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: 2011 volume:10 issue:2

Article
Demographic and Clinical Presentations of Pediatric Hydrocephalus in Medical City

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ABSTRACT: BACKGROUND: Hydrocephalus is distension of the ventricular system of the brain related to inadequate passage of cerebrospinal fluid from its points of production within the ventricular system to its points of absorption into the systemic circulation. OBJECTIVE: To study the demographic and clinical presentations of pediatric hydrocephalus in medical city complex , Baghdad. PATIENTS AND METHODS: This is a prospective study ,which was carried out on 100 children with a mean age+- standard deviation ( 24.3 +/- 16.06 )months and median 16 months, who were admitted to Children Welfare Teaching Hospital & neurosurgical department ( Surgical Specialties Hospital) / Medical City complex, Baghdad in the period from April first 2009 to October first 2009. A specially designed questionnaires were used to aid the investigators in performing a family interview. General and neurological examinations, and investigations including neuroimaging studies were done. RESULTS: Of 100 patients,(62%)were males and (38%) were females, with male to female ratio of 1.6:1. Family history of congenital anomaly was positive in (26%) of patients, while hydrocephalus was positive in (14%). Seventy-Two percent of patients had congenital hydrocephalus. Eighty–Seven percent of patients were full term. Fifty-Seven percent of patients were products of NVD ,while (43%) were products of CS,(2%) of them were emergency CS& (41%) were elective. The macrocephaly was diagnosed or noted at birth in (32%)of patients. The study showed that U/S finding of hydrocephalus was positive in (49%). CONCLUSION: The majority of the patients had congenital hydrocephalus, but there was delay in the diagnosis of macrocephaly. Prenatal ultrasound diagnosis yield was low in this study. Family history of hydrocephalus and other neural tube defect was important to be elicited


Article
Acute Renal Failure in Neonates

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ABSTRACT: BACKGROUND: Acute renal failure (ARF) is a common problem in admitted neonates in intensive care units. In most patients ARF accompanies with a predisposing factor such as sepsis, heart failure, perinatal asphyxia or prematurity. OBJECTIVE: This study was to determine the causes and outcome of ARF in hospitalized newborn PATIENTS AND METHODS: In a descriptive cross sectional study we evaluated neonates with ARF who had been hospitalized in Children welfare teaching Hospital from july 2009 to july2010. RESULTS: There were 50 cases diagnosed as ARF in 2500 hospitalized neonates (2%).The male to female ratio in patients with ARF was 3.16:1. Most of involved patients were term 35(70%). The prevalence of renal, pre renal and post renal causes of ARF was 29 (58%), 15(30%) and 6(12%) respectively. The most common predisposing factors for ARF in our study was sepsis 28(56%), genitorenal anomalies 15(30%), perinatal asphyxia 3(6%), drug toxicity in 3(6%) One patient (2%) had respiratory distress syndrome. Among admitted neonates with ARF 6(12%) died and it was significantly higher in patients with sepsis (P<0.05). CONCLUSION: ARF is a common emergency entity , physicians play a critical role in recognizing early ARF, preventing iatrogenic injury, and reversing the course of ARF.


Article
Prevalence of Amoebic Dysentery among Children Attending Al-Battool Teaching Hospital in Diyala Governorate

Authors: Dawood Salman Hameed Al-azzawi
Pages: 149-154
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ABSTRACT: BACKGROUND: This study is carried out throughout the year 2009 to show the prevalence of amoebic dysentery among the children affected with diarrhea in Diyala who were referred from the primary health centers to the pediatric clinic in Al-Battool teaching hospital. OBJECTIVE: This study puts the light on the extent of distribution of amoebic dysentery as a cause of diarrhea among children in our community and for thorough recognition of this social problem and its important drawbacks on the general health. PATIENTSANDMETHODS: Children affected with diarrhea who were referred from the primary health centers to the pediatric clinic in Al-Battool teaching hospital, the center of Diyala province. Examination of a freshly passed stool within 30minutes was done and more than two samples for every case examined carefully by an expert laboratory personnels. RESULTS: The study includes (18450)patients who did visit the pediatric clinic during 2009 , their age is ranging from early days of life up to 15years old , the number of patients affected with diarrhea of different causes was 7752 and the patients complaining from amoebic dysentery were 2640 according to stool examination i.e.the prevalence in our community is 14.3% . 1. A total of 1563 (20.1%) of patients were affected by Entamoeba histolytica cyst and 1077 (13.9%) were affected by Entamoeba histolytica trophozoite . 2. It is more common among male (1490) than female(1150), male to female ratio is 1.3 :1 3. The infection is present throughout the year but it is more common during hot months from around the beginning of April to the end of September . 4. It is accompanied occasionally by complications; intestinal, extra-intestinal, relapses, and even death . CONCLUSION: 1. Among children in the study there is no age immune to E. histolytica infection. It is more common among age group from two months up to five years old. 2. Infection is more common among male than female. 3. Entamoeba histolytica infection is widely spread among our children and it is more common in sectors in the periphery ( Baladrouz and Mukdadia ) than the center of the governorate mostly explained by the bad sanitation and water pollution


Article
Percutaneous Plumonary Valvuloplasty in Critical Plumonary Valve Stenosis

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ABSTRACT: BACKGROUD: Critical plumonary valve stenosis represents an emergency and immediate treatment is mandatory. Percutaneous plumonary valvuloplasty is the treatment of choice for isolated plumonary valve stenosis OBJECTIVE: Results and complications, of this procedure in our cath. Lab. PATIENTS AND METHODS: From January 2006 to August 2009, 28 neonates and infants with critical plumonary valve stenosis (mean age 33.5 days : range 6-88 days) underwent percutenous plumonary valvulopalsty. All patients were cyanosed, and the clinical diagnosis was confirmed by cross sectional and Doppler echocardiography RESULTS: The plumonary valve was successfully crossed in all patients. The trasvalvular gradient dropped from 86.9+_21mmgh to 33.2+_20.9mmgh, the mean right ventricular systolic pressure dropped from 100.4+_2o.7mmgh to 54.2+_20.9mmgh, and oxygen saturation increased from 81+_8% to 97+_2% .There were 9(32.1%) major complication including 4(14.2%) death ,3(10.7%) hemopericardium reguiring drainge and transfusion, and two(7.1%) patients developed considerable venous congesation . During a mean followup of 1.6 years , 19(86.3%) of the 22 patients remain free of important restenosis. CONCLUSION: Percutaneous plumonary valvuloplasty is effective procedure of first choice in treatment neonates and infants with critical plumonary stenosis


Article
The Role of IL-1 and Tumor Necrosis Factor-α in Pathogenesis of Rheumatoid Arthritis

Authors: Eman Sh.Al-Obeidy --- Shatha F. Abdullah
Pages: 161-165
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ABSTRACT: BACKGROUND: Rheumatoid Arthritis (RA) is a common chronic inflammatory and destructive arthropathy that cannot be cured.Interlukin-1 (IL-1), IL-6 and tumor necrosis factor (TNF- α) are the key cytokines that drive inflammation in the disease. OBJECTIVE: The study was established to shed light on the possible role of IL-1 and TNF- α in pathogenesis of RA. PATIENTS AND METHODS: Rheumatoid Factors (RF),TNF-α and IL-1 were detected by Enzyme-Linked Immunosorbent Assay (ELISA) .C-reactive protein(CRP) on the other hand has been detected by using latex agglutination kit in the serum of 50 Iraqi patients with RA in comparison with 50 healthy individuals. RESULTS: Significant high levels of IL-1and TNF- α were observed in RA patients sera with P-value ( 0.04 and 0.001) respectively compared to healthy control group, in addition a positive linear association was found between the concentration of IL-1and TNF- α and CRP with P-value ( 0.05 and 0.001) respectively. CONCLUSION: IL-1and TNF- α play a role in pathogenesis of RA


Article
Extent of Coronary Arteries Disease Between Angiographic FIndings and Some Atherogenic Lipid inDices

Authors: Basil N. Saeed
Pages: 166-169
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ABSTRACT: BACKGROUND: Modification of lipid subtypes improves the prognosis of ischemic heart disease. OBJECTIVE: Correlating the coronary angiographic finding with the measurement of different plasma lipid parameters. PATIENT AND METHODS: (180) hundred eighty patients admitted in the study, (120) patients were male, (60) patient were female, their age range (29-72 years) were randomly assigned into four groups. Group (1): Patient with myocardial infarction (STEMI). Group (2): Patient with non-STEMI myocardial infarction. Group (3): Patient with unstable angina. Group (4): Patient with ischemic cardiomyopathy. The angiographic findings, were classified according to the guidelines of (ACC/AHA) all patients had lipid parameters correlated to their angiographic finding (A, B, C, respectively). RESULTS: This study showed that there was significantly correlated between the levels of HDL, LDL, triglyceride and the coronary angiographic findings in groups (A, B, C) (0.05, 0.001, 0.001) respective. However the use of Atherogesic index (TG/HDL-c) was highly significant and nave clinical evaluation the severity of extent of coronary artery disease (i.e. the Raton (5.9) in group A, (5.2) in group B, (4.8) croup C). CONCLUSION: Using more than one lipid parameter can assess the severity of coronary artery disease.


Article
Thyrotoxicosis-10 Years Experience

Authors: Taha Othman Asaad Mahwi
Pages: 170-179
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ABSTRACT: BACKGROUND: Thyrotoxicosis is one of the most common presentations in thyroid disease, Graves’ disease, multinodular goiter, toxic adenoma and thyroiditis are its main common causes, almost every system is affected and there is great individual variation in the dominant features. OBJECTIVE: The study objectives are to explore the pattern of thyrotoxicosis in Sulaimania city during the years1996-2006. METHODS: From January1996 to January 2006,452 thyrotoxic cases 165 males and 287 females were evaluated for the causes, history of iodine prophylaxis program ,their manifestations, the eye signs and relation of the smoking with the eye signs. RESULTS: Analysis of 452 patients proved to have thyrotoxicosis by thyroid function tests, females were 64% and males 36%, the mean age was around 39 years, graves’ disease was the cause in 59.51% of the cases, followed by Iodine-induced thyrotoxicosis 21.9%, multinodular goiter 9.96%, single nodule goiter 7.97%, then finally subacute thyroditis 0.66%,Among the thyrotoxic cases 61.06% has weight loss and 50% has hand tremor , in those with eye sign 56% has non-infiltrative and44% has infiltrative eye signs. CONCLUSION: Thyrotoxicosis is twice more common in females than males, Graves’ disease is the commonest cause while iodine induced thyrotoxicosis is another important cause in the setting of iodine prophylaxis program, weight loss and hand tremor are commonest manifestation. In between ophthalmopathic smokers infiltrative eye signs were more common than non infiltrative.


Article
Levels of Magnesium, Zinc, Calcium and Copper in Serum of Patients with Fibromyalgia Syndrome

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ABSTRACT: BACKGROUND: Fibromyalgia syndrome (FMS) is a chronic musculoskeletal syndrome; almost invariably, symptoms persist at 5- and 10-year follow-ups. Several studies reported the importance of trace elements on the immune system. It plays an important role in physiological processes that are crucial for normal functioning of the immune system. Fibromyalgia could be the result of an over-active immune system, the immune system works to protect the body by attacking bacteria, viruses, and other foreign cells. When over-active, the immune system can cause severe inflammation and pain. OBJECTIVE: The main objective of this study is the association between the levels of Magnesium, Zinc, Calcium and Copper in patients with FMS. PATIENTS AND METHODS: This study was performed during the period from April 2009 to February 2010, and included 60 patients with FMS according to the ACR 1990 criteria, these criteria, a history of widespread pain has been present for at least three months affecting all four quadrants of the body, i.e., both sides, and above and below the waist, and there are 18 designated possible tender or trigger points. During diagnosis, four kilograms-force (39 newtons) of force is exerted at each of the 18 points; the patient must feel pain at 11 or more of these points for fibromyalgia to be considered. Four kilograms of force is about the amount of pressure required to blanch the thumbnail when applying pressure. Their age range was from 20-60 with the mean age of 39.95 ± 1.10 years. These patients were matched by age and sex to 30 healthy control subjects with the mean age 42.81 ± 2.16 years. Blood samples were taken from each individual and separated for the estimation of Mg, Zn, Ca and Cu levels using atomic absorption technique. The laboratory tests were done in Teaching Laboratories of the Medical City and the Department of Physiological Chemistry / College of Medicine University of Baghdad. RESULTS: The level of Mg, Zn and Ca in serum of patients with FMS was significantly lower than in serum of healthy control while the level of Cu in serum of FMS patients was significantly higher than healthy control. CONCLUSION: Thelevels of Mg, Zn, Ca concentrations in serum of patients with FMS were significantly lower than healthy control subjects, while Cu concentration in patients with FMS was significantly higher than healthy control subjects and levels of Mg, Zn, Ca and Cu may be a good indicator to evaluate this disease.

Keywords

Mg --- Zn --- Ca --- Cu and fibromyalgia syndrome


Article
Relationship Between FEV1& PEF in Patients with Obstructive Airway Diseases

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ABSTRACT: BACKGROUND: Spirometry is the recommended investigation for diagnosis and categorization of the severity of the air flow limitation, however Spirometer is not widely available, while Peak-flow meter is cheap, portable, and easy to operate and maintain, so the PEF is frequently proposed as alternative to FEV1 for this purpose, and widely used in general practice as a surrogate for FEV1 in assessment of airway obstruction diseases. OBJECTIVE: To determine effect of FEV1 & PEF in obstructive airway diseases. PATIENTS AND METHODS: This study was took place between 1st December 2006 and 1st July 2007in Baghdad teaching hospital. A total of 100 patients with history suggestive of obstructive airway diseases (symptoms of cough, wheezes, shortness of breath, and chest tightness), and their pulmonary function test show obstructive pattern (FEV1/FVC <70%) were included. They were (60%) male and (40%) female, and their age ranged from 16 to 82 years. RESULTS: In screening for obstructive airway diseases, there was a significant relationship (P value <0.05) between FEV1% and PEF%, (94%) of patients with obstructive airway disease as assessed byFEV1% (FEV1 %< 80%) had PEF %< 80%.In severity categorization, the PEF% and FEV1% were concordant in only (60%) of patients, with better concordance as severity of obstruction (based on FEV1%) became more. In patients with mild to moderate airway obstruction (FEV1%>40%), PEF% tended to underestimate FEV1%; while in patients with more severe obstruction (FEV1 %< =40%), PEF% tended to overestimate FEV1%. For the entire study population, PEF% underestimated FEV1% by mean of only 0.35%. However, limits of agreement were wide and exceeded-/+ 14.5. In our study 70% of patients had discordance more than 5% apart between PEF% and FEV1%, (which could be considered clinically important error for estimation of severity of airway obstruction), and this discordance more marked in women, short patients, and in patients with mild airway obstruction. CONCLUSION: The PEF% can reliably exclude airway obstruction, when normal value is present. Assumption of parity between PEF% and FEV1% must be avoided especially in categorization of severity of air way obstruction


Article
Comparison of the Effect of Salicylic Acid Chemical Peel Combined with Topical Modified Kligman Formula and Topical Modified Kligman Formula Alone in the Treatment of Melasma

Authors: Ali Mozan Dhahir Ethawi --- Lana Mohamed Sidiq
Pages: 191-197
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ABSTRACT: BACKGROUND: Many chemicals have been used in the skin peeling for melasma such as trichloacetic acid, Jessner’s solution, glycolic acid, lactic acid and salicylic acid which is beta-hydroxy acid used topically in different dermatoses. OBJECTIVE: To evaluate the efficacy and safety of superficial chemical peel with salicylic acid in combination with topical depigmenting agents in comparison to depigmenting agents alone in treatment of melasma. PATIENTS AND METHODS: Eighty-eight patients with melasma (45 group-1 and 43 group -2) were selected, mostly of skin type III, IV. Most of them were females recruited in this trial, in particular those who attended outpatient’s clinic, Department of Dermatology and Venereology in Sulaimania city from February 2008 to August 2008. Treatment is performed by using a combination of superficial chemical peel with salicylic acid peels of increasing strength from 20% to 30% once every 2 weeks and by application of modified Kligman formula between sessions in group -1, and topical treatment alone in group -2. RESULTS: Most of the patients had showed a good improvement in their melasma with the use of our treatment with adequate sun protection. The clinical response was much better in epidermal than mixed type and very mild in dermal. The MASI scores significantly decrease after treatment especially in epidermal type while no statistical difference was established among final MASI values of patients with mixed and dermal types (p<0.000) with the result being significantly higher in group -1. CONCLUSION: Superficial chemical peel with salicylic acid in combination with topical modified Kligman formula for melasma is more effective than topical modified Kligman formula alone. It is easy and cheap. The results of the epidermal type were better than other types .


Article
Cranioplasty ( Monomeric Acrylic Designed in Dental Laboratory Versus Methylmethacrylate Codman's Type)

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ABSTRACT: BACKGROUND Cranioplasty is a surgical procedure for closure of skull defect either duo to traumatic or non traumatic causes, using a synthetic or natural materials for repair METHODS: 14 patients collected from AL-Kadhimiya teaching hospital ,complaining of skull defect ,12 males,2 females. 8 patients had history of bullet injury. RESULTS: Surgery done for all using methylmethacrylate Codman's type for 8,the other 6, monomeric acrylic designed in the hospital.1 patient had history of loss of consciousness postoperatively, 1 patient had postoperative dizziness, mild improvement of headache in two patients. CONCLUSION: Monomeric acrylic designed preoperatively decreasing the time of surgical maneuvere


Article
HbA1c in Patients with Diabetic Foot: A Prognostic Index

Authors: Hasanain Hashim Al-Yasiri
Pages: 204-208
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ABSTRACT: BACKGROUND: Diabetes mellitus (DM) is a common worldwide disease; which if poorly controlled, would be associated with high risk of complications, and diabetic foot is one of them. Glycated hemoglobin A1c (HbA1c) is an important control index of DM, and nowadays it is used as a diagnostic test. OBJECTIVE: To assess the benefit of HbA1c as a prognostic index in patients presented with diabetic foot. PATIENTS AND METHODS: This study included 176 patients presented to Al-Hilla Teaching Hospital with diabetic foot during a period of 38 months from 1st March 2007 to 1st May 2010. HbA1c was measured for all patients at time of enrollment which is mostly day of presentation. Level of 8 was considered a separation control point between good and bad control, and patients were classified into two groups; good control group (GCG) where HbA1c levels < 8, and bad control group (BCG) where levels ≥ 8. The end points for the study were determined as death, amputation, surgical wound excision without amputation, improvement on medical treatment only. Death and amputation were considered bad prognosis group (BPG), while others were considered good prognosis group (GPG). Statistical analysis was done using means, independent t-test and F-test. RESULTS: One hundred seventy six patients were studied with age range of 35-76 years, 60.15% (107/176) of them were males. At the end of follow up; 47.7% (84/176) of patients were found in BPG and 52.3% (92/176) in GPG as the following: death (11 patients), amputation (73 patients), wound excision without amputation (52 patients) and medical treatment only (40 patients); while 64.2% (113/176) of patients were found in BCG (HbA1c ≥ 8) and 35.8% (63/176) in GCG (HbA1c ˂ 8). 61.1% (69/113) of BCG patients had bad prognosis; whereas only 23.8% (15/63) of GCG patients had bad prognosis, a statistically significant difference (P-value 0.001); Higher HbA1c levels were seen in patients with bad prognosis as mean HbA1c was 8.97 in BPG and 7.79 in GPG; a difference that is statistically significant (P-value ˂ 0.001) CONCLUSION: HbA1c is a significant prognostic index in patients presented with diabetic foot. Levels greater than 8 were associated with poor prognosis and longer hospitalization. So; diabetic control is a very important factor in preventing and alleviating diabetic complication


Article
Cystoscopic anystoscopic an ystoscopic an ystoscopic an d Histopathologic istopathologic istopathologic istopathologic istopathologic Patternsatterns atterns in in Iraqi raqi Patients atients atients with with Chronic hronic hronic Cystitis /ystitis /ystitis / ystitis / Painful ainful Bladder ladder ladder ladder Syndromeyndrome yndromeyndromeyndrome

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ABSTRACT: BACKGROUND: Chronic cystitis symptoms with negative cultures always represent achallenge to the urologist because of the uncertainty in etiology and heterogenous pathological findings. OBJECTIVE: To elecit the role of cystoscopy and biopsy in disclosing the different pathological patterns in our patients with chronic cystitis like syndrome and to compare them with the pathological patterns of western patients. PATIENTS AND METHODES: This study included 64 patients (40 males and 24 females) with a persistent symptom complex of supra pubic pain, dysuria,frequency and urgency (cystitis –like syndrome)for 12 months and above , in the absence of neurological and gynaeco logical findings or positive cultures. The mean patient age was 38 years (20-68ys). The mean duration of symptoms was 26 months . All patients were subjected to a full urological evaluation, cystoscopy under G/A with hydro distension , biopsy and histopathologic examination . RESULTS: The commonest cystoscopic findings were dilated vessels, sub mucosal petechial haemorrhage after hydro distension , bilharzial lesions, mucosal cracks and small polypoid masses. Histopathologic examination revealed variable lesions as chr. Inflammatory cell infiltration, Brunns nests, cystitis cystica, metaplasia , Bilharzial reaction and ova and in situ carcinoma. Most patients had more than one lesion , especially sub mucosal petechial haemorrhage associated with bilharzial lesions or in situ carcinoma. CONCLUSION: In our patients, the chronic abacterial cystitis syndrome is common in both males and females and has different pathological findings. It is therefore , different from the pattern of the syndrome found in western patients where it mainly affects females and most often in the form of interstitial cystitis . This may be attributed to the high prevalence of stone disease and bilharziasis in addition to the highly concentrated urine of our patients. We, thus , consider it mandatory to do cystoscopy and bladder biopsy for every patient presenting with chronic cystitis like symptoms


Article
Endoscopic Endonasal Dacryocystorhinostomy Versus External Dacryocystorhinostomy

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ABSTRACT: BACKGROUD: Epiphora and recurrent dacryocystitis are common problems between adult patients consulting ophthalmic and ENT departments. They are occur mostly duo to obstruction of nasolacrimal duct for different causes. Surgical treatment is the only available way to treat them. OBJECTIVE: To study the clinical outcomes of a new endoscopic endonasal dacryocystorhinostomy (EENDCR) technique compared to the conventional external Dacryocystorhinostomy technique (Ext-DCR). METHODS: A retrospective, comparative cross sectional study on 105 cases with epiphora operated upon in 5 years (2004-2009), 60 consecutive EENDCRs and 45 Ext-DCRs. Patients with anatomic nasolacrimal duct obstruction were included in the study; previous lacrimal surgery, functional nasolacrimal, canalicular obstruction and nasal problems were excluded. Two surgeons performed the EENDCRs, using a standardized operative technique, which involved creation of a large bony ostium and mucosal flaps between the lacrimal sac mucosa and nasal mucosa. One surgeon performed all Ext-DCRs. RESULTS: 53 patients (15 men, 38 women) underwent 60 EENDCRs. The average age of the patients was 40 years (range, 5 to 70 years). In the Ext-DCR group, 45 patients (14 men, 31 women) underwent 45 DCRs. The average age was 30.5 years (range, 6 to 49 years). The average follow-up time was 10 months for the EENDCR group and 12.2 months for the Ext-DCR group. Success was defined as relief of symptoms and by anatomic patency, which was assessed by history, fluorescein dye and syringing of lacrimal drainage system. The success rate was significantly higher in cases underwent Ext-DCRs {95.55% (43/45)} as compared to cases underwent EEDCRs {81.66% (49/60)}. (P < 0.05) CONCLUSIONS: Ext-DCR offers better symptom free outcomes (95.55%) than endoscopic DCR (81.66%). Patients who are more interested than others in cosmetic subject, their operations must be conducted with EENDR. A larger, randomized prospective trial is needed to fully assess the efficacy of this new technique.


Article
Serum Concentration of Vitamin D in Preeclampsia

Authors: Faisal Gh. Al-Rubaye
Pages: 220-223
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ABSTRACT: BACKGROUND: Preeclampsia, the de novo occurrence of hypertension and proteinuria after the 20th week of gestation, continues to exert an inordinate toll on mothers and children alike. Vitamin D, on the other hand, has direct influence on molecular pathways proposed to be important in the pathogenesis of preeclampsia, yet the vitamin D-preeclampsia relation has not been studied. OBJECTIVE: To assess the vitamin D status of preeclamptic women in different gestational period with respect to normal pregnancy. PATIENT AND METHODS: the present study is a cross-sectional case-control study (2008-2009) At Al-Kadhimiya Teaching Hospital. Includes measurement of serum vitamin D3 in 60 patients with preeclampsia who were classified into two groups according to the gestational age: o Preeclamptics in the second trimester G1: (n=30). o Preeclamptics in the third trimester G2: (n=30,). The results were compared with 60 apparently healthy pregnant women (as controls). They were classified according to the gestational age into two groups: o Pregnants in the second trimester G3: (n=30). o Pregnants in the third trimester G4: (n=30). RESULTS: Showed a significant decrease in serum vitamin D3 in the preeclamptics as compared with the controls (p < 0.001)this was accompanied by a significant reduction of this parameter with advancing gestational age in both preeclamptic and healthy pregnents. CONCLUSION: Preeclamptics (in different gestational age groups) experienced hypovitaminosis D when compared with healthy pregnant women matched with their age and gestational age; this can be explained partly by the reduction of insulin–like growth factor which has a stimulatory effects on vitamin D3 and partly explained on genetic defects affecting fetoplacental unit. The above results were supported by the significant low level of s. vitamin D3; which call for the need for vitamin D supplementation in pregnancy.

Keywords

preeclampsia --- vitamin D.


Article
Cesarean Section Rate for Induction of Labor Using Low Dose Oxytocin in the Presence of an Unfavorable Cervix

Authors: Yosra Tahir Jarjees
Pages: 224-228
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ABSTRACT: BACKGROUND: Induction of labor (IOL) implies stimulation of uterine contractions before the spontaneous onset of labor, with or without ruptured membranes. The condition or favorability of the cervix is important to labor induction. Induction to active labor is usually successful with a cervical score of 9 or greater. OBJECTIVE: (A) to estimate the cesarean section rate for induction of labor with low dose Oxytocin in the presence of unfavorable cervix. (B) To analyze the possible predictors of unsuccessful induction. PATIENTS AND METHOD: This is a case series study done at Al-Batool Maternity Teaching Hospital with a total of 13000 deliveries per year. Eighty pregnant ladies that underwent labor induction at 37 weeks of gestation or more with an unfavorable cervix (Bishop score 5). The study was conducted at Al-Batool Maternity Teaching Hospital in Mosul, north of Iraq from January to August 2005. The patients were assigned to receive 2 mIU/ min. oxytocin in one pint of intravenous fluid at day one. When contractions did not start by this dose, the patient is postponed to the second day to receive 2 and 4 mIU/min. oxytocin in two pints, respectively. If there was no response, we started the third day with 4, 8 and 16 mIU/min. in 3 pints, respectively, maintaining these doses if the contractions started. The primary outcomes were successful induction rate and cesarean delivery rate and fetal condition at birth. RESULTS: Primary cesarean delivery rate was (27.9%). Increasing Bishop Scores decreased the risk of failed induction. CONCLUSION: The use of the daily repeated low dose oxytocin infusion with gradual increase in this study is safe and may reduce the high rate of operative delivery associated with induction of labor


Article
VCAM-1 is Another Ugly Face of IFN-γ in Women with Recurrent Spontaneous Abortion

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ABSTRACT: BACKGROUND: The Th-1 cytokines were well implicated in adversely affecting pregnancy and the mechanism by which they cause pregnancy loss was suggested to be mainly vascular by activation of mediators of inflammation like certain adhesion molecules. OBJECTIVE: To study the pathological effect of IFN-γ and VCAM-1 in recurrent pregnancy loss. PATIENTS AND METHODS: The study included three groups of women; Group A: patients had recurrent abortion (n=24), Group B: patients had spontaneous abortion for the first time (n=10), Group C: women with elective pregnancy termination (n=6). Curate samples obtained from these women were subjected for in situ hybridization technique to determine the in situ expression of IFN-γ, and immunohistochemistry analysis to detect the expression of VCAM-1. RESULTS: The in situ expression of IFN-γ was significantly higher in women with RSA as compared with normal pregnant and first abortion groups (p=0.000 and 0.002) respectively, and the expression of VCAM-1 was also significantly higher (p=0.005) in women with RSA as compared with those who had abortion for the first time, with a positive correlation between the expression of IFN-γ and VCAM-1 (r=0.418; p<0.05) in women with RSA. CONCLUSION: The data of this study strengthen the possibility that type-1 immune response may have the upper hand in the pathology of RSA on multidirectional bases including up regulation of the surface expression of VCAM-1


Article
The Detection of Transcription Factor Nuclear Factor Kappa-B in Oral Squamous Cell Carcinoma by in Situ Hybridization

Authors: Ban Abbas Abdul-Majeed --- Muna Salih Merza
Pages: 237-243
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ABSTRACT: BACKGROUND: Nuclear factor – kappa B is an important transcription factor that plays a pivotal role in cell biology and the control of apoptosis. The vast majority of studies focused on the regulatory roles of this factor on apoptosis suggest that it is acting on the upstream pathways of apoptosis, either negatively or positively. It has got an important role in the development of oral squamous cell carcinomas. OBJECTIVE: To detect mRNA of nuclear factor- kappa B in oral squamous cell carcinoma by in situ hybridization compared to its presence in foci of dysplasia in premalignant lesions and to link it to tumor grade and degree of dysplasia. MATERIALS AND METHODS: Forty two cases, including 30 cases of oral squamous cell carcinoma and 12 cases of oral premalignant lesions containing foci of dysplasia were included in this study. Sections on positively charged slides were made from their paraffin blocks and were used for the detection of nuclear factor-kappa B mRNA using in-situ hybridization technique. RESULTS: Nuclear factor-kappa B mRNA was detected in 10(83.33%) cases of oral dysplasia and 24(80%) cases of oral squamous cell carcinoma. A significant orrelations was found between the marker and the degree of dysplasia, but it was not significant regarding tumor grade. CONCLUSION: The highly significant increased intensity of nuclear factor kappa B m RNA may indicate a role in increasing the degree of dysplasia in oral squamous epithelium. In keeping with the malignant phenotype, the functions of other genes are needed besides nuclear factor –kappa B.


Article
The Anthropometric Ratio of Index Finger to Ring Finger (2D:4D) Correlation with Some Seminal Fluid Analysis Parameters.

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ABSTRACT : BACKGROUND: The 2D:4D ratio can be considered as a measure of prenatal androgen exposure, with the lower 2D:4D ratios pointing to higher androgen exposure. Moreover, common molecular signals (HOX genes) control the embryological development of the appendicular skeleton and the gonads. OBJECTIVE: To investigate the correlation between semen quality and an anthropometric measurement of digit ratio. To evaluate the relationship of spermatogenesis and body parts ratio which have a common embryological determinants. METHODS: The study was performed on individuals attending the Institute of Embryo Research and Infertility Treatment /Al-Nahrain University/ Baghdad / Iraq. They were allocated from random pool of individuals required to perform seminal fluid analysis. The total number was (161) males. The index finger to ring finger (2D:4D) ratio was calculated after measuring the fingers with vernier. The ratio was correlated with sperm concentration, percentage of actively motile sperms and the percentage of normal sperms in single ejaculate. RESULTS: sperm concentration was negatively correlated with 2D:4D ratio (P=0.004), while no statistical correlation was found between the digit ratio and percentage of actively motile sperm (P=0.82) and the percentage of normal sperms(P=0.84). CONCLUSION: The ration of (2D:4D) is an indicator of sperm concentration. The lower the ratio (indicating longer ring finger), the higher is the sperm concentration. While no significant statistical correlation was found between the digit ratio and the percentages of actively motile sperms and morphologically normal sperms seminal fluid analysis.


Article
Changes in Personality and Mood profile of Women with Toxoplasmosis

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Abstract

ABSTRACT: BACKGROUND: Acquired T. gondii infection of immunocompetent patients may cause central nervous system manifestations (Gullain-Bare syndrome or brain abscess) and may be associated with psychiatric manifestation. Iraq is highly endemic with T. gondii, however, publications on psychiatric manifestation of T. gondii infection are scarce. OBJECTIVE: To demonstrate psychiatric manjfestations in women with Toxoplasmosis. METHODS: A total of 68 toxoplasma positive pregnant women and 68 toxoplasma negative pregnant women were included in this study. It was conducted for the period of 5th Aug. 2008 to 28th Feb. 2009. ELISA was used to diagnose T. gondii. Questionnaire was used to diagnose personality type and depression was used. The diagnosis was according to ICD10 and DSM-IV. RESULTS: Rates of pseudpsychopathic and limbic personality epilepsy syndrome were significantly high among toxoplasmosis positive pregnant women. Significant high rate of depression was associated with acquired T. gonii infection. CONCLUSION: These findings might provide evidence supporting role of T. gondii infection in the onset of some behavioral disorders.


Article
Hepatocellular Carcinoma Presentation & Management , A Prospective Study in the Medical City Baghdad - Iraq

Authors: Wissam Jaffar Altaee
Pages: 253-260
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Abstract

ABSTRACT: BACK GROUND : The development of HCC is a major global health problem , It's incidence has increased world wide and nowadays it constitute the 5th most frequent cancer representing around 5% of all cancers, and estimated to rank 4th in terms of mortality of cancers incidence world wide , it accounts for 80 –90% of all primary liver tumors . The Etiology of this tumor is multifactorial , certain viral, environmental & hereditary causes of cirrhosis have a strong correlation with HCC . HCC is a highly malignant tumor with poor prognosis . OBJECTIVE: To evaluated the Etiological , Epidemiological , Patho physiological , Diagnostic series , Therapeutic approaches & Advanced studies in detection and prevention of HCC . PATIENTS AND METHODS : Across sectional study of (57) patients with HCC ( 43 males , 14 females ) during the period from January 2000 to December 2002 . The patients were collected from medical & surgical units of Baghdad teaching hospital & the gastroenterology & hepatology teaching hospital . History taken from these patients & physical examination , Lab investigation ,CBP, liver function test ,Virology study , serum AFP. Titer ,U/S study , MRI , CT scan . Ascitic fluid tapping , Liver biopsy. Modalities of treatment : Palliative Treatment, Chemotherapy, Injection of Alcohol , Hemilobectomy ,Segmental resection , Debulking resection of tumor in the liver, Conservative treatment , any complications or hazards during surgical procedures were recorded. RESULTS : Male to female ratio is approximately (3:1), The mean age of (57.1) yr . more common between (51-60) yrs old ( 28.25% ) , Most of the patients were from Baghdad ( 47.4% ) . Increasing no. of patients from 2000 ( 21.1 % ) to 2002 ( 45.6 % ). (84% ) have previous history of chronic liver disease & (16%) haven't such a history . Most of chronic liver diseases are due to previous history of hepatitis B- infection (41.6%) . High level of AFP ( 66.6% ), all of them are of standard type of HCC. Ascitic fluid cytological study bloody (14%) & positive malignant cells (17.2%) . Liver biopsy (82.7%) had chronic liver diseases, and (96.5%) moderate to poorly differentiated type of standard HCC,(3.5%) fibrolamellar type .Outcome of treatment , Conservative (35%), Injection therapy (3.5%) , Chemotherapy (28%), Surgical procedures (16%) , Segmental & Right lobectomy (3.5%) for each , Debulking (9%) . CONCLUSION : AFP and U/S study are very important in the early detection and follow up of the patient with HCC , Liver biopsy - very important study to detect various type of HCC , Surgical resection is the only potentially curative treatment of HCC


Article
Role of Surgery and Laparoscopy in Management of Abdominal Tuberculosis

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ABSTRACT : BACKGROUD: Tuberculosis (TB) considered as the most communicable disease world wid. Among extra pulmonary TB the prevalence of abdominal TB shows rising tendency. Abdominal TB is defined as an infection of one or more common of two or more of the following sites; peritoneum, mesentery, gastrointestinal tract and or solid organs. Reported incidence of abdominal TB varies from country to country. The most common clinical features are abdominal pain, fever and weight loss. OBJECTIVE: To evaluate the role of surgery in the management of abdominal TB especially with the advent of minimal access surgery (laparoscopy) in the diagnosis of this disease. PATIENT AND METHODS: Prospective study was conducted in Al-Kadhymia Teaching Hospital over three years (2007-2010), fifty six patients with abdominal TB were included, the patients were managed by full surgical and or medical teams, results was analyzed by appropriate statistical measures. RESULTS: Most patients were in the 2nd, 3rd and 4th decades of life. Female to male ratio was 1.5:1. Most of the patients (82%) considered to have primary abdominal TB. Diagnostic laparoscopy was done for 21 patients and proved TB in 19 patients. Explorative laparotomy was done in 19 patients, the commonest operative finding was ascites and peritoneal tubercles. CONCLUSION: Abdominal TB should be considered in all patients who presented with unexplained abdominal symptoms and signs. Laparoscopy is an effective modality for diagnosis of abdominal TB.


Article
The Clot-lysis Effect of Selective α1-Adrenoceptor Antagonist in Vitro Model Associated with High Peroxynitrite Level

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ABSTRACT: BACKGROUND: Alpha1-adrenoceptor blocking agents showed several effects beyond their action on the vascular smooth muscles. They improve the lipid profile and inhibit the aggregation of blood platelets. OBJECTIVE: To investigate the clot-lysis effect of selective α1-adrenoceptor antagonists and its relation to peroxynitrite level in vitro experimental model. MATERIALS AND METHODS: Venous blood samples obtained from ten healthy subjects. To each pre-weighed clot, 100 μL of either distilled water as a negative control, prazosin (10 μg), terazosin (20 μg) and alfuzosin (25 μg) were added. Peroxynitrite level was measured in sera and sangious fluid that formed after clot-lysis. RESULTS: Prazosin, terazosin and alfuzosin,in order, significantly reduced the clot weight up to 3.7%. Peroxynitrite level in sangious fluids was higher in treated groups than that of negative control or sera levels. CONCLUSION: α1-adrenoceptor antagonists induced clot-lysis effect. This effect is associated with generation peroxynitrite


Article
Solid-Pseudopapillary Tumors of the Pancreas

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BACKGROUND: Solid-pseudopapillary or solid-cystic papillary tumors are rare tumors of the pancreas which has special characters that they rarely metastasize and the patient usually enjoys long term survival. This is a case report of a fifty years female who had cystic tumor involved the pancreatic tail and she underwent distal pancreatectomy with splenic preservation, the histology study revealed solid pseudopapillary tumor of pancreas

Table of content: volume:10 issue:2