Table of content

Iraqi Academic Scientific Journal

المجلة العراقية للاختصاصات الطبية

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

This journal is Open Access

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Table of content: 2012 volume:11 issue:1

Article
Incidence of Bronchiolitis in Breast Fed Infants Below 2

Authors: Haider Nadhim Abd
Pages: 1-5
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ABSTRACT: BACKGROUND: Acute viral bronchiolitis is a common respiratory infectious disease of children. OBJECTIVE: To study the relationship between bronchiolitis and breastfeeding in children below 2 years of age. MATERIAL AND METHODS: A prospective study was carried out with100 child aged up to 24 months to evaluate their breastfeeding status as possible risk factors for unfavourable evolution in department of pediatric in AL-Kahdimiya Teaching Hospital during the period from first of October 2008 to the end of March 2009. RESULTS: Hundred cases of bronchiolitis were included in this study. Most of them ( 78 %) were below one year. Male children were 70%, female children were 30%. Fifty-four of the children were exclusively breastfeeding. Eighty of the children were admitted to the hospital because of severe attack. The median length of hospital stay was four days and of oxygen-use was three days. CONCLUSION: The duration of exclusive breastfeeding was inversely related to the length of oxygen-use and the length of hospital stay. Shorter exclusive breastfeeding was observed in children who were assigned to a pediatric ward or to an intensive care unit. Longer duration of breastfeeding was associated with better clinical outcomes.


Article
Knowledge, Attitude and Practice Regarding Obesity Management among Family and Non Family Physicians Working in Primary Health Care Centers in Baghdad

Authors: Huda Adnan Habib
Pages: 6-12
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ABSTRACT: BACKGROUND: The rising level of obesity has been called the most urgent challenge to public health for the 21st century. While many social institutions should be involved in addressing this problem, family physicians have an important role in identifying and managing obesity. OBJECTIVE: To assess and compare the knowledge , attitudes and practice regarding obesity management among family and non family physicians working in primary health care centers. Methodology : A cross-sectional survey has recruited a randomly selected sample of primary health care physicians working in primary health care centers in Baghdad in 2010. A structured self-administered questionnaire was used to collect data from 232 physicians. These include family medicine board certified and other non-family medicine certified physicians. The questionnaire had four main parts: personal data, knowledge, attitude and practice. RESULTS: The majority of the respondents depend on the waist circumference to diagnose obesity with 100% among the family physicians and (74.2%) among non-family physicians. The majority of the respondents think that obesity is a major health problem in Iraq with 49 (96.08%) among the family physicians and132 (72.93%) among non family physicians. About (84.3%, 72.5% and 41.2%) of family physicians agreed to prescribe Weight reduction medication when BMI >30, Patient not on diet and on patient request respectively. Almost all family physicians (92.1%) agreed that is it better to have a training course in obesity management compared to 49.46% among non- family physicians. CONCLUSION: Both the family and nonfamily physicians working in the primary health centers need to improve their knowledge and skills regarding obesity management


Article
Microbiological Profile of Neonatal Septicemia

Authors: Sinan Abdulrazzaq Ibrahim
Pages: 13-18
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ABSTRACT: BACKGROUND : Neonatal septicemia is a major cause of morbidity and mortality in developing countries. OBJECTIVE: The study is to determine the prevalence , the pattern of organisms and the mortality of neonatal septicemia in a neonatal care unit. PATIENTS AND METHODS: All the cases of neonatal septicemia diagnosed and treated in the neonatal care unit at al-kadimiya teaching hospital for the period january-june 2010 were included in this study. The collected data were : Gender, Birth weight, Gestational age, Onset of sepsis, Place of delivery and Outcome of disease. RESULTS: Out of 589 newborns admitted, 73(12.4%) were confirmed cases of neonatal septicemia. The mortality from neonatal sepsis was 16.4%.Low birth weight and prematurity were independent factors associated with death (P value=0.004 and 0.020 respectively).There were 24 cases (32.9%) of early onset sepsis and 49 cases (67.1%) cases of late onset sepsis. The most common pathogens were gram- negative bacilli causing early-onset sepsis (54%) and late onset sepsis (59%). Only 6 cases out of the total 73 cases of neonatal septicemia were caused by staphylococus aureus (8.2%) . Over 50% of gram-negative bacilli are antibiotic resistant. CONCLUSION: The high rate of gram-negative septicemia and the antibiotic resistance to both ampicillin and gentamycin indicate that the infection was most probably nosocomial in origin.


Article
Effect of Maternal Age on the Course and Outcome of

Authors: Enas Talib Abdul -Karim
Pages: 19-25
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ABSTRACT: BACKGROUND: Delayed childbirth has become a common phenomenon in the developed world as a result of social, educational, and economic factors . OBJECTIVE: To demonstrate the effect of age on the pregnancy course and outcome among young and old mothers. Subjects &methods: A cross sectional study was conducted at Al-Kadhimia Teaching Hospital. Data was collected by a trained medical students during the period from first of February to April 2010 .Total of 230 women were included in the study using a convenient random sample technique, the sample was divided into two groups,128 women < 30 years old (group A) and 102 women ≥ 35 years old (group B), and were taken from obstetric department in Al-kadhimiya teaching hospital . Information were directly obtained from the mother herself and filled in a well designed questionnaire form. RESULTS: The results showed that there was no significant difference between the two groups regarding some sociodemographic characteristics like address, education, occupation, antenatal care. There was a significant increase in the presence of medical &obstetric complication, parity, history of abortion and No of abortion in the older age group mothers. As to the outcome of pregnancy, twin delivery and low birth weight babies were significantly higher in older age group mothers. Interestingly, there was no significant difference regarding presence of congenital anomalies in babies of mothers in both groups. CONCLUSION: Mothers ≥35 years old showed higher rate of obstetric complication than young age group of mothers, while congenital anomalies were higher but not significant among young age group of mothers (≤30 years old).


Article
Whether Selective or Routine Episiotomy is More Useful to Protect Anal Sphincter in Primiparous Women

Authors: Adulrazak H. Alnakash
Pages: 26-32
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ABSTRACT: BACKGROUND: Perineal trauma is a common event, affecting up to 90% of first time mothers. It is a cause for concern for many women and in some countries has led to a large increase in the numbers of women requesting elective caesarean section. OBJECTIVE: To highlight when episiotomy can be useful in preventing anal sphincter injury in primiparous women. MATERIALS AND METHODS: This study is a prospective interventional clinical study conducted at AL-Elwiya Maternity Teaching Hospital in Baghdad throughout the period between Jan. 2009- Dec. 2009. Three hundred term primiparous ladies at time of their delivery with cephalic presentation were collected and subdivided into 3 equal groups randomly. The first group, women who were subjected to routine mediolateral episiotomy, while the second group of the participants were delivered without doing episiotomy, and the third group, a mediolateral episiotomy was done selectively to them when we found it is necessary (selective episiotomy). State of the perineum, length of 2nd stage, weight of the baby, fetal head position and the occurrence of anal sphincter injury were all notified and carefully recorded on special form designed for the study. RESULTS: Selective episiotomy was found to be more useful than routine episiotomy in preventing anal sphincter injury (the incidence of anal sphincter injury was 2% for those in whom episiotomy was performed selectively, while it is 8% for those with routine episiotomy and 7% for those delivered without episiotomy), and the difference is statistically significant (P value 0.045). There was a significant effect of the length of second stage of labour on the incidence of anal sphincter injury (P value 0.017), similarly for the weight of baby (P value 0.017). CONCLUSION: Selective episiotomy is more useful intervention than routine episiotomy in protecting the anal sphincter when delivering a primiparous lady.


Article
Serum leptin Levels and Their Correlation with Thyroid Hormones in Women with Hyperemesis Gravidarum

Authors: Miami Abdul Hassan Ali ,
Pages: 33-38
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ABSTRACT: BACKGROUND: Leptin is a protein that regulates energy expenditure and food intake. It is found that maternal leptin level increases progressively during gestation. However, in other hypothesis, rapid increase in maternal leptin concentration disproportional to gestational week is a marker for hyperemesis gravidarum. OBJECTIVE: To assess the maternal serum leptin , the adjusted leptin levels in first trimester women with hyperemesis gravidarum and with normal pregnancy and to find the correlation between leptin level and thyroid hormones in the two groups. PATIENTS AND METHODS: A case-control study conducted in AL- Yarmouk teaching hospital /department of obstetrics and gynaecology for one year from March 2009 to March 2010. A hundred pregnant women were enrolled in this study. Fifty women with hyperemesis gravidarum and fifty women without hyperemesis gravidarum as a control group were included in the study.The two groups were compared for age, parity, body mass index. Fasting serum thyroid stimulating hormone ,free thyronine hormone, free thyroxine hormone and leptin levels were measured . The adjusted leptin level (ALL ) : maternal serum leptin level / gestational week , was calculated in each case. RESULTS: Body mass index was found significantly lower in the hyperemesis gravidarum group than in the control group(p = 0.018) .The mean leptin level in the hyperemsis gravidarum group was14.78+4.46 ng /ml which was significantly higher (p = 0.035) than the mean leptin level in the control group which was12.51+4.08 ng/ml.The mean adjusted leptin level in the hyperemsis gravidarum group was 1.86+0.23 which was significantly higher (p<0.001) than the mean adjusted leptin level in the control group which was1.38+0.20 . Serum thyroid stimulating hormone was significantly lower (p = 0.001) and free thyronine hormone , free thyroxin hormone levels were significantly higher (p <0.001, <0.001 respectively) in the hyperemesis gravidarum group than in the control group. CONCLUSION: Maternal serum leptin level was significantly higher in the HG group. ALL was also significantly higher in the HG group and there was no significant correlation between leptin level and thyroid hormones.


Article
Assessment of Endometrial Thickness in Postmenopausal Women with and without Hypertension

Authors: Nada Salih Amen
Pages: 39-44
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ABSTRACT : BACKGROUND: Hypertension in postmenopausal women is a risk factor for endometrial hyperplasia. OBJECTIVE: To examine whether the endometrium of hypertensive postmenopausal women is thicker than that of non hypertensive postmenopausal women, to determine whether this thickening is directly related to the antihypertensive drugs and whether is associated with abnormal pathology. METHODS: A Case control study of Forty five hypertensive asymptomatic postmenopausal women was conducted in Al Yarmouk Teaching Hospital, (22) were treated with B- blockers combination medication and (23) were treated with other medications. They were compared with each and with (25) non hypertensive women. All women were interviewed; blood tests were performed and endometrial thickness in antero-posterior diameter was measured by vaginal ultrasonography. Endometrial sampling had been taken for those with increased endometrial thickness more than 5mm. RESULTS: 24.44% of hypertensive women and 4.00% of non hypertensive women had an endometrial thickness more than 5mm. There was no statistically significant difference between those who treated with medication including B- blocker and those who were treated with other medication. The histological findings were mainly of endometrial hyperplasia for those with thickened endometrium. CONCLUSION: Hypertension may have a role in endometrial thickness. We were unable to substantiate an association between the type of treatment administered and the increase in endometrial thickness. Those with increased endometrial thickness more than 5mm, the histological findings were mainly of endometrial hyperplasia


Article
Chronic Idiopathic Thrombocytopenic Purpura Effects of Certain Variables on the Response to Treatment.

Authors: Khudhayer A. Al-Khalissi
Pages: 45-49
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ABSTRACT: BACKGROUND: Idiopathic thrombocytopenic purpura is an acquired chronic autoimmune disease .Treatment when indicated is usually by corticosteroids,then splenectomy if no acceptable response,with variable response rate to both types of treatment. OBJECTIVE: To look for the effects of certain variables on the type of response to steroid therapy in patients with adult idiopathic thrombocytopenic purpura, and to study the outcome of splenectomy in relation to previous steroid therapy. METHOD: A prospective study on 80 patients, presented with bleeding and a platelet count of ≤ 30 X 109 / L. Initially treated with prednisolone and the response was studied in relation to gender , age , duration of bleeding and platelet count on presentation. Patients who failed to maintain permanent complete remission were advised to have splenectomy. RESULTS: Of the 80 patients, 62 (77.5 %) were females and 18 (22.5%) were males. Mean age was 23 ± 10.1 years. Ten (12.5%) patients only had permanent complete remission after steroid therapy. While 70 (87.5%) patints failed. Response to steroid therapy was significantly related to duration of bleeding but not to gender, age and platelet count. Thirty seven (46%) patients underwent splenectomy, permanent complete remission were achieved in 29 (78.2%). CONCLUSION: 1. Duration of bleeding of ≤ 3 weeks is a good predictor of successful steroid therapy. 2. Results after splenectomy is not related to previos steroid therapy


Article
The Association Between Adiponectin with Lipid Profile and Troponin in Acute Myocardial Infarction Patients

Authors: Ammal Esmaeel Ibrahim
Pages: 50-56
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ABSTRACT: BACKGROUND: Adiponectin is thought to be exclusively synthesized by adipocytes; however, a recent suggestion stated that adiponectin is also synthesized and secreted by human cardiomyocytes. Adipose tissue is increasingly recognized as a key regulator of energy balance, playing an active role in lipid storage and buffering, and synthesizing and secreting a wide range of endocrine products that may be directly involved in the pathogenesis of the complications associated with obesity. So obesity consider the major independent risk factor for atherosclerotic cardiovascular disease Acute Myocardial Infarction (AMI), is the interruption of blood supply to part of the heart, causing some heart cells to die. Insulin is a very important hormone as it regulates the level of glucose, in the blood. Troponin is a complex of three regulatory proteins that is integral to muscle contraction in skeletal and cardiac muscle. OBJECTIVE: To monitor adiponectin level and its effect on lipid profile and Troponin levels in Acute Myocardial infarction patients. SUBJECTS AND METHODS: The study included 50 patients with Acute Myocardial infarction and forty healthy subject as control group. This study designed to measure adiponectin, lipid profile and troponin levels. RESULTS: Levels of adiponectin, cholesterol, LDL-C and Troponin were significantly elevated with (p<0.001), while HDL-C was significantly lower with (p<0.001), There was negative correlation between adiponectin with , cholesterol LDL-C, triglyceride and VLDL, and there was positive correlation between adiponectin with HDL in acute myocardial infarction. CONCLUSION: The significant increase in adiponectin in AMI may be related to inflammation. From the relation of adiponectin with lipid profile, adiponectin can increase level of HDL and decrease level of triglyceride so this suggested that adiponection have anti-atherosclerosis properties


Article
The Clinical& Radiological Respiratory Features in Acute Leukemia At Presentation: A Descriptive Study of 118 Iraqi Adult Patients

Authors: Adil Siwan Al-Aqabi
Pages: 57-61
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ABSTRACT: BACKGROUND: Acute leukemia is a hematological malignancy characterized by an uncontrolled proliferation of hemopietic primitive cells. Presenting features of acute leukemia include fever, anemia, pallor; hepatosplenomegaly &lymphadenopathy, bleeding tendency, bone pain&gum hypertrophy. Intrathoracic manifestations of acute leukemia include infection,mediastinal widening , hemorrhage, infiltration, embolism, edema, pericarditis ´ respiratory distress syndrome. OBJECTIVE: To describe the clinical &radiological respiratory features of acute leukemia at presentation,before starting chemotherapy. PATIENTS AND METHODS: Patients with acute leukemia of age ranged from 15-75 years were incorporated in this study, patients were excluded from the study if they had previous malignancy, lung disease, or if received cytotoxic treatment. Every patient had a detailed history of pulmonary symptoms & chest examination,chest xray examination, sputum samples & pleural aspirates for relevant patients. RESULTS: Of 118 patients with actue leukemia at presentation, 60% of patients were males& 40% were females. Respiratory symptoms including cough,dyspnea&chest pain were found in27.7% of patients (cough 24.4% ,dyspnea 2.5%,chest pain 0.8%) . Respiratory signs including crepitations ,decreased air entry & bronchial breathing were found in 12.5% of patients(crepitation 3.3%, decreased air entry in 6.7%, bronchial breathing in 2.5%). Chest X-ray abnormalities were found in 14.3% of patients ,these include mediastinal widening in 5.9% of patients .Pleural effusion in 4.2% & parenchymal infiltrates in 4.2% of patients CONCLUSION: The chest findings in patient with actue leukemia at presentation were not uncommon. mediastinal widening was the commonest, pleural effusion&parenchymal infiltrates were less common findings


Article
Investigation of Certain Immunological Markers in First Degree Relatives of Type 1 Diabetic Patients

Authors: Madha Mohammed Sheet Saleh
Pages: 62-70
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ABSTRACT: BACKGROUND: Detection of certain autoantibodies and other non-specific inflammatory markers were employed in to predict an ongoing process of developing diabetes in first degree relatives of T1D patients. OBJECTIVE: The main objective of this study was to evaluate the value of monitoring of selected specific and non specific serum markers in the presumptive prediction of Type 1 diabetes in first degree relatives of diabetic patients. PATIENTS AND METHODS: First degree relatives of diagnostically confirmed diabetic patients were used as a test group. Type 1 diabetic patients and non-relatives healthy control groups of both genders were used for comparison. Sera from all subjects were monitored for glutamic acid decarboxylase antibody, anti-insulin antibody, complement C3 and C4, C-reactive protein and fasting blood sugar and the standardization of the maximum and minimum limits of the studied markers level was plotted to reduce the overlapping in the markers' values between each pair of the studied groups. RESULTS: The frequency of seropositivity for glutamic acid decarboxylase antibody was 24.0% in first degree relatives group compared to 77.1% and 0% in patients and control groups respectively. For antiinsulin antibody and C-reactive protein, a very few members of the first degree relative group were positive compared to those in the patients group. The results of C3 revealed a higher than normal level in 44.0% of first degree relatives group, 65.7% in patients group and 0% in control group. In contrast to that, C4 showed a lower than normal level in 28.0% of first degree relatives group compared to 57.1% and 0% in patients and control groups respectively. CONCLUSION: Monitoring of glutamic acid decarboxylase antibody, C3 and C4, but not anti-insulin antibody and C-reactive protein levels may be used as markers for a possible developing T1D in first degree relatives that precede the elevation of fasting blood sugar in serum. a narrow scale border line in the quantitative serum values of these markers is helpful in the standardization of this prediction.

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Article
Bcl-2 Expression in CagA Strain H. Pylori Gastritis (Immunohistochemical and Insitu Hybridization Study)

Authors: Hussam Hasson Ali
Pages: 71-75
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ABSTRACT: BACKGROUND: Carriage of Helicobacter Pylori in the human stomach is associated with increased risk of peptic ulcer disease, distal gastric adenocarcinoma and gastric B-cell mucosa associated lymphoid tissue lymphoma. OBJECTIVE: To study the immunohistochemical expression of bcl-2, as apoptosis makers in the gastric mucosa of patients infected with cagA Helicobacter Pylori demonstrated by insitu hybridization method. PATIENTS MATERIALS AND METHODS: Gastric antrum biopsies from 99 patients presented with dyspeptic symptoms (50 men, 49 women, median age 40) were analysed for the presence of H. pylori, and were classified according to updated Sydney system. Insitu hybridization technique was done to detect cagA H. pylori. Immunohistochemical expression of bcl-2 using (Avidin- Biotin method) was performed on paraffin embedded biopsy specimens. RESULTS: Forty four patients (44.44%) had H. pylori cagA positive starin. Atrophy of gastric mucosa was present in 14 (14.14 %) patients. Intestinal metaplasia was present in 8 (8.08%) patients. The frequency of atrophy and intestinal metaplasia were significantly higher in cagA H. pylori gastritis than non-cagA H. pylori gastritis (p=0.023 and 0.041respectively). Bcl2 expression was not significantly higher in H. pylori gastritis than non-H. pylori gastritis (p= 0.101). Bcl2 expression was significantly higher in the presence of atrophy (p<0.001). Bcl2 expression was significantly higher in the presence of intestinal metaplasia (p<0.001). CONCLUSION: The rate of apoptosis decreases when lesions (gastric atrophy and intestinal metaplasia) are present.


Article
Functional and Developmental Analysis of CD4+CD25+Regulatory T Cells Under the Influence of Streptococcal MProtein in Rheumatic Heart Disease

Authors: Zaman I. L. Al-Kaabi
Pages: 76-81
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ABSTRUCT: BACKGROUND: CD4+CD25+ regulatory T cells are known to suppress the immune response in general, these cells were studied in the presence of streptococcal M protein which has an important role in the pathogenesis of rheumatic heart disease. OBJECTIVE: The purpose of this study was to determine the role of streptococcal M protein in naturally occurring CD4+CD25+ regulatory T cells (nTregs) function and development in rheumatic heart disease Iraqi patients. METHODS: Streptococcus pyogenes was isolated for subsequent M protein extraction. Also, peripheral blood nTregs and CD4+ T cells were isolated by using Magnetic Cell Separation System (MACS). Tissue culture system for isolated cells was performed in the presence and absence of M protein stimulation. Cell count was performed, also, TNF-α, and IL-4 were determined in culture supernatant using ELISA system. RESULTS: It was found a highly significant positive association between the number of the cellular proliferation for both nTregs and CD4+ T cells with or without streptococcal M protein stimulation in isolated cell culture systems (p < 0.01), but, there found a highly significant negative correlation between the mean number of nTregs and CD4+ T cells in mixed culture system in the absence of M protein (r = -0.995). whereas, in the presence of M protein, there was a positive non-significant association between the mean number of both nTregs and CD4+ T cells (r = 0.353) (p > 0.05). Results obtained from ELISA test revealed that M protein-stimulated CD4+ T cells produced IL-4 in very little amounts (< 4 pg/ml) in all cultures of samples and there was no significant difference among them. Whereas, TNF-α was produced in higher concentrations in the culture supernatants when compared with IL-4. CONCLUSION: Streptococcal M protein has an important role in increasing the proliferation of both CD4+CD25+ regulatory T cells and CD4+ T cells, but the newer generation of CD4+CD25+ regulatory T cells in the presence of M protein has lower suppressive activity against CD4+ T cells.


Article
Troponin I and Creatine Kinase (MB) as Biochemical Markers in Acute Myocardial Infarction

Authors: Salman A Ahmed
Pages: 82-86
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ABSTRACT: BACKGROUND: Ischemic heart disease is the leading cause of death among adults. Broad based studies that include all ED patients who received an ECG for the evaluation of chest pain syndromes found that 5% of these patients were ultimately diagnosed with acute myocardial infarction (AMI) and an additional 10% had non-AMI acute coronary syndromes (ACS). Thus, 85% of patients have non-ACS causes for their symptoms. OBJECTIVE: To study the relation between the level of cardiac troponin I and creatine kinase (MB) in Acute Myocardial infarction. SUBJECT AND METHOD: The present study was designed to investigate changes in serum cardiac biomarkers in patients with acute myocardial infarction. The present study consists of 61 patients who were admitted to the hospital with acute myocardial infarction. Serum levels of cardiac troponin I (cTnI) and creatine kinase (MB) were determined on day 1 (within24 hours) and the 3rd day after acute myocardial infarction. Serum cardiac biomarkers were compared between day 1 of acute myocardial infarction and the 3rd day after the acute myocardial infarction with healthy subjects (control group). All measurements were taken through September 2009 to April 2010 in department of medical and molecular biotechnology/ Biotechnology Research Center/ Al-Nahrain university and Ibn Al-Nafees Hospital Department of Clinical Chemistry and Coronary Care Unit. Cardiac troponin I (cTnI) and CK-MB were measured by using microtitre plate ELISA method, absorbance is measured spectrophotometrically at 450 nm. Levels of serum cTnI and CK-MB for smoker patients who suffered from MI and other diseases(diabetes mellitus, and hypertension) (group 4) higher than levels for patients who complained from MI in addition to other diseases(group2), group 2 higher than levels for smoker patients who suffered from MI (group 3) and group 3 higher than levels for patients who complained from only MI (group 1). RESULTS: Results showed significant (p<0.01) decreases observed for the levels of cTnI in group 4 with group 1 and group 2 with group 1, and significant (p<0.05) decreases in group 4 with group 3. Significant (p<0.05) decreases were observed for the levels of CK-MB in group 4 with group 1. CONCLUSION: Myocardial infarction patients with diabetes mellitus , hypertension and smoking suffer increase levels of cTnI and CK-MB. This proved that cardiac risk factors increase risk for heart injury. However, such results must be considered during the evaluation of the results of cardiac biomarker in patients of MI .


Article
Comparison Between Hemoglobin Serum Level and Serum Ferritin level in Detecting Low Iron Store in Adult Menstruating Females with Chronic Telogen Effluvium

Authors: Ali Mozan Dhahir Elethawi
Pages: 87-91
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ABSTRACT: BACKGROUND: Chronic telogen effluvium is a non-scaring diffuse hair loss which lasts longer than 6 months. Low iron stores are considered a possible cause of chronic diffuse telogen hair loss in women. Serum ferritin concentration is an indicator of the status of iron stores. OBJECTIVE: This study was done to Compare the hemoglobin serum level and serum ferritin level in detecting low iron store in adult menstruating females with chronic telogen effluvium and show the relation between chronic telogen effluvium and iron deficiency. PATIENTS AND METHOD: Case-control study of 63 adult menstruating female subjects. Case group; 38 patients with chronic telogen effluvium and control group; 25 healthy volunteers. Serum ferritin levels and hemoglobin were estimated for the case group and some other investigations were done in selected cases as indicated. For controls only measurements of hemoglobin and serum ferritin levels were done and were statistically compared. RESULTS: The mean serum ferritin level was low in the case group (17.6ng/ml) in comparison with control group (41.2ng/ml). The difference was statistically significant (P<0.001) between both groups. The mean hemoglobin levels were similar in both groups and there was no significant statistical difference (P=0.868) between both groups. CONCLUSION: There was a statistical association between low serum ferritin and chronic telogen effluvium. Hemoglobin levels may not reflect the real iron state in patients with chronic telogen effluvium and serum ferritin level is a better indicator for early detection of low iron store

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telogen --- effluvium --- ferritin --- hemoglobin --- iron store


Article
Association of Helicobacter Pylori and Nasal Polyposis

Authors: Ahmed Muhamad AI –Abbasi
Pages: 92-96
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ABSTRACT : BACKGROUND: Helicobacter pylori is recognized as an important human pathogen by virtue of its association with peptic ulcer disease , gastric cancer , gastric lymphoma and high prevalence of infection worldwide. Recently this organism was detected in tonsil and adenoid tissue after adenotonsillectomy , as well as in mucosa of patients with chronic rhinosinusitis , but its association with simple nasal polyposis has not been investigated yet in our country . OBJECTIVE: To investigate a possible contribution of Helicobacter pylori (H.pylori) in the etiopathogenesis of simple nasal polyps . Study Design: Prospective clinico –pathological investigation. METHODS : Twenty eight patients with nasal polyposis were studied for the presence of Helicobacter pylori in the nasal polyp specimens by histopathological examination of serial sections stained by modified Giemsa stain . RESULTS: Helicobacter pylori was detected in 10 (35%) of total 28 simple nasal polyps specimens. CONCLUSION: This study found a significant percentage 10/28 patients (35%) with Helicobacter pylori infection in nasal polyps and to confirm the role of Helicobacter pylori in the etiopathogenesis of nasal polyposis , extensive epidemiological studies would be necessary


Article
Occurrence of MexAB-OprM Efflux Pump Operon on Septicemic Pseudomonas Aeruginosa Chromosome

Authors: Ibtesam Ghadban Auda Al-Grawi
Pages: 97-102
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ABSTRACT: BACKGROUND: P. aeruginosa remains an important cause of life-threatening bloodstream infection in immunocompromised patients, particularly those with hematologic malignancies complicated by neutropenia. One of the most worrisome characteristics of P. aeruginosa consists is its low antibiotic susceptibility This low susceptibility is attributable to concerted action of chromosomally-encoded multidrug efflux pumps genes. These genes are often controlled by regulatory gene located on the same operon of efflux pump. One of particular significance is the MexAB - OprM efflux system, which is expressed constitutively, thereby contributing to the well-known intrinsic resistance of this organism to multiple antimicrobials. OBJECTIVE: To detect the occurrence of mexAB-OprM operom on the chromosomes of septicemic P. aeruginosa(SPA). METHODS: This study was include 53 Pseudomonas aeruginosa isolates isolated from patients their ages ranging from two days to 73 years,28 males and 25 females. Some of the isolates were isolated from acute, 15(28.3%), and chronic, 7 (13.2%), leukemic patients, 5 (9.4%) from each lymphoma and gastrointestinal neoplasms patients. Nine (17%), 3(5.7%), 6 (11.3%) and 3(5.7%) from urogenital neoplasms, breast cancer patients, septicemic patients due to burn infections and neonatal septicemia respectively. Chromosomal DNA was extracted from SPA isolates and subjected to PCR to amplify three genes of mexAB-OprM efflux pump. RESULTS: Multiplex PCR of mexAB-OprM efflux pump genes revealed that 53 (100%) were positive to all three genes of operon, mexA, mexB and the regulatory gene, mexR. CONCLUSION: P. aeruginosa can cause septicemia in cancer patients and other compromised patients, like patients suffering from extensive burns and neonatal infants. mexAB-OprM efflux pump genes are a chromosomal encoded genes and can be used as a markers in identification of SPA by molecular methods. These genes can be used individually or collectively in rapid identification of SPA, and rapid detection for mexAB-OprM efflux pump occurrence on their chromosomes.


Article
Immunological Evidence In Idiopathic Dilated Cardiomyopathy

Authors: Basil Nageeb Saeed
Pages: 103-106
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ABSTRACT: BACKGROUND: Immunological factors in the pathogenesis of idiopathic dilated cardiomyopathy (IDC) were suggested previously on the basis of the demonstration of mononuclear cell infiltrates and autoantibodies against the myocardium. OBJECTIVE: Was to determine the changes in the percentage of T cell subsets in peripheral blood in order to investigate the role of cellular immunoregulation in patients with idiopathic dilated cardiomyopathy. PATIENT AND METHOD: The surface markers of peripheral T and B lymphocytes were detected and percentages of helper (CD4+) and suppressor (CD8+) T lymphocytes subsets in the peripheral blood and their ratio. (CD4+/CD8+) were determined in 62 patients with IDC and in 50 healthy controls. RESULTS: There were no significant differences between IDC and control groups with respect to CD4+ T cell subsets ( p=0.4). CD8+ T cell percentage was significantly decreased in patients with IDC than in controls (p=0.005). CD4+/CD8+ ratio was markedly higher in patients with IDC than controls (p=0.005). CONCLUSION: Decreased CD8+ T cell subset is the cause of increased CD4+/CD8+ ratio, which may imply decreased self-tolerance and an immunoregulatory defect in the pathogenesis of IDC.

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Article
Evaluation of Different Methods for Management of Humeral Diaphyseal Fracture

Authors: Ali Alias Ali
Pages: 107-112
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ABSTRACT: BACKGROUND: Fractures of the humeral shaft account 3% of all fractures. OBJECTIVE: purpose of the present study is to study in a consecutive series of humeral shaft fractures; union rate, time of union, rate of nonunion, evidence of malunion, shoulder and elbow joints function and symptoms after each method, to confirm previously published results, and to study the effect of postoperative fracture distraction in fracture union. METHODS: By using conservative and operative methods, we treated 54 patients who had a fracture of the humeral shaft. 48 patients were available for follow-up, which ranged from 5 to 40 weeks. RESULT: The average age of patients was 31.39 yrs (ranges from 5 to 65 Yrs), 26 males and 22 females. From these patients (42 were of close and 6 were of open fractures), the average time of union was 10.5 weeks for conservative method and 8.4 weeks for operative method. In non operative method approximately 41.66% of the patients (ten patients) had an excellent functional result and an essentially full range of motion of the shoulder and elbow. 33.33% (eight patients) had a good functional result but lacked 15 degrees of forward flexion of the shoulder, or less, or 5 to 15 degrees of extension of the elbow. 8.3% (two patients) had a fair functional result but lacked more than 20 degrees of motion in both shoulder and elbow joints (specially in elbow extension) with mild pain. 16.6% (four patients) had a poor initial resulted secondary to instability that was due to nonunion of the fracture. CONCLUSION: Because of the low morbidity and high rate of success in conservative method and because statistically there was no significant difference between the two methods (P value more than o.o5), we concluded that the treatment of choice for diaphyseal fractures of the humerus is better to be by non operative method unless there’s a clear indication for surgery.


Article
Outcome of Major Liver Resection in Gastroenterology & Hepatology Teaching Hospital Review of Nine Cases

Authors: Talib AL-Jasha′ami
Pages: 113-117
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Abstract

ABSTRACT: BACKGROUND: Major hepatectomies consider one of the most challenging procedure and did not become commonplace until the dramatic improvement in periopertive care in the 1980s. OBJECTIVE: Review the outcome of liver resection performed recently in Gastroenterology& Hepatology Teaching Hospital . PATIENTS AND METHOD: From June 2008 to March 2011, nine major anatomic hepatic resection was performed. Enucleation, Non- anatomic or wedge resection was excluded from this study. RESULTS: There were 4 men, 4 women and one child. Age range between 5-43 years median age 40 years. Nine major resection was done this include; extended right hepatectomy 1 patient, right hepatectomy 2 patients, left hepatectomy 3patients, left lateral lobectomy 2 patients, right anterior sectionectomy one patient. The inflow pedicle was controlled either by extrahepatic approach in 6 patients or intrahepatic pedicle ligation by vascular stapler in 3 patients. Post-operative hospitalization was 3-16 days, median 8 days. There were no mortality. Two patients developed bile leak in form of biloma which was treated by percutaneous drainage under ultrasound for 2weeks. Two patients develop intra-operative hypothermia that led to stop the operation for one hour until warming of the patient. CONCLUSION: Major liver resection can be performed in our hospital with acceptable morbidity rate.


Article
The Effect of Acute Urinary Retention on The Accuracy of Serum Prostate-Specific Antigen Level Measurements

Authors: Ehab Jasim Mohammad
Pages: 118-122
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Abstract

ABSTRACT: BACKGROUND: The level of PSA in serum is increased by inflammation of the prostate, urinary retention,prostatic infection, benign prostatic hyperplasia,prostate cancer, and prostatic manipulation. [3] OBJECTIVE: To study the effect of acute urinary retention on the serum prostate-specific antigen (PSA) concentration. METHODS: Blood samples for serum PSA measurement were obtained (PSA1), and an indwelling urethral catheter was inserted for 2 weeks. Before catheter removal, a second blood sample for measurement of serum PSA level (PSA2) was obtained. In patients who were able to void, a third sample was obtained 3 weeks later (PSA3). In the first and second visits, digital rectal examinations (DRE1, DRE2) were performed to assess prostate volume. Mean PSA levels (PSA1, PSA2, and PSA3) and prostate volumes (DRE1, DRE2) were compared. RESULTS: Fourty-two patients with a mean age of 70.18 years (range 56 to 85 years) participated in this study.mean PSA level at the time of AUR (PSA1) was 7.02 ng/mL (median, 5.8 ng/mL; range, 0.9 to 30.4 ng/mL). The mean PSA2 level was 5.5 ng/mL (median, 3.9 ng/mL; range, 0.7 to 39 ng/mL), lower than the PSA1 level .This association was statistically non significant P > 0.05. The mean prostate volume at the time of DRE1 (43.4 mL; median, 45 mL; range, 30 to 60 mL) was significantly higher than at DRE2 (37.8 mL; median, 40 mL; range, 25 to 50 mL) (P < 0.001). PSA3 was measured in 42 patients 4 weeks after retention (2 weeks after catheter removal). In this group of patients, mean PSA2 and PSA3 levels were 5.5 ng/mL and 5.1 ng/mL, respectively (median, 3.9 and 3.5, respectively, P > 0.05). CONCLUSION: Acute urinary retention can increase serum PSA levels. In this series, we found that this effect may continue up to 2 weeks.


Article
The Seroprevalence of IgM Among Iraqi Aborted Women Infected with Human Cytomegalovirus

Authors: Maysara S.Khalf
Pages: 123-129
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Abstract

ABSTRACT: BACKGROUND: Fetal loss and abortion are responsible for significant emotional distress for couples desiring children. There are many documents which support the role of some certain asymptomatic infections such as Cytomegalovirus (CMV) in spontaneous abortion. OBJECTIVE: This study was aimed to evaluate the prevalence of seropositivity of specific IgM antibody for CMV by ELISA in the sera of (108) women with recurrent abortion associated with obstetric complications. METHODS: This study was carried out in two central hospital in Baghdad (Al-Elwea& Baghdad teaching hospitals )during (2009-2010).A number of (108) women with definite diagnosis of previous abortion ,35women with recurrent abortion , 30 women with premature delivary and 43women with intra uterine death .compered to (50)women with history of normal full term delivary and negative history of miscarrage as control groups .Serum samples were collected and then tested by using ELISA for detection of anti- CMV IgM antibodies . RESULTS : Cytomegalovirus (CMV)specific IgM antibody was detected in (15.7%) of the 108 women studied ,while the women with obstetric complications were positive for CMV specific IgM antibody these compriesd of(16.6%)with premature delivary ,(14%) with recurrent abortion and (16.2%) with intra uterine death . these result statistically significant (P<0.05) .Our data faild to found asignificant association between the Cytomegalovirus infection with age and residence of patients (p>0.01). CONCLUSION : Higher seropositivity for cytomegalovirus (CMV)in women with spontaneous abortion compared to women with normal obstetric history suggests that cytomegalo virus Plays a sigificant role in abortion


Article
The Study of Antibacterial Activity of Plantago Major and Ceratonia Siliqua

Authors: Basma Monjd Abd Razik
Pages: 130-135
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Abstract

ABSTRACT: BACKGROUND: Antibiotics are generally beneficial in treating susceptible microbial infections but such beneficial effects are counter balanced by rampant irrational use. In fact, the misuse of antibiotics leads to the emergence of antibiotic-resistant bacteria. On the other hand, the consumption of foods contaminated with some pathogenic microorganisms represents a serious health risk to humans. OBJECTIVE: Therefore the present study describes the comparison of antibacterial activity between two plants which are known traditionally by their biological activities and used in Iraqi folk medicine as antidiarrheal. METHODS: Agar – well diffusion method tested antibacterial activities of methanolic crud extracts with different concentrations of the two plants on six types of bacteria strains which are:-:- Lactobacillus sp., Staphylococcus aureus, Proteus sp. , Pseudomonas aeruginosa, Escherichia coli ,and Enterococcus sp. RESULTS: Two plants extract had antibacterial activity ,methanolic extract of Plantago major was more active than methanolic extract of Ceratonia siliqua against the same tested bacteria. The biological activity was determined by measuring the inhibition zone in millimeters, results were expressed as means ± standard deviation of triplicate experiments. CONCLUSION: These results suggest that extract of two plants possesses antimicrobial and properties, and therefore they can be used as a potential source of active ingredients for food, pharmaceutical industry or preservatives.


Article
Superficial Temporal Artery Aneurysm Two Case Reports

Authors: Mohammed Jaber Al-Mamori
Pages: 136-139
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Abstract

ABSTRACT: Aneurysms of the superficial temporal artery (STA) are a rare and potentially critical cause of facial masses. Usually, these aneurysms are Pseudoaneurysm and occur following blunt or penetrating trauma to the head or following surgery in the temporal region. Most cases (about 75%) are the result of blunt head injury. Only 11 cases of spontaneous aneurysms were reported. These aneurysms are assumed to have been congenital or arteriosclerotic. Pseudoaneurysm has occurred mainly in the anterior branch of the STA. The first case of a STA Pseudoaneurysm was described by Thomas Bertholin in 1740 and since then about 400 cases have been published in the literatures. I present two cases of traumatic pseudoaneurysm of the STA and I discuss pertinent diagnosis and treatment options, as well as provide a brief review of the anatomy and histopathology of pseudoaneurysms

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Table of content: volume:11 issue:1