomy cases, bleeding occurred when the laparoscopic port was extended laterally beyond the 10-12mm wide incision at the point 5cm inferior to the xiphisternum. Conclusion: A variably large superior epigastric artery should be kept in mind during surgical interventions; the absence of accompanying arterial anomalies indicated that the large size of the artery is a normal anatomical variation. In the epigastric region, a safety zone could be determined lateral to 5cm off the midline. In laparoscopic cholecystectomy, the port incision in the epigastric region should not be extended laterally beyond 12mm off the midline. If circumstances dictate then the port should be enlarged using a dilator. Key words: Superior epigastric artery, anatomical variation, laparoscopic cholecystectomy


Article
CYTOCHROME OXIDASE ACTIVITY IN THE VENTRAL HORN CELL OF THE SPINAL CORD IN THE RABBIT: ULTRA STRUCTURAL STUDY
دراسة فعالية مؤكسدات السيتوكروم في خلايا القرن الأمامي للحبل الشوكي في الأرنب بواسطة المجهر الالكتروني

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Background: Dynamic property of the neurons in the ventral horn cells of the spinal cord in the rabbit were partly treated utilizing the activity of cytochrome oxidase, a mitochondrial enzyme which is responsible for electron transport in oxidative phosphorylation needed for vital processes. Objective: It has been known recently that the vital role of this enzyme was clearly evident in the apoptosis. This study high lightens a point on a part of the metabolic map of the anterior horn cells with the use of cytochrome oxidase activity as a tool. Methods: Healthy adult New Zealand rabbits in resting condition were used. After Laminectomy slices of cord tissue obtained from the lumbosacral region precisely its gray mater of the anterior horn, then they were treated with a histochemical method based on the oxidative polymerization of diamino- benzidine, then examined under electron microscopy. Result: Results revealed different intensity of final reaction products at both cellular and subcellular levels. Conclusion: This reflects that the oxidative metabolism was varied in this area of the CNS, the majority of this activity were due to effect of the higher centers. At subcellular level the initiation of retrograde cell reaction "apoptosis" correlates positively with intensity of the FRP. Key word: Cytochrome oxidase, Enzyme commission number, Central nervous system, Final reaction product


Article
CANDIDA ALBICANS INFECTION AMONG IRAQI WOMEN: SOME EPIDEMIOLOGICAL VARIABLES
المبيضات بين النساء العراقيات: بعض المتغيرات الوبائية

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Background: Several studies were carried out on candidiasis among several groups. Objective: This study was held to study the prevalence of candidiasis in women complaining of vaginal discharge. Methods: A total of 100 female patients attending the gynecological clinic at Baghdad teaching hospital through the period from January 2004 to September 2004. Results: Candidiasis was detected in 38% of the studied groups. It was in 50% of women complaining of vaginal discharge and 15% of diabetic women without vaginal discharge. C. albicans infection was significantly associated with age, menstrual status and marital status of women. Conclusion: Candidiasis is a common infected agent among married women with vaginal discharge. Key words: C. albicans, women, vaginal discharge, Iraq


Article
SERUM LEVELS OF CALCIUM AND MAGNESIUM IN PATIENTS INFECTED WITH SCHISTOSOMA HAEMATOBIUM AND THOSE WITH BLADDER CARCINOMA
مستويات الكالسيوم و المغنيسيوم في مصل دم المرضى المصابين بالمنشقات البولية و سرطان المثانة

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Background: Schistosomiasis is an ancient human disease with universal correlation between the endemicity of S. haematobium, genitourinary schistosomiasis and the frequency of bladder carcinoma. Calcium is the fifth most abundant mineral element in the human body and clearly correlated with T-cell activation. Magnesium is the fourth most abundant cation in the body with suggested a role of magnesium in the humoral antibody responses. Objective: To correlate the serum levels of calcium and magnesium during S. haematobium infection and the immunosuppression state associated with this disease in addition to their possible role in the development of bladder carcinoma. Methods: 200 individuals were included in this study (56 patients with acute schistosomiasis haematobium, 18 with chronic schistosomiasis, 20 with chronic schistosomiasis with bladder carcinoma, 50 with bladder carcinoma and 56 healthy controls). Venous blood was collected from each individual and the levels of calcium and magnesium were estimated in the serum of each individual. Results: Calcium levels were found to be significantly lower in patients with acute schistosomiasis and significantly higher in patients with chronic schistosomiasis with bladder carcinoma when compared to the healthy controls. No significant difference was found between the levels in patients with chronic schistosomiasis and the healthy controls. Magnesium levels were found to be significantly lower in patients with acute schistosomiasis, chronic schistosomiasis with bladder carcinoma and bladder carcinoma, whereas no significant difference was found in those with chronic schistosomiasis, when compared to the healthy controls. Conclusion: Because calcium and magnesium were found to be vital in the immune responses, the alteration in their levels might be one of the factors for the development of bladder carcinoma in patients with schistosomiasis. Key words: Schistosoma haematobium, calcium, magnesium, bladder carcinoma.


Article
PURIFICATION AND PROPERTIES OF ASPARTYL PROTEINASE FROM CANDIDA ALBICANS
تنقية و توصيف انزيم الأسبارتيل بروتينيز من الفطر المبيضات

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Background: Aspartly proteinase, EC.3.4.23 isolated from leukemic patients with candidermia. Objective: Purification and properties of proteinase from Candida albicans. Methods: The enzyme was purified from Candida albicans by Ion exchange chromatography and gel filtration Sephacryl S-200 column. Results: Different strains of C.albicans isolated from leukemic patients with candidemia were used for production of proteinase enzyme. Wheat bran incorporated in Sabouraud s broth to increase production of proteinase by the organism. The specific activity of purified enzyme was 400 unit/mg, fold of 19.68, and a yield of 8.48 % .The molecular weight of enzyme is 57676 daltons when estimated by using Sephacryl S-200. Stability of proteinase enzyme and its activity at different pH and temperature were studied in details. Conclusion: Consecutive elevation of the enzymes specific activity values with the respective steps of purification. A more virulent strains the more reproducible of proteinase enzyme Keywords: Aspartyl proteinase ; C. albicans'. Purification; Sephacryl S-200.


Article
THE USE OF WATERY EXTRACT OF KUJARAT FLOWERS HIBISCUS SABDARIFFA AS A NATURAL HISTOLOGICAL STAIN
استخدام المحلول المائي لزهرة نبات الكجرات كصبغة طبيعية للشرائح النسيجية

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Background: Hibiscus sabdariffa is cultivated in many countries in the world, Iraq is one of these countries. Watery extract of kujarat flowers Hibiscus sabdariffa is red in color and acidic in taste. Previous investigations used watery extract of kujarat in medical studies and food industry. Others used its watery extract to stain blood film, fungi and plants. No previous studies use the watery extract of kujarat instead of eosin and together with hematoxylin stain in the routine H and E stain. Objective: to see the possibility of using watery extract of kujarat as a natural histological stain and instead of eosin. This study proposed because of the similarity in some characters between kujarat and eosin stain. Methods: watery extract of kujarat flowers was prepared in 20% concentration weight/volume. It was used to stain tissues from albino mice. It was used instead of eosin stain in the ordinary hematoxylin-eosin stain. Results: Stained tissues reveal acceptance to kujarat stain. Erythrocytes, cytoplasm of epithelial cells of kidney tubules and smooth muscle fibers appear brownish in color. Nuclei of stained cells appear dark violet in color. Conclusion: watery extract of kujarat flowers need chemical purification to separate its acidic from basic components. This study proposes the use of purified acidic part with the pigment instead of eosin. This part will have closer characterization (physical and chemical) to the eosin stain. Keywords: Hibiscus sabdariffa, Roselle, kujarat flowers, natural histological stains.


Article
HISTOLOGICAL CLASSIFICATION OF CHRONIC MYELOID LEUKAEMIA IN IRAQI PATIENTS
التصنيف النسيجي لابيضاض الدم المزمن في المرضى العراقيين

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Background: Chronic myeloid leukemia (CML) is a stem cell disorder, which progresses from a “benign” chronic phase to a refractory acute leukemia. It is characterized by the presence of Philadelphia chromosome (Ph), in more than 90% of the cases. Objective: To analyze comparatively histological and cytological features of bone marrow in CML at diagnosis, and to confirm the validity of histologic classification from the clinical point of view. Methods: All cases were retrospectively collected from the Teaching Laboratories of the Medical City during the period of January 1985 and April 1994. Special attention was paid to histopathology of the bone marrow of diagnostic biopsies of 72 patients with chronic myeloid leukemia (CML) at the time of diagnosis prior to any therapy with particular reference to haemopoietic cellularity , megakaryocyte (MKCs) per unit area, reticulin fibrosis, blood vessels per unit area, osteoblast index, and trabecular bone width. Results: Based on the number and morphological characteristics of MKCs, cases were classified into 31 patients with common type-chronic myeloid leukemia (CT-CML), and 41 with increased megakaryocytes (MI-CML). Both groups showed relevant clinical, haematological and histologic differences between them. The MI-CML was characterized by mixed proliferation of neutrophile, eosinophile and basophile series besides the megakaryocytic component , while the CT-CML cases predominantly revealed neutrophilic proliferation. Conclusion: The MI-CML accumulated cases with unfavorable prognostic criteria such as older age, larger spleen, anemia, leucocytosis, thrombocytosis, higher percentage of normoblast, basophile and immature precursors (blast and promyelocyte). Among the quantitative parameters obtained from the bone marrow biopsies the quantitative fibrous tissue was significantly higher in MI-CML cases. Key words: Chronic Myeloid leukemia, Iraqi Patients, Histological Classification.


Article
RELATIVE PLASMA VISCOSITY: A SIMPLE TEST FOR THE BED SIDE DIAGNOSIS OF MULTIPLE MYELOMA
استعمال ممصة كريات الدم الحمراء لتشخيص الورم النقيي المتعدد بجانب السرير

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Background: The measurement of plasma viscosity (PV) has long been recognized to be important for the diagnosis of paraproteinemia and it is widely used recently for the assessment of peripheral vascular disorders, diabetes mellitus and malignant diseases. The WHO recommended method for measuring PV is the electronic Harkness viscometer, but it is expensive and not widely available. Objective: A simplified, cheaper and accurate technique using the red cell pipette is worth trying as a rapid bedside test. Methods: The relative plasma viscosity (RPV) was measured in 30 patients with multiple myeloma and 150 healthy adults. The method applied was that of Wright and Jenkins in which a comparison of the vertical flow of plasma to distilled water using the red cell pipette is used to measure the relative viscosity of plasma. The erythrocyte sedimentation rate for both the patients and control was performed for comparison. Results: The mean RPV in multiple myeloma patients was highly raised compared to normal and that increment is highly significant statistically (p<0.001). These results are considered highly supportive of the diagnosis of myeloma. In the other hand, although the results of ESR were statistically significant, it cannot be differentiated from those due to other disorders. Conclusion: The measurement of RPV has proved to be simple and reliable and may be used at the bed side to detect the activity and to assess the diagnosis of multiple myeloma. Key words: Plasma viscosity, multiple myeloma.


Article
MEDICOLEGAL POSTMORTEM STUDY OF SOME ANATOMICAL VARIATIONS IN THE THYRIOD GLAND AMONG BAGHDADIANS
دراسة طبية عدلية بعد موتية لبعض الفوارق التشريحية في الغدة الدرقية عند البغداديين

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Background: Up till now no postmortem study was done in our country about the anatomical variations in the thyroid gland and their prevalence. Objectives: To determine the presence of certain chosen anatomical variations in the thyroid gland among Baghdadians and to clarify the importance of forensic pathology in different medical studies. Method: A prospective study was done in the medicolegal institute of Baghdad for 6 months duration. The thyroid gland was studied grossly in 122 randomly chosen cadavers to reach the above mentioned objectives. Results: The presence of pyramidal lobe was the most prevalent anatomical variation (5,7%) while the absence of the isthmus was found in 4.9% of cases and the presence of the thyroid ima artery was seen in 4.9% of cases. There were no significant statistical differences between male and female. Conclusion: The presence of pyramidal lobe was the most prevalent anatomical variation followed by the absence of the isthmus and the presence of the thyroid ima artery. Key words: Postmortem, thyroid gland, anatomy, variation.


Article
ATTENTION DEFICIT HYPERACTIVITY DISORDER: AN OVERLOOKED PROBLEM IN CHILDREN
عجز الانتباه وفرط النشاط مشكلة مهملة عند الأطفال

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Background: This condition is one of the most prevalent disorders among school-aged children treated by child neurologists and pediatricians. It is characterized by inattention, hyperactivity-impulsivity or combination of these features. It is one of the most common causes of poor school performance. It remains under diagnosed and under recognized. Objectives: To study the characteristics of Attention Deficit Hyperactivity Disorder in our children. Methods: 42 children diagnosed as having ADHD (according to Statistical Manual of Mental Diseases edition IV) in the pediatric neurology clinic in Al-Kadhimiya Teaching Hospital. 40 non-ADHD children matching with age and sex were used as control. Chi square was used to find the significance of the characteristics of ADHD. Results: Males were affected twice as the females. 59.5% of the patients were of the combined type. 42.9% had significant history of nocturnal enuresis (P= 0.01). 71.4% had significant history of daily injuries, (P= 0.004). 61.9% had significant history of poor school performance, (P= 0.0001). 80.9% had significant history of sleep problems, (P= 0.0003). 69% of all subtypes had onset of symptoms after 7 years of age and all cases of the hyperactive subtype before 7 years of age. Conclusion: Boys with ADHD are more commonly affected. The most common type of ADHD is the combined type, and the hyperactive type is the least. The hyperactive type is more common in the younger age group. ADHD children are more likely to have nocturnal enuresis, daily injuries, poor school performance and sleep problems. Key words: Attention deficit, hyperactivity, children


Article
RISK FACTORS FOR ACUTE DIARRHEA MORTALITY
عوامل الأختطار في حالات الاسهال الحاد

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Background: Diarrhoeal diseases are a leading cause of childhood death and disease in the developing countries. Dehydration, dysentery and persistent diarrhea cause these deaths. Childhood morbidity and mortality associated with diarrhea share a dramatic burden of health services and cost in these countries. Objective:Tostudy the important risk factors for death in children with acute diarrhea less than two years of age. Methods: A retrospective study between 1996 – 2000 was performed to study the risk factors for death in children admitted to Al–Kadhimiya Teaching Hospital because of acute diarrhea below two years of age, the number of admitted cases were 336 case and there was 11 cases of death. Results: The characteristics of the died cases are the followings: Young age mainly less than one year, low body weight, male sex, artificial feeding, and residency in a rural areas and severe degree of dehydration are important risk factors for death. Conclusion: The important risk factors for death in cases with acute diarrhea are severe dehydration , male sex ,artificial feeding ,low body weight and residency in rural areas. Key words: Acute diarrhea , Severe dehydration , risk factor


Article
INJURIES DUE TO SEIZURE IN CHILDREN WITH NEWLY DIAGNOSED AND UNTREATED EPILEPSY

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Background: There is an increased risk for physical injury during convulsion in children with epilepsy before control or in poorly controlled fits. Objectives: To study the rate and features of physical injuries due to seizure in newly diagnosed children with epilepsy before the use of anti-epileptic drugs. Method: Newly diagnosed and untreated children with epilepsy with at least two unprovoked a febrile fits of any type aged 1-14 years presenting to Al-Kadhimiya Teaching Hospital and the author’s private clinic along 12 months period (April 2004-March 2005) were studied. Information was collected from the parents about whether physical injuries resulted from the seizure. Features of the fits and the injuries with their management were fixed. Results: Eleven children (17.7%) sustained physical injury out of 62 with epilepsy. Nine children (81.8%) had single injury while 2 children (18.2%) had multiple injuries. Eight children (72.7%) sustained their injury at home, 2 at school (18.2%) and one (9.1%) in the garden. Most of the injuries were bruising of head and/or face (63.6%). The most common seizure type causing injury is generalized tonic-clonic (72.7%) and all the children with typical absence seizure did not experience any injury. Conclusion: Physical injuries from seizures are not uncommon, but they are simple. We have to find a balance between seizure precaution and the freedom to enjoy life. Keywords: Injuries, Seizure, Children, Epilepsy.


Article
SURGICAL TREATMENT OF CHRONIC SUBDURAL HEMATOMA: RETROSPECTIVE STUDY
العلاج الجراحي للخثره تحت الام القاسيه

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Background: Chronic subdural hematoma (CSH) is a common disease of the elderly, most of the patients being above fifty. It usually follows minor head trauma, and is bilateral in 25% of cases. Although surgical treatment is successful in most cases, it still involves high rates of mortality and recurrence. Objective: To propose a new surgical technique and evaluate it’s efficacy in reducing the Incidence of complications and recurrence. Methods: Twenty-four consecutive cases with CSH were diagnosed with computerized tomography and MRI and surgically treated using double burr hole evacuation and irrigation using small catheter manipulated inside the hematoma cavity. Results: The patients were 21 males and 3 females; the average age was 56 years. Progressive hemiparesis was the most common presentation, followed by headache and mental confusion. All patients except one made excellent neurological recovery, and were back to their pre-morbid condition. There was no mortality or recurrence. Conclusion: The surgical method used in this study offers simple way for slow and effective evacuation of CSH, and reduces recurrence. Key words: Chronic, intracranial hematoma, subdural hematoma, surgical treatment.


Article
UNUSUAL CAUSES OF HEAD INJURIES
إصابات الرأس بكيفيات غير معتادة

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Background: Although the patterns of common causes of head injury (HI) are well established all over the world, however, unusual causes of HI, incurred inadvertently to many patients, do occur every now and then. Objective: To bring to the attention of the practicing neurosurgeon the possibility of an unusual pattern of HI. Furthermore, such injuries may endanger the patient's life. Methods: A retrospective study of 30 HI cases encountered by the author between 1986 – 2003. The Accident and Emergency Hospital in Amara, The Teaching Hospital in Basrah, The Neurosurgical Hospital and The Teaching Hospital at Kadhimiyah, Baghdad. All had 3 standard plain skull X-ray projections: postero-anterior, lateral, and Townes views; occasionally, occipito-mental and orthopentgraphic views were done. Although few cases needed conventional angiographic examination, none of them had the test because of the non-availability of the contrast medium. Few patients had computerized tomography (CT) examination. All cases presented before magnetic resonance (MR) imaging was introduced into the country. Results: Different age groups are represented. Although both sexes were affected, however, most of the victims were males (24, 80%), and most injuries were compound and of a penetrating nature; all calvarial regions are represented in this study. There was no death in this series as all patients made, in due course, an excellent recovery. Conclusions and recommendations: Under certain situations, especially when the financial resources are limited, or up-date neuro-imaging machines are unavailable, plain skull X-ray films prove adequate investigative tool disclosing the extent of bony damages and state of penetration. Domestic animals and tools can, un-expectedly, be harmful; an educational program in this respect is helpful. A protective safety helmet may be mandatory in certain professions when the risk of having a HI is likely. Although most of our patients suffered a certain degree of transient morbidity, however, they were back to normal active life. The practicing neurosurgeon may face an unusual type of HI that may constitute a serious threat to the victim's life. Addressing the management of such events, an urgent non-hesitating attitude is to be practiced by following the standard lines of dealing with penetrating injuries. Key words: Unusual causes of head injury, penetrating injury, plain skull X-ray.


Article
SKULL FRACTURES IN HEAD-INJURED PATIENTS ATTENDING THE ACCIDENT AND EMERGENCY DEPARTMENT OF THE TEACHING HOSPITAL AT KADHIMIYA: A RETROSPECTIVE STUDY OF 100 CONSECUTIVE CASES
كسور الجمجمة لدى المصابين بالرّأس المراجعين لقسم الطوارىء بالمستشفى التعليمي في الكاظمية: دراسة وصفية لمائة حالةٍ متتالية

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Background: A skull fracture (SF) finding in acutely head injured patient represents a neurosurgical emergency that necessitates admission to the hospital as it indicates a significant head trauma and can be accompanied by life threatening complications. Objective: To study the pattern of SF in 100 head injured patients presented to the Accident and Emergency (A and E) Department at Al-Kadhimiya Teaching Hospital. Methods: 100 patients having fresh SF were examined during October 2001 to February 2003 inclusive. All patients had plain skull X-ray, CT scanning; MRI study. Results: The most common causes were fall from height (FFH) (40%), road traffic accidents (RTA) (37%), assaults (13%), collapse of building (4%), diving (1%), missile (1%) and miscellaneous causes (4%). While eighty-six patients had single SF, 14 patients harbored multiple SF, all totaling 118 SF. The pattern of SF was fissure fracture (66.1%), depressed (20.3%), fracture base of skull (8.5%) and diastatic (5.1%). At Glasgow Coma Scale (GCS) scoring, 69% had a score of 13-15, 22% a score of 9-12, and 9% had a score of 3-8. Intracranial haematomas were extradural 14, subdural 3, and 1 intracerebral haematoma. Conclusions: The majority of SFs are simple fissure patterns affect mainly young age groups who sustain HI; males are more involved than females. Conventional X- ray, spiral CT scan and MRI are essential for determination of the type of SF. Since the majority of accidents have occurred in urban sites, 80%, the authors think that HI may be a phenomenon of urbanization. Moreover, the majority of the causes of SF(s), the authors think, are preventable, like FFH and RTA, by adequate measures such as family supervision, community education, safe house construction and traffic regulation legislation. Although the majority of cases had high GCS scores indicating a mild severity of trauma, however, a proper management and skilled care would contribute to avoidance of life-threatening complications and effect recovery. Key words: head injury, skull fracture, neuro-imaging, CT scan, MRI venography, family and school supervision

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