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:3

Article
Determination of Endometrial Thickness Threshold for Prompt Biopsy in Postmenopausal Women Without Vaginal Bleeding

Authors: Nada S. Amen --- Manal Madani Abdul Qader
Pages: 292-296
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ABSTRACT: BACKGROUND: Transvaginal sonography is performed as part of a pelvic sonogram in postmenopausal women and images of the endometrium are frequently obtained . In asymptomatic postmenopausal women without vaginal bleeding, the threshold separating normal from abnormally thickened endometrium is not known. OBJECTIVE: To determine an endometrial thickness threshold using transvaginal sonography for prediction of endometrial cancer in postmenopausal women without vaginal bleeding (asymptomatic) . METHOD: The study group includes 100 asymptomatic postmenopausal women without vaginal bleeding, We measure the sensitivity and specificity of trasvaginal sonography in the prediction of cancer in asymptomatic postmenopausal women without vaginal bleeding at endometrial thickness ≤5mm ,5-10 mm &>10mm , RESULTS: Four cases (4) of cancer were detected at >10mm endometrial thickness. In asymptomatic postmenopausal women without vaginal bleeding the sensitivity 100% ,specificity 47.91% ,positive predictive values 7.40% and negative predictive values 100% at 10mm endomtrial thickness while at 5mm endomtrial thickness,the sensitivity 100% ,specificity 9.3% ,positive predictive values 4% and negative predictive values 100% CONCLUSION: In asymptomatic postmenopausal women promotion for endometrial sampling if endometrial thickness >10mm seen by trasvaginal sonography give better positive predictive value, sensitivity & specificity than>5mm endometrial thicknes


Article
Evaluation of Some Spontaneous Abortion-Causative Factors for Women in Baghdad Province A Serological and Histological Study

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ABSTRACT: BACKGROUND: The spontaneous abortion is considered as one of the important clinical problems that may affects pregnant women during the 1st 20-22 weeks of pregnancy causing dangers to the mother and her fetus. The present study was designed to focus on some spontaneous abortion causes and intrauterine fetal death. OBJECTIVE: Study certain risk factors that may play a role in abortion such as serum level of , progesterone hormone , estradiol hormone , interlukine-6 and perform a histological study on placenta to identify any specific histop- METHODS: Seventy (70) Women were selected to represent the samples of spontaneous aborted women. The women were classified into two groups , the first represented aborted women during the first trimester of pregnancy (52) and the second were females in the second trimester of pregnancy (18) , in comparison with result of (20) normally delivered pregnancies. The samples (sera and placenta) were collected during the period from November 2008 to April 2009 in Baghdad. RESULTS: Significant decrease (p<0.01) in the level of progesterone and estradiol hormone was found in all aborted women at different stages of pregnancy compared with control. There was no significant difference (p>0.05) in level of IL-6 between aborted women and control. There was a correlation (positive) between progesterone with IL-6 in first and second trimester (p<0.05, p<0.01), respectively. And progesterone with estradiol (p<0.05) in second trimester. The histological study shows hydropic degeneration fibroids with hyalinization of fibrinosis changes. CONCLUSION: These results suggest an important role of progesterone, estradiol and IL-6 in spontaneous abortion women during first and second trimester. And apparition of the histological changes corresponding to the aborted women.


Article
“Cytomegalovirus Seroprevelance in Iraqi Pregnant Women”

Authors: Sajed Nader --- Mohammed Ayad**
Pages: 303-307
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ABSTRACT: BACKGROUND: Cytomegalovirus is the commonest cause of congenital viral infection in the developed and developing countries. It is a symptomatic in 90% of infected females. Forty percent of pregnant females transmit the virus to their fetus. Ten percent of born infants whom gain the virus will get the clinical signs plus its neurological sequelae. OBJECTIVE: To outline the relationship between Cytomegalovirus infection among pregnant women and its influence upon their pregnancy outcome. PATIENTS AND METHODS: A case-control study was carried out was carried out in the teaching laboratories – medical city, Baghdad through a period from June 2010 till March 2011; upon 165 pregnant women whom taken as a patient group. Blood samples were taken from them and Cytomegalovirus-IgM antibodies plus Cytomegalovirus-IgG antibodies levels were measured via Elisa technique in both to evaluate the viral infection if present or not. RESULTS: The usual age whom attended the gynea-obestetric clinics were the age group from 11-19 years old 73 cases (44.24%); Next came the age group from 20-29 years old 66 cases (40.00%), thirdly was the age group from 30-39 years old 20 cases (12.12%), Lastly was the age group from 40-49 years old 6 cases (3.64%). The concentration of CMV-IgG among females whom attended clinics were seropositive in nearly half the included cases 66/165 (40.0%); while the CMV-IgM concentration was within the seronegative limits. Secondly came another group of patients with seronegative limits regarding both the CMV-IgM and CMV-IgG antibodies 56/165 cases (33.94%), next 30/165 cases (18.18%) were seropositive in their results pointing to both CMV-IgM and IgG limits; and this might be a middle point distance between the previous group and the last group were the CMV-IgM was positive and the CMV-IgG concentration was negative 13/165 cases (7.88%). CONCLUSION: Cytomegalovirus-IgG antibodies got important role as a protective agent against gestation abortion, if Cytomegalovirus-IgM antibodies are seropositive alone this is a risky factor to the pregnancy outcome


Article
Antithyroid Autoantibody in Unexplained Recurrent Abortion

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ABSTRACT: BACKGROUND: Recurrent miscarriage is a common complication of pregnancy and when the cause is unknown; relationship of autoimmune thyroid disease to pregnancy loss has been the object of considerable interest. OBJECTIVE: To estimate whether thyroid auto-antibodies (thyroglobulin and thyroid peroxidase antibodies) could be used as a marker for detection of abortion in cases with unexplained recurrent miscarriage. METHODS: This study was carried out at the department of obstetrics and gynecology in AL- Kadhymia Teaching Hospital from March 2008 through September 2009. Fifty pregnant women in their first trimester (7th – 12th weeks) were followed up till 20th weeks of gestation by the researcher himself (they have three previous unexplained first and second trimester miscarriages).Thyroid peroxidase (TPOAB) measurement by ELISA and thyroglobulin antibodies (TGAB) by slide methods with flourescein were done to the patients, cases with abortions were reported and the status of thyroid antibodies was evaluated. Free T3; free T4, TSH measured by RIA technique. RESULTS: In eighteen patients the antibody titer was positive while thirty-two had negative tests for thyroid auto-antibodies. TGABS (thirty-six) were negative, (thirty-three) continue pregnancy and only (three) aborted. TGABS (fourteen) were positive, (four) cases continue and (ten) aborted. TPOABS (forty-one) were negative (thirty-nine) cases continue pregnancy and only (two) aborted. TPOABS (nine) cases were positive, (seven aborted and only (two) cases continue pregnancy. This study showed a significant association between AB. Positivity and maternal age. CONCLUSION: Thyroid auto antibodies can serve as a useful biochemical marker for cases with unexplained recurrent miscarriage and there is a positive relation with increasing maternal age (thyroid auto antibodies).


Article
Efficacy of Intravaginal Misoprostol in Different Media for First and Second Trimester Termination of Pregnancy

Authors: Najah Shaker Yassen --- Lava Chazi Faithullah
Pages: 315-320
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ABSTRACT: BACKGROUND: Medical abortion becomes the 1st choice for early 1st and 2nd trimester termination of pregnancy in many countries although dilatation and evacuation is commonly used in USA ,Medical abortion has been more patchy in its introduction in England and Walse and there continuous to be significant variation in its provision across health authorities .Medical method are often favored because they appear more physiological ,like a miscarriage and avoid the need for uterine instrumentation and also share the advantages of low rate of complication and failure. OBJECTIVE: To evaluate the effect of different media ( acetic acid , normal saline or dry)on the efficacy of intravaginal misoprostol used for induction of first and second trimester abortion. PATIENTS AND METHOD: During the 12 months of the study period, 90 pregnant women seeking termination of early pregnancy loss up to 24 weeks, as an indication for induction of abortion, their mean age were 27.7±5.5 years, and mean weight 72.3±3.9 kg.The first 30 pregnant patients received intravaginal 400μg misoprostol moistened with 2 ml of 5% acetic acid for 4hours interval up to 5 doses for 24 hours ,if the participant failed to achieve abortion the same regimen repeat for the next 24 hours, including 8 primiparous and 22 multiparous. Next 30 patients received intravaginal 400μg misoprostol moistened in 2ml of normal saline for 4 hours interval up to 5 doses for 24 hours ,if abortion failed then the trial repeated once again , including 15 primiparous and 15 multiparous. The last 30 patients received dry intravaginal 400μg misoprostol , 4hours intervals up to 5 doses for 24 hours. if abortion failed the same regimen repeat for the next 24 hours, including 10 primiparous and 20 multiparous. RESULT: All patients aborted within 48 hour. Significantly shorter induction –abortion interval for the moistened misoprostol tablet in acetic acid ( mean 8.3 ±2.2 hours), P value (0.000) ,than induction- abortion interval for moistened misoprostol tablet in normal saline (mean 19.5±7.7 hours) , and dry misoprostol tablet (mean23.1± 8.8hours) . The number of doses required to achieve response for moistened misoprostol in acetic acid was significantly less(mean 1.5±0.5), P value (0.000),than that required for moistened misoprostol in normal saline( mean 3.1±0.8),and for the dry misoprostol tablet (mean 3.7±0.8). The side effects being of no statistical significant. CONCLUSION: Acidic medium enhance the effect of misoprostol administered for induction of abortion. Moistening intra vaginal misoprostol may affect the pharmacokinetics of the drug to achieve a constant plasma profile.

Keywords

abortion --- misopristol --- vaginal ph


Article
In vitro Resistance to Cephalosporins in Women with Bacterial Urinary Tract Infections

Authors: IsamHamoMahmood --- Yosra Tahir Jarjees --- Zeina Satam
Pages: 321-325
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ABSTRACT: BACKGROUND: Urinary tract infections are the most frequent nosocomial and community-acquired infections. Cephalosporins have a role in treating urinary tract infections, but are not recommended for empiric therapy because of the relatively high rates of resistance and low efficacy. Effective management of urinary tract infections has been hampered by the fact that many strains have developed resistance to several antimicrobial agents. OBJECTIVE: A. To demonstrate the common local bacterial pathogens and, B. To test the in-vitro the susceptibility to cephalosporinsin women with urinary tract infections. PATIENTS AND METHODS: One hundred and twenty women from the outpatient department ofAlbatoolMaternity Teaching Hospital from the coauthor's private clinic with signs and symptoms of uncomplicated acute urinary tract infections with no previous history of antibiotic intake were included in the study. Culture and sensitivity tests to cephalosporins and other antibiotics were done to all of them. RESULTS: Six types of bacterial species were isolated from the urine samples. E. coli was isolated from 49 cases (40.83%), Klebsiella was found to be the second most common bacteria isolated in 31cases (25.83%).About one third of E. coli, Klebsiella, Proteus and Citrobacterwere resistant to cephalosporins.E. coli and Klebsiella resist most cephalosporins. CONCLUSION: Many types of bacteria cause urinary tract infection, most of these bacteria resist cephalosporins. Cephalosporins should not be used as first line therapy and when used have to be preceded by culture and sensitivity testing.


Article
Catheter Associated Fungal Urinary Tract Infection

Authors: Ehab Jasim Mohammad
Pages: 326-329
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ABSTRACT: BACKGROUND: Fungal urinary tract infections are an increasing problem in hospitalized patients. There are specific criteria for evaluating urinary tract infections caused by bacteria.There are also specific guidelines for prevention of catheter associated bacteruria. No such criteria or recommendations are available for fungal urinary tract infections. OBJECTIVE: To evaluate the incidence of catheter associated fungal infection among all patients with catheter associated urinary tract infection and its risk factors. MATERIALS AND METHODS: From January 2009 to March 2011 (72) patients with indwelling urinary catheter for different indications with significant pyuria presented to urologic department at Al-Ramadi teaching hospital were included in this prospective study, all patients were subjected to urine culture for bacteria and fungi. The following information was obtained: age, sex, antibiotic therapy, immunosuppressive therapy, duration of catheterization and the presence of diabetes mellitus. The type of growth whether bacterial or fungal was noted. The age of patients ranges from 2 to 70 years. RESULTS: The age of patients ranged from 2 to 70 years (mean 34.6). Of 72 patients, 12 had diabetes mellitus, 18 patients were on long term antibiotic use and 15 patients on immunosupressants. Bacterial infection accounted for 70.9% of catheter associated urinary infection with E. coli is the most commonly isolated organism(41.6%), fungal infection accounted for 16.6% and mixed fungal and bacterial infection account for 12.5.Risk factors among patients with fungal infection were diabetes mellitus (47.6%), long term antibiotic use (42.8%) , immunosuppressive therapy (9.5%), and prolonged duration of catheterization (85.7%). CONCLUSION: Fungal infection constitutes a significant proportion of all catheter associated urinary tract infection and diabetes mellitus, long term antibiotic use, immunosuppressive therapy, and prolonged duration of catheterization are the most common risk factors.


Article
Role of Early Surgical Repair of Penile Fractures

Authors: Malath Anwer Hussein
Pages: 330-335
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ABSTRACT: BACKGROUND: Fracture of the penis is a relatively rare condition that is defined as a rupture of the tumescent corpora cavernosa as a result of blunt trauma, most commonly during sexual intercourse or masturbation, which needs urgent surgical intervention to achieve good postoperative outcome. OBJECTIVE: To study the etiology and outcome of early surgical repair in patients presenting with fracture of penis. MATERIAL AND METHODS: This study carried out in the surgical departments of Al-Kindy teaching Hospital from June 2005 to March 2011. Patients with the clinical diagnosis of fracture penis were admitted and operated. All patients were admitted to the hospital 2 to 10 hours after injury. No invasive investigation was used for diagnosis. The treatment was surgical in all cases with subcoronal circumferential degloving incision, evacuation of hematoma and primary suturing of the tunica tear with absorbable suture. No drain was used and a light compression dressing was done in all patients. Catheter was removed on the second postoperative day. All patients had were followed up for 3-12 months postoperatively. RESULT: During the study period 30 patients aged 19 to 42 years, presented with a penile fracture were operated for fracture penis. Mean age at presentation was 31 years. The commonest cause of fracture penis was due to sexual intercourse. The commonest mode of presentation was with a cracking sound, local pain and immediate detumescence (90%, 96% & 100% respectively). All patients showed penile haematoma. None of the patients had urethral bleeding. All patients were surgically treated; at the time of surgery unilateral albugineal rupture was found in all cases. With follow up all cases were able to achieve an adequate erection. No complications such as deformations, penile plaque or erectile dysfunction were reported. Average hospital stay was 3.4 days. CONCLUSION: The commonest cause of fracture penis is due to sexual intercourse. The best treatment option is immediate surgical repair to obtain better functional outcome and to avoid potential complications


Article
Inhibitory Effect of Parsley (Petroselinum Crispum) Juice Against Some Urinary Pathogens in Vitro

Authors: Khalida Kareem Al-Kareemi
Pages: 336-342
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ABSTRACT: BACKGROUND: Information's on the potency of many medical plants against microorganisms are scanty, and in the current wave of antimicrobial resistance against chemotherapeutic drugs, there is a need to search for plants that could be resistance-free and affordable. OBJECTIVE: The objective of this study was to investigate the antibacterial effects of Parsley (Petroselinum crispum) against uro-pathogens and to compare with the effect of some drugs used for the treatment of urinary tract infection caused by different Gram positive and Gram negative bacteria. MATERIALS & METHODS: A total of thirty eight Gram positive and Gram negative bacteria(Escherichia coli ,Proteus sp.,Enterobacter spp.,Pseudomonas aeruginosa, Klebsiella sp. , Staphylococcus aureus) isolated from urine samples of different child patients between first of June 2011 to first of July 2011 admitted to Children Mel fare Teaching Hospital in Baghdad were tested against different dilutions of Parsley (100%,1:1,1:5,1:10:1:15,1:20) to examine the inhibitory activity in vitro ,in addition antibiotic susceptibility test was done. RESULTS: All isolates showed sensitivity to concentrated parsley 100% concentration except Pseudomonas aeruginosa isolates, the highest effect observed on Proteus sp. and Staphylococcus aureus isolates, while inhibitory effect stopped after 1:1 dilution against all isolates, while in antibiotics therapy (29) isolates were resistant to Co-Trimoxazole and Cefotaxime and (30)isolates showed resistance to Tri-imetheprim+clavulanic acid. CONCLUSION: It seems that Parsley has potent antibacterial activity against some uropathogens in vitro.


Article
Thyroid Surgery with Drain Versus without Drain

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ABSTRACT: BACKGROUND: The nature and indications for thyroid surgery vary and a perceived risk of postoperative complications such as seroma , haematoma , wound infection and haemorrhage post-surgery is one reason why wound drains are frequently inserted. They are generally used as a matter of the surgeon’s habit or preference more than a matter of proven benefit in the patient’s postoperative period. OBJECTIVE: To evaluate the differences in outcome and complications following thyroid surgery whether draining the wound or not . PATIENTS AND METHODS: One hundred forty five patients with different thyroid diseases requiring surgical intervention presenting to the first surgical unit in Baghdad teaching hospital between the first of October 2007 to the 31th of December 2009(27 months period) were enrolled. Patients were divided into two groups : those who had their wounds drained postoperatively ; (the drain group DG) and those who had their wounds closed without drain ; (the non drain group NG). RESULTS: Seroma occurred in three patients (3%) in the DG, and in two patients (4.4%) in the NG. Small haematoma occurred in three patients (3%) in the DG, and in two patients (4.4%) in the NG. Large haematoma occurred only in one patients (1%) in the DG, and it didn't occur in the NG. Wound infection occurs only in two patients (2%) in the DG, and in one patient (2.2%) in the NG. The mean of in-hospital stay was 2.07 days in the DG, and 1.06 days in the NG. CONCLUSION: The use of drain showed no effect on the prevention of wound infection , seroma , haematoma formation or the need for re-exploration, indeed the use of drain had lengthened the in hospital stay .So the Routine use of drains after thyroid surgery might be therefore not necessary, if not detrimental.


Article
Drain or Not to Drain in Appendectomy for Perforated Appendicitis

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ABSTRACT: BACKGROUND: Acute appendicitis is the most common surgical cause of acute abdomen necessating surgical intervention. Prophylactic drainage is commonly used in surgical practice, as in acute perforated appendicitis. OBJECTIVE: To evaluate the advantages & disadvantages of the prophylactic drainage after appendectomy for acute perforated appendicitis. METHODS: Eighty four patients of acute perforated appendicitis were enrolled in this prospective comparative study done in Al-Kindy Teaching Hospital from October 2009 to March 2011. They were divided into two groups; 46 patients (54.76%) drainage group & 38 patients (46.24%) non-drainage group. Hospital stay time & postoperative wound infection were assessed in both groups. Statistical analysis using Minitab software version 14 to calculate the P value was done. RESULTS: Patients’ age ranged from 6-50 years (mean27±12), male:female ratio was 2.6:1. The incidence of perforation in acute appendicitis was 15.9% irrelevant to age or sex. Mean hospital stay time was 36 hours in the non-drainage group & mean of 58±4 in the drained group. Wound infection was 39.13% in the drainage group & 36.84% in the non-drainage group, with a P value was >0.05. CONCLUSION: postoperative wound infection & hospital stay were less in the non-drainage group for this prophylactic drainage should be reconsidered


Article
Presentation and Management of Cystic Neoplasms of the Pancreas in the Gastroenterology and Hepatology Teaching Hospital

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ABSTRACT: BACKGROUND: Pancreatic cystic neoplasms are relatively uncommon, and constitute about 1-2% of all primary pancreatic tumors and are thought to account for approximately 10-15% of all pancreatic cystic lesions. These tumors are composed of a variety of neoplasms with a wide range of malignant potential OBJECTIVE: To define the clinical differences among different pathologic groups of cystic neoplasm of the pancreas, distinguish these neoplasms from pancreatic pseudocysts, and benign from malignant or premalignant varieties. PATIENTS AND METHODS: Retrospective study of 49 patients with clinical, laboratory and imaging features suggestive of cystic neoplasms of the pancreas who were managed at the Gastroenterology and Hepatology teaching Hospital over the period from September 2004 to January 2011. All the patients underwent CT scanning and EUS. ERCP was performed for 16 patients. RESULTS: The mean age was 46 years, 31 patients' females and 18 males. (73%) were symptomatic, 32 lesions (65.3 %) were located in the pancreatic body and tail whereas 13 lesions (26.5 %) were located in the pancreatic head, neck and uncinate process. The mean of maximum tumor diameter was 8.76 cm. An attempted curative resection was undertaken for 21 patients. CT gave accurate result in 9 out of 16 patients in SCN,16 out of 19 in MCN and 5 out of 6 in IPMN ,EUS including EUS guided FNA gave accurate diagnosis in all patients. CONCLUSION: The role of imaging in detecting the cystic neoplasms of the pancreas and confirming their locations and proximity to surrounding structures is well recognized and CT or MRI is the best for this purpose. EUS including EUS-guided FNA for cytology and fluid studies has proven to be a useful addition to the diagnostic armamentarium of the clinicians


Article
Lactic Acid 5% Mouthwash is an Effective Therapeutic and Prophylactic Agent in Treatment of Recurrent Aphthous Ulcer (Single blind placebo controlled therapeutic study

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ABSTRACT: BACKGROUND: Recurrent aphthous ulcer (RAU) is a common oral disease. It is treated by a variety of agents. Lactic acid has been used in the treatment of many skin diseases. OBJECTIVE: To assess the therapeutic, prophylactic effectiveness and safety of 5% lactic acid mouthwash in management of patients with RAU. PATIENTS AND METHODS: This single blind placebo controlled therapeutic study where 40 patients with early onset RAU were recruited in Department of Dermatology -Baghdad Teaching Hospital from April 2005-April 2006. Patients ages ranged 20-60 (29.6 ±9.6) years and were divided randomly into 2 groups (20 patients for each one):Group A used 5% lactic acid mouthwash,5 ml twice daily. Group B was instructed to use distilled water as placebo in a similar way to Group A. Short term assessment of each patient of both groups was done to evaluate the therapeutic effect of drug by using oral clinical manifestation index (OCMI), mean size of largest diameter of ulcers. A long term assessment was done for each patient to evaluate the prophylactic effect of drug by using OCMI before, after 1, 2& 3 months of therapy. RESULTS: The mean of OCMI in group A started to decline directly after 4 days of therapy and to its lower level after 8 days, and it was statistically significant (P value <0.05).The change in mean of OCMI of group B after 4 and 8 days of therapy was also statistically significant (P value <0.05).The response rate after 4 days of therapy in Group A was 33.3% and in Group B was 6.44%, while the response rate after 8 days of therapy in Group A was 69.16% and in Group B was 44.98%. The difference in response rates after 4 and 8 days between groups A and B was statistically significant (P value <0.05).The mean size of ulcers in Group A started to decline directly after 4 days of therapy and to its lower level after 8 days of therapy. It was statistically significant (P value <0.05). The change in mean size of ulcers of group B after 4 and 8 days of therapy was also statistically significant (P value <0.05). The response rate after 4 days of therapy in group A was 44.92% and in Group B was 15.08%, while the response rate after 8 days of therapy in group A was 85.68% and in group B was 55.36%. The difference in response rates after 4 & 8 days between Groups A and B was statistically significant (P value <0.05). The therapeutic action of lactic acid mouth wash was statistically significant more effective than placebo. Lactic acid mouth wash showed statistically significant prophylactic effect in comparison to placebo after 1,2&3 months from starting therapy using oral clinical manifestation index, (P value <0.05). CONCLUSION: Lactic acid 5% mouthwash is a new, safe effective therapeutic and prophylactic remedy in management of RAU.

Keywords

lactic acid --- RAU --- mouthwash.


Article
Diagnostic Value of C - Reactive Protein and Other Hematological Parameters in Neonatal Sepsis

Authors: Hafadh Jaleel Hussein --- Yusra Fayyadh Alwan
Pages: 370-375
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ABSTRACT: BACKGROUND: There have been many attempts to develop screening tests or scoring systems that can identify infected infants at the time of initial assessment, sparing others from invasive diagnostic procedures, intravenous antibiotics therapy, mother-infant separation and parental anxiety. OBJECTIVE: Is to analyze hematological parameters and C - reactive protein so as to evaluate their diagnostic value in neonatal sepsis. PATIENTS AND METHODS: A cross-sectional study was performed in the neonatal care unit (N.C.U) at the Central Teaching Hospital for Pediatrics and Al-Habibiya Maternity and Children Teaching Hospital during a period from the first of June 2005 to the first of January2006 One hundred neonates having clinical features of sepsis and 100 normal asymptomatic neonates were evaluated with a set of investigations including C-reactive protein(CRP), White Blood cells Count(WBC), Absolute Neutrophil count (ANC), Platelets count (thrombocytopenia), Immature to Total neutrophil ratio (I/T ratio) and Erythrocyte Sedimentation Rate (ESR) to diagnose neonatal sepsis. RESULTS: C-reactive protein (CRP) was positive in (82.4%) of group-A and (81.8%) of group-B and had a specificity of 93.0%. ANC was the second most sensitive test having sensitivity of 61.8% for group-A and 48.5% for group-B and specificity of 86.0%. The sensitivities of platelets count (thrombocytopenia), WBC, I/T ratio and ESR for group-A were: 55.9%, 29.4%, 17.6% and 26.5% respectively, with specificities of 91.0%, 89.0%, 92.0% and 81.0% respectively. While group-B had sensitivities of 42.0%, 33.3%, 15.2% and 22.7% respectively with specificities of 91.0%, 89.0%, 92.0% and 81.0%respective ly. CONCLUSION: The implementation of CRP and other hematological parameters (ANC, Platelets count and WBCs) are useful in early detection of neonatal sepsis and diagnosis of neonatal sepsis in those who have false negative blood cultures


Article
Stroke Related Pneumonia Incidence and Possible Risk Factors

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ABSTRACT: BACKGROUND: The stroke patient is at risk of developing hospital acquired infection, with the lungs being especially vulnerable. Stroke associated pneumonia (SAP) occurring after two days of admission and is the most nosocomial infection seen in the medical wards , pneumonia is the major cause of morbidity and mortality after stroke .The establishment of an accurate diagnosis of stroke associated pneumonia remains problematic and yet there is still no accepted "gold standard" for diagnosis. OBJECTIVE: To determine the incidence and risk factors of stroke associated pneumonia. METHODS: This is prospective cohort study for 82 stroke patients admitted to medical wards .The study conduct from the 1st July 2009 to the 10th January 2010. Initially stroke diagnosed clinically and by CT scan. Theses cases are assessed after 48 hours after admission, full history, physical examination and investigations were done using clinical criteria (body temperature, WBC count and chest radiography ) for diagnosis of pneumonia. RESULTS: 11(13.4%) patients developed stroke associated pneumonia from 82 stroke patients admitted to medical wards. Most patients who were developed pneumonia were older than patients who did not developed pneumonia . The incidence is higher in patient with infarction and older age groups than patients with hemorrhagic stroke and younger age groups, and there is no association between the disease and gender .The incidence of late onset is more common than early onset pneumonia. Presence of dysphagia was present in (81.8%) nasogastric tube in (72.7% ),unconsciousness(54.5%),tobacco ,vomiting (36.6%) and fit (27.2%) were found as an important risk factors .The mortality more in hemorrhagic(75%) than thrombotic stroke (14.3%). CONCLUSION: stroke associated pneumonia is an important cause of mortality. It is associated with older age, dysphagia , NG intubation ,coma ,vomiting and fit .Simple assessment of these variables could be used to identify patients at high risk of developing pneumonia after stroke.

Keywords

Pneumonia --- stroke --- risk factors


Article
The Vallue off Pollymerase Chaiin Reacttiion iin tthe Diiagnosiis off Tubercullous Meniingiittiis iin a Samplle off Iraqii Pattiient

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ABSTRACT: BACKGROUND: Tuberculous meningitis (TBM) is a medical emergency. Early diagnosis is of utmost importance to minimize morbidity and mortality. Polymerase chain reaction (PCR) seems to be a promising test for rapid and early diagnosis of TBM. OBJECTIVE: To investigate whether PCR detects tubercle bacilli in CSF specimens that are missed by direct microscopy and culture, and if so whether PCR has significant diagnostic value compared to conventional methods. METHODS: PCR, culture and acid- fast bacilli (AFB) were performed on CSF samples taken from 43 patients with TBM (based on clinical features and cytochemical parameters of the CSF) and 15 with non- TBM as control group. RESULTS: Of the 43 CSF specimens from highly probable TBM patients, 33 were positive by PCR (76.7%), whereas only 5 was acid-fast microscopy (AFM) positive (11.6%) and 22 were culture positive (55.2%). No positive results were found by AFM, culture or PCR in the non-tuberculous control group. CONCLUSION: The results of this study indicate that application of PCR is extremely useful for the diagnosis of TBM.The PCR is superior to the currently available techniques for the diagnosis of tuberculous meningitis in terms of sensitivity, specificity and rapidity and can play a critical role in the diagnosis of suspected cases.


Article
Ultrasound Value in the Diagnosis of Intussusception

Authors: Ahmed Zubar Zain --- Nael A. Hussein
Pages: 392-396
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ABSTRACT: BACKGROUND: Intussusception is an invagination of one portion of the intestine into the lumen of an immediately adjoining part. OBJECTIVE: To evaluate the sensitivity and specificity of ultrasound in the diagnosis of intussusception. PATIENTS AND METHODS: This is a prospective study of 50 cases of intussusception in the Central Child s Teaching Hospital in the period between April 2008 and February 2010. forty five patients (90%) were below 6 months and five patients ( 10%) were above 6 months Male patients predominated and the male to female ratio was (1.2:1). Seasonal variation was seen in primary intussusception (i.e. in age group of 6 to 24 months old) with peak incidence in spring and summer. Abdominal pain and vomiting were the most common symptoms in intussusception (92% and 88% respectively), followed by bleeding per rectum (76%), abdominal mass was found in 66% and constipation was found in 28%. RESULTS: The diagnostic tool used was the ultrasound for fifty patients; in forty five cases ,diagnosis was made by a characteristic ultrasonic findings of intussusception (i.e. target sign or pseudokidney sign), forty three patients of the group had a classical intussusceptions' mass during operative procedure, the rest (i.e. 2) had negative operative findings for intussusception. 5 of the patients, the ultrasonic findings were negative for intussusception preoperatively (no mass), but during surgery we found an intussusception mass. CONCLUSION: So ultrasound study in our hospital gives us sensitivity of 95.5% to diagnose intussusception


Article
Clinically Isolated Syndrome of Early Onset Multiple Sclerosis in a Sample of Iraqi Patients

Authors: Hasan Azeez Al-Hamadani
Pages: 397-401
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ABSTRACT: BACKGROUND: The first acute demyelinating event without encephalopathy, termed a clinically isolated syndrome, can manifest with signs and symptoms caused by a single lesion (monofocal clinically isolated syndrome) or with polyfocal features, implicating multiple lesions. It is becoming increasingly recognized that MS affects children and adolescents, with many of these patients receiving the diagnosis and initiating therapy prior to their 18th birthday(2). OBJECTIVE: To evaluate the clinically isolated syndrome in individuals with early onset of multiple sclerosis. MATERIALS AND METHOD: The records of the multiple sclerosis centers in Baghdad teaching hospital have been surveyed. The study enrolled 77 patients who had early multiple sclerosis (onset before age of 18 years), their clinically isolated syndrome data have been analyzed. RESULTS: Two thirds of the patients were female (a female/male ratio of 1.6:1). Forty eight of the patient where female (62.3%) and twenty nine patients where males (37.7 %). Mean age at onset was 14.95 years. Seven patients where children (age below 10years) (9.1%) and seventeen patients where adolescents (age 10 to 18 years) (90.9%) at onset. The most common presenting clinically isolated syndrome was optic neuritis (35.8%) followed by brain stem lesion. Fifty nine patients had monofocal presentation (76.6%) and eighteen had polyfocal presentation (23.4%). forty seven patients had complete improvement of the clinically isolated syndrome (61.0%), the rest had partial or no improvement. CONCLUSION: The most common clinically isolated syndrome of early onset Multiple sclerosis is optic neuritis. monofocal clinically isolated syndrome more than polyfocal. Complete improvement is high.


Article
Evaluation of Serum Magnesium, Chromium, Vanadium, and Selenium Levels in Type 2 Diabetic Patients in Sulaimania City

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Abstract

ABSTRACT: BACKGROUND: Diabetes mellitus is a metabolic disorder; a clinical syndrome which occurs due to absolute or relative insulin deficiency or insulin resistance. Direct association of trace elements, such as magnesium in both type 1 and type 2 diabetes, alteration in the metabolism of these minerals has been demonstrated in diabetes in many studies. OBJECTIVE: To evaluate magnesium, chromium, vanadium, and selenium levels in the serum of type 2 diabetic subjects. METHODS: The present study was conducted on fifty type 2 diabetic patients, and thirty age-sex-matched healthy controls. In groups, those having renal failure, lipemic serum, or using diuretics, antibiotics, and the pregnant, where excluded. Samples were analyzed using Inductively Coupled Plasma Spectrometer. RESULTS: Serum levels of Mg in type 2 diabetic patients group were significantly lower than in the control group p< 0.001; a similar result was observed for serum Vanadium level p< 0.05. Serum Cr levels in both diabetic and control groups were below the reference range limits. Analysis of Se in serum of controls and patients indicated no significant difference. Gender did not significantly affected plasma Magnesium, Chromium, Vanadium, and Selenium concentrations. Duration of the disease did not significantly affect plasma levels of (Mg, V, and Cr), but it significantly inversely affected the plasma level of (Se); decreased with increasing duration of diabetes (r = -0.3539) and p< 0.05. CONCLUSION: Diabetes mellitus can result in low levels of Mg and V especially in long standing and insulin treated patients which may affect their management


Article
Prognostic Significance of Serum Albumin Levels in Patients with Systolic Heart Failure

Authors: Muataz Fawzi Hussein
Pages: 411-417
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Abstract

ABSTRACT: BACKGROUND: Hypoalbuminemia is considered as poor prognostic factor in patients with certain chronic diseases, such as cancer and end-stage renal failure. Low serum albumin is common in patients with heart failure; nevertheless, the relationship between serum albumin and heart failure prognosis has not been well verified. OBJECTIVE: To elucidate the effect of serum albumin level on prognosis of patients with systolic heart failure. METHODS: This study included 250 patients with systolic heart failure who were admitted to Baghdad teaching hospital between February 2008 and April 2010. Patients were divided into groups based on presence of hypoalbuminemia (≤3.4 g/dL). RESULTS: The mean age of patients was 55 ± 14 years and the mean left ventricular ejection fraction [LVEF] was 28 ± 11 %). The mean serum albumin was 3.9 ± 0.7 g/dL; 27.2 % of patients had hypoalbuminemia. Patients with and without low serum albumin levels were similar in age, cause of heart failure, and ejection fraction. Patients with hypoalbuminemia had higher New York Heart Association (NYHA) class, higher serum urea, creatinine and C-reactive protein levels but lower levels of sodium, hemoglobin, and cholesterol. In patients with body mass index (BMI) < 25 kg/m2, 26% had hypoalbuminemia compared to 20% in those with BMI ≥25 kg/m2 (P ≤ 0.01). One-year survival was 64.71% in patients with and 85.72% in those without hypoalbuminemia (P < 0.001). Risk-adjusted hazard ratio for 1-year mortality was 1.9 (1.5-2.4). CONCLUSION: Hypoalbuminemia is common in patients with heart failure and is independently associated with increased mortality.


Article
Association of Protein Tyrosine Phosphoatase Nonreceptor Type 22 Genes with Type 1 Diabetes Melitus

Authors: Hanaa Naji Abdullah
Pages: 418-422
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Abstract

ABSTRACT: BACKGROUND: Type 1 diabetes is a multifactorial disease caused by a complex interaction of genetics and environmental factors. The Genetics factors involved consist of multiple susceptibility genes such as protein tyrosine phosphoatase nonreceptor 22, which have been associated with T1DM in different populations. Recent studies showed a genetic variation within protein tyrosine phosphoatase nonreceptor 22 gene to be an additional risk factor. OBJECTIVE: To analyze the genetic association between protein tyrosine phosphoatase nonreceptor 22 and type 1 diabetes mellitus in some Iraqi population and correlation of Glutamic acid decarboxylase antibodies and interleukin -2 receptor with type 1 diabetes. METHODS: A total of 50 type 1 diabetes patients from diabetes center were genotyped for protein tyrosine phosphoatase nonreceptor 22 genes by using an restriction fragment length polymorphism method. Level of Glutamic acid decarboxylase antibodies and interleukin -2 receptor were determined using enzyme linked immunoassays. RESULTS: Glutamic acid decarboxylase antibodies were a highly significant increase (P<0.0001) in type 1 diabetes patients as compared with healthy control group. Circulating levels interleukin -2 receptor were highly significant in diabetic patients than healthy subjects (P<0.001). The frequency of protein tyrosine phosphoatase nonreceptor 2 gene among the 50 patients [ CT (33%) , TT(4%) , CT and TT (37%] compared with healthy control [ CT (18%) TT(1%), CT and TT (4%)], while the percentage of T allele of patients (21%) and healthy control ( 10%). In addition, the protein tyrosine phosphoatase nonreceptor 2 genotype was significantly associated with Glutamic acid decarboxylase positivity (CT- 19%, CT and TT -24%). CONCLUSION: Strong association between protein tyrosine phosphoatase nonreceptor 2 gene and diabetes type 1. In addition,The protein tyrosine phosphoatase nonreceptor 22 genes were associated with Glutamic acid decarboxylase antibodies


Article
Subclinical Hypothyrodism and Central Adiposity

Authors: Ikhlas Khalid Hammed
Pages: 423-429
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Abstract

ABSTRACT: BACKGROUND: The pandemic of central obesity has driven new interest in the relationship between thyroid hormone and body weight distribution since it is well known that thyroid hormones play a key role in regulating energy homeostasis and that subtle elevation in TSH as in subclinical hypothyroidism (SCH)is associated with deficiency in resting energy expenditure and increased body weight. OBJECTIVE: The aim of our study was to assess possible associations of subclinical hypothyroidism with central obesity in apparently healthy women. METHODS: 133 apparently healthy, clinically euthyrotic women were included in this study; 91of them were centrally obese and 42 were centrally non obese, Thyroid function tests and waist circumference measurement were done in all participants. RESULTS: 13.5 %( n=18) of the studied population had subclinical hypothyroidism.In the centrally obese group the frequency was 17.5 %( n=16), while in the non obese it was 4.7% (n=2), the highest frequency was found in the 40-49 years old women (38.8%). Positive significant correlation was found between waist circumference and age, negative significant correlation was found between age and T3. CONCLUSION: The frequency of SCH is more in centrally obese women. Assessment of thyroid function must be regarded as part of the screening program in obese.


Article
Transcatheter Closure of Nonrestrictive Aortopulmonary Window

Authors: Zayir H. Khalid
Pages: 430-432
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Abstract

ABSTRACT : Aortopulmonary window is an uncommon congenital heart defect. It is usually nonrestrictive and conventionally treated surgically at an early age to prevent the development of pulmonary vascular obstructive disease . Only in 10% of the cases it is restrictive and case reports of it is transcatheter closure are mostly limited to these patients. We report transcatheter closure of large non restrictive aortopulmonary window in a 2 years old , 8 kg child. Using Amplatzer duct occluder device.


Article
Recurrent Embolic Stoke In Children Due To Giant Congenital Cardiac Diverticulum

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Abstract

ABSTRACT: One of the great challenges we face in clinical neurology practice is stroke among children, which is considered to be among the ten top causes of death in the United States. The cardiac diseases are the most common causes of strokes among children; But a recurrent embolic stroke among children is rarely reported to be due to giant cardiac diverticulum originating from the left cardiac chamber as presented in this paper

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Table of content: volume:11 issue:3