Table of content

Al-Kindy College Medical Journal

مجلة كلية الطب الكندي

ISSN: 18109543
Publisher: Baghdad University
Faculty: Al-Kindy Medicine
Language: English

This journal is Open Access

About

Al-Kindy College Medical Journal ((Al-Kindy Col.Med.J)), a periodic peer reviewed scientific journal published biannually by Al-Kindy College of Medicine –University of Baghdad. specialised
in research of medical and related subject ISNN 1810-9543
The articles and research studies published in the journal are carefully selected and reviewed by a high standard advisory board from doctors who are most seniors and experts in their medical fields according to the subjects submitted to the journal.
Al-Kindy Col.Med.J is well recognized by Baghdad ,Mustansiriya and Nahrain universities for promotion of their teaching staff.
Three hundred articles ,research papers, case reports and studies have been published ourn medical journal since 2003 till now and the journal has been distributed to all medical collages of Iraq and most counties in the Middle East.

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Mobile: +964 7803546157
web site: www.kmc.edu.iq
E-mail: journal@kmc.uobaghdad.edu.iq
info@kmc.uobaghdad.edu.iq

Table of content: 2008 volume:4 issue:2

Article
Exfoliative Cytological Changes in Peritoneal Fluid fromPatients on Peritoneal Dialysis

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Abstract

Background: Ambulatory peritoneal dialysis introduced by Popvich et al (13) in 1978 , consists of a four to five hours lavage of peritoneal cavity with 2000 ml of glucose solution .It remains a useful method for treating patients with end stage renal failure till renal transplantation becomes possible. Objectives: The aim of the study is to evaluate the value of cytological changes of mesothelial cells in dialysate patients. Methods: Within one year period, 32 cytological peritoneal fluid samples were collected from patients with end stage renal failure regardless of the underlying causes, admitted to the dialyzing unit in Kadimya Teaching Hospital. Smears were prepared and fixed in 95 % ethyl alcohol and then stained with H & E stain to be interpreted by the same pathologist. Results: Thirty two samples of peritoneal fluid were obtained from patients in peritoneal dialysis with a mean age of 54.8 years and male to female ratio of about 1.9: 1. Twenty two had short term dialysis were compared with 10 patients with long term dialysis. Gross examination of the samples revealed clear yellow fluid. Macroscopical examination showed no evidence of inflammatory cells with increased exfoliation, cellularity and three dimensional mesothelial cellular clustering pattern with increased nuclear size. No statistical significances were found in the changes seen in cytological smears between both groups but remarkable nuclear changes were shown in both of them. Conclusion: This study demonstrated that peritoneal dialysis of any duration can induce significant atypical changes in mesothelial cells. The pathologist needs to be aware of these changes and to include peritoneal dialysis in the list of other benign conditions that cause reactive mesothelial atypia.


Article
Association of some Viral infectionsand asthma: serological evidence

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Background: It is well known that mycotic antigens have an important role in atopy and the induction of asthma. Now one of the important subjects is the relation between respiratory bacterial and viral infections in the inflammatory reactions accompanied with bronchial asthma viruses Bacteria or their metabolites act as trigger for asthma or increase it's intensity .
Objectives: To show the relation between asthma and some viral infections serologically.
Methods: Direct ELISA test was employed to detect lgG specific for Respiratory Syncytial virus (Rsv) parainfluenza virus type (p13) and influenza virus in sera of (100) asthmatic patients of two age groups. (10-17) and(18-50) years old. Serum samples from(32) intact control individuals of the same age groups were also investigated.
Results: significant mean values of lgG specific for parainfluenza type-3 and Respiratory Syncytial viruse were found incontrast to normal control individuals. Non significant values of lgG specific for influenza virus were detected in asthmatics in contrast to control normal individuals.
Conclusion: Respiratory Syncytial virus appears to be a prominent cause of concomitant infections in asthmatic children and some adults as well as parainfluenza virus type-3 within age group ( 10-17) years old asthmatics so RSV and p1-3 viruses may be contributers to asthma severity in asthmatic patients.
Keywords: Asthma, Infection and asthma, Virus and asthma.


Article
Lipid Profile and Menopausal Status

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Background: Dyslipidemia is a major cause of cardiovascular disease, which in turn, is the most common cause of female morbidity and mortality. Postmenopausal women (natural and surgical) are at higher risk of developing cardiovascular disease, especially coronary artery atherosclerosis.
Objective: To observe the relationship between blood lipids: total cholesterol (TC), high density lipoprotein-cholesterol (HDL-C), low density lipoprotein-cholesterol (LDL-C), triglycerides (TGs), and very low density lipoprotein- cholesterol (VLDL-C), LDL-C/ HDL-C ratio (atherogenic index) and menopausal status, and to determine the co-factors that may explain this relationship
Methods: A prospective, cross-sectional study, which includes 279 women, age range from 35-55 years agreed to participate in this study. They were divided into 4 groups according to their menopausal status. These were pre-, peri post- natural and surgical post- menopausal. Data were collected from participants in a pre-coded questionnaire and an overnight fasting blood sample was collected for biochemical analysis.
Results: Postmenopausal women had higher levels of lipids than pre or peri-menopausal. TC concentration and LDL-cholesterol levels were higher in natural and surgical menopause than in pre and pri-menopausal women (p<0.01 and p<0.05 respectively). While LDL/HDL-C ratio (atherogenic index) were higher in the surgical postmenopausal women than in pre-menopausal group (p<0.05). No significant inter-group differences were found in HDL-C. Triglycerides, and VLDL levels were higher in surgical menopause group than in both pre- and peri-menopause groups (p<0.05). No significant differences were demonstrated in pre-, peri-, and natural menopausal women with regard to triglyceride and VLDL levels and LDL/HDL-C ratio.
Conclusion: Dyslipidemia is more frequent among women with natural and surgical menopause groups than in the other groups. This makes those women more susceptible to CVD. Certain co factors appear to have direct associations with lipid levels in each group and those were discussed.
KeyWords: Menapause, Lipid profile

Keywords

menapause --- lipid profile


Article
Left Ventricular Hypertrophy in Diabetic Patientsand Its Relation to Other Diabetic Complications

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Background: left ventricular hypertrophy is independent risk factor for cardiovascular morbidity and mortality. The presence of diabetic complications such as autonomic neuropathy and retinopathy may predict cardiac structural changes in diabetic patients.
Objective: To explore the chance of occurrence of left ventricular hypertrophy in diabetic patients and whether it is related to the presence of other diabetic complications.
Methods: ninty seven (97) normotensive diabetic patients (57) type II with mean duration of diabetes of (12±6 y) and forty (40) type I with mean duration of (8±6 y) were studied by echocardiography and compared with 41 patients as control.
Results: The LVMI was significantly higher in type II diabetics compared to control (102±31 vs. 67±16 p< 0.001), although LVMI was higher in type I compared to controls but it was statistically non significant (76.7±18 vs. 76 ±16 P < 0.25). The increased in LVMI was correlated with long duration of diabetes > 15 years in type I but not in type II (p<0.001), retinopathy (34.5% vs. 4.8 p< 0.001), sings and symptoms of autonomic dysfunction (32.7% vs. 10.4% p=0.008) and (38.2% vs. 12.7%p=0.004) respectively. After adjustment for duration of diabetes, age, gender and the type of diabetes, the LVMI was only significantly correlated with long duration of diabetes (>10y).
Conclusion: LV mass index was higher in diabetic patient mainly in type II, more prevalent with long duration of diabetes and if there are other diabetic complications.
Key words: lvh, diabetes, autonomic neuropathy

Keywords

Ivh --- diabetes --- autonomic neuropathy


Article
Etiology of Bloody Diarrhea among Children Admitted to Maternity and Children’s Hospital-Erbil

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Background: Bloody diarrhea plays a major role in morbidity and mortality especially in developing countries, it is usually a sign of invasive enteric infection, there is a thought that amoebic dysentery is more common than bacillary dysentery in Iraq, and from 1989 to 1997 amoebic dysentery increase from 20000to 550000 patients.
Objectives: This study aims to:
1. Outline the incidence of various infectious causes of bloody diarrhea in Erbil district.
2. Assess the effect of multiple factors like age, sex, source of water supply, etc... On the incidence of amebic and bacillary dysentery.
3. To provide baseline data for making strategic plan to reduce the diarrhoeal mortality and morbidity.
Methods: A prospective case- series study was conducted on 116 infants and children aged 2 month –12 years admitted to hospital complaining of bloody diarrhea. Information was taken from their mothers regarding (age, sex, geographical area, feeding pattern and source of water supply) , their stool have been examined for the presence of RBC, leukocyte, parasitic cyst and trophozoit, however blood examination was conducted for the presence of band.
Results: The results reveal 77.5% of patients were in the younger age group (<2 year). Entamoeba histolytica was the most common enteropathogen isolated in 60.3% of patients, other enteropathogens identified were Shigella 3.5%, E.coli2.6%, Salmonella2.6%, mixed infection were reported in 1.72%, 28.5%of patients have non isolated pathogen.
On the other hand, source of water supply and type of feeding have significant effect on incidence of enteropathogens. The presence of fever, vomiting, convulsion and band in peripheral blood mostly indicates bacterial etiology.
Conclusion: Entamoeba histolytica was the commonest enteropathogen isolated; the incidence of bloody diarrhea was more in younger age group. There was significant effect of source of water supply on the incidence of bloody diarrhea with most enteropathogen isolated from patients who have well water supply. Breastfeeding was protective against enteropathogen especially bacterial agents in infants under 6 month of age. Presence of band in the peripheral blood indicates most probably bacterial agents.
Key words: Bloody diarrhea, etiology, Entamoeba histolytica


Article
Knowledge, Beliefs and Attitudes towards AIDS among Intermediate and Secondary School Teachers; Baghdad

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Back ground: AIDS is considered a dreaded disease. According to recent estimates, 42 million people suffer from HIV/AIDS (90% of these being in the developing countries), with 5 million people newly infected with HIV and 3.1 million deaths in the year 2002 globally. At present, there is no effective vaccine to prevent the disease. Hence, Health education (Information, Education and Communication) activities bringing about behavioral changes in the community, promoting healthy sexual behavior and preventing the risky ones is the best possible solution to the problem of AIDS.
Objectives: To find out the knowledge, beliefs and attitudes regarding various aspects of HIV/AIDS amongst intermediate and secondary school teachers in Baghdad.
Methods: For this cross-sectional study, we randomly selected 48 intermediate and secondary schools covering the 6 educational directorates in Baghdad, and 642 teachers serving in these schools were selected to answer the questionnaire containing different statements concerning basic knowledge of the human immunodeficiency virus (HIV) and Acquired Immune Deficiency Syndrome (AIDS).
Results: Revealed an intermediate overall awareness about HIV/AIDS.
Conclusions: Study highlights the need for teaching the proper aspects of HIV/AIDS curriculum in Iraqi schools.
Keywords: HIV/AIDS Knowledge, believes and attitudes, teachers.


Article
Three Years Experience in the Management of Uterine Rupture atAl-Battool Teaching Hospital Mosul-Iraq

Authors: Dr. Samar D. Sarsam
Pages: 30-34
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Background: Ruptured uterus is a catastrophic event to both mother and her fetus. Apart from maternal and fetal mortality rates, the incidence of rupture of uterus is often taken as an index of the standard of obstetric care.
Objective: To determine the frequency, causes, management outcome of ruptured uterus at Al Batool maternity hospital.
Method: The study was conducted in the department of obstetrics and gynecology at Al Batool maternity hospital Mosul-Iraq over a period of three years from October 1st 2002 to August 30th 2005. All the cases of uterine rupture presented during the study period were recorded and managed in the department. Data was recorded on designed forms.
Results: Thirty nine cases of ruptured uterus out of 44539 deliveries were registered, the incidence was 0.087%. Age ranged from 15 to45 years. The majority of the patients were grandmultipara (Para 5 and above), but 7 of the patients were nulliparous women (17.94%). 26 ruptures (66.66%) occurred in unscarred uterus and 13 ruptures (33.33%) occurred in scarred uterus, cephalopelvic disproportion and obstructed labor were the cause of rupture in 11 cases (28.2%), in addition to the mentioned causes 11 cases of the uterine ruptures we registered in our study (28.2%) were mishandled by the traditional birth attendants, and in 14 cases (35.89%) there was injudicious use of oxytocin. We had three maternal deaths (7.69%) out of 39 patients, and only 10 fetuses out of 39(25.64%) were alive.
Conclusion: Rupture uterus is still an important cause of maternal and perinatal mortality and morbidity in Iraq, it is not always suspected, and hence increased vigilance is vital. Further studies may help in the development of preventive strategies and ensure prompt management to reduce maternal and perinatal mortality and morbidity.
Keywords: uterine rupture, previous cesarean section, traditional birth attendants


Article
Evaluation of Patients with Liver InjuriesTreated by Perihepatic Gauze Packing

Authors: Laith Naef Hindosh
Pages: 35-44
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Background: The liver is one of the most common organs injured after blunt abdominal trauma. The control of severe hemorrhage remains a problem.
Methods: One-hundred thirty-eight patients diagnosed as liver injury between 09/2003 and 08/2006 had been evaluated prospectively in Al- Kindy Teaching Hospital.
A distinction was made between hemodynamically stable and unstable patients. Different modalities of surgical procedures were done concentrating on perihepatic gauze packing.
Results: (60 out of 138) patients included in the study were clinically evaluated as hemodynamically stable. The average abbreviated injury severity score (ISS) was 25. Twenty patients underwent abdominal surgery. In 12 of them additional liver treatment was performed. The mortality was three, all were non-liver related.
Seventy eight patients were considered to be hemodynamically unstable, and had an average ISS of 38. All of them needed abdominal surgery.
Gauze packing was used as initial therapy for bleeding control from injured liver in 34 patients of both hemodynamically stable and unstable groups with a mortality of 11 patients (32.7%).
Conclusion: perihepatic gauze packing is considered as a life saving and a quick method for controlling ongoing hemorrhage in the treatment of liver injuries before undertaking definitive repair under controlled conditions.
Key words: surgery, liver injury, and gauze packing.


Article
Chest Radiographic Finding in Neonatal Dyspnea

Authors: Raed Haleem Al-Saad --- Falah Diab Salih
Pages: 40-44
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Abstract

Background: Respiratory distress is one of the commonest disorders within the firs 48 - 72 hours of live and any sign of postnatal respiratory distress is an indication for roentgenogram of the chest.
Objectives: Is to show the range of chest radiographic findings in full term newborn babies suffering from respiratory distress, at or soon after birth.
Method: This is a prospective study that was conducted in the special care baby units in Baghdad teaching hospital and Children welfare teaching hospital during 2002. Anteroposterior chest radiograph in supine position of (129) full term newborn babies, presented with a chief complaint of respiratory distress were examined.
Results: The commonest cause of respiratory distress was transient tachypnea of newborn (41.8%), most of these showed hyperinflation (77%) and prominent pulmonary markings (68%) .Normal chest films seen in (16%). Pulmonary infection seen in (17.8%) of cases, with findings of bronchopneumonia (43%), and lobar consolidation affecting mostly the right upper lobe (34%). Other causes were respiratory distress syndrome (13.1%), meconium aspiration (13.1%), congenital heart disease (9.3%). Less frequent causes were pneumothorax, congenital lobar emphysema, congenital diaphragmatic hernia and pleural effusion.
Conclusion: Any sign of post– natal respiratory distress is an indication for roentgenogram of the chest which should be taken as early as possible. In addition, chest radiograph should be read by an expert radiologist.
Key words: chest radiography neonatal dyspnea


Article
Evaluation of the Potential Role of Serum Seleniumin Diabetic Patients

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Background: The altered status of some essential trace elements observed in diabetes could have deleterious influences on the health of the diabetics.
Objectives: To estimate and study the potential role of serum Selenium in type 1, type 2 diabetics and healthy subjects; and its relation with lipid profile and glycemic index.
Methods: A case control designed study was carried out at the National Diabetes Center (NDC) / Al-Mustansiria University; on a total of 94 participants formed of 32 type 1 diabetics, 32 type 2 diabetics and 30 healthy control participants. Data collected about age, sex and BMI; also, blood samples examined for FPG, HbA1C, serum total cholesterol, HDL cholesterol, non-HDL cholesterol, serum triglyceride and sera were examined for Selenium by using atomic absorption technique.
Results: Type 1 and type 2 diabetic groups show respectively 75% and 65% decrement in S. Selenium, <70 µg/L. The mean of S. Selenium, age, BMI, waist/hip ratio, FPG, HbA1c, total cholesterol, triglyceride, HDL, Non-HDL and atherogenic index (total cholesterol/HDL cholesterol) for the type 1 and type 2 diabetics shows statistically significant differences from control group. Type 1 diabetics versus type 2 diabetics shows statistically insignificant differences between mean of the S.Selenium, total cholesterol, HDL cholesterol and atherogenic index (t-test, P > 0.05) while the mean of FPG, HbA1c and triglyceride show highly statistical significant differences (t-test, < 0.001).Simple linear correlation and regression analysis of FPG, HbA1c, total cholesterol, triglyceride, HDL, Non-HDL and atherogenic index of the studied groups shows weak to moderate correlation with their serum Selenium levels.
Conclusions: The inverse relationship between Selenium status and glucose tolerance suggest the potential role of Selenium in diabetics. Serum Selenium levels show high statistically significant differences from healthy subjects; while the differences between type1 and type 2 diabetic groups’ shows no statistically significant differences. Inverse correlations and regression were noticed between S.Selenium levels of all studied groups with their FPG, HbA1c, total cholesterol, triglyceride, HDL, Non-HDL and atherogenic index. Low S.Selenium and HDL-cholesterol plus an increase in total cholesterol, non-HDL and atherogenic index enhance risk of cardiovascular diseases progression among the diabetics.
Key Words: Serum Selenium, diabetes mellitus


Article
Clinical Evaluation of the Levels of CEA,CA15-3 and Alpha-Feto Protein in Malignant and Benign Pleural Effusion

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Background: Pleural effusion is a common clinical problem.
Objective: The aim of the study was to evaluate the diagnostic utility of Carcino embryonic antigen (CEA), CA 15- 3, and alpha-feto protein ( AFP ) as a tumor markers in serum and pleural effusion and evaluate the value of combining them as a diagnostic tools that are complementary to cytology in the diagnosis of malignancies .
Methods: Forty patients (18 malignant and 22 benign pleural effusion) were included in this study .The serum and effusion levels of CEA, CA 15 – 3 and AFP were measured using immunoradiometric assay
Results: from the 40 effusions studied 26 were exudates and 14 were transudates. The level of pleural effusions of CEA, CA 15 – 3 and AFP were increased above the cutoffs in 72.5%, 94.4 % and 5.5 % of tested samples with malignancies respectively.
A direct strong significant correlation between serum and pleural fluid CEA, CA 15 – 3 and AFP was noted.
Conclusion: Pleural effusion CEA is the most accurate marker for the diagnostic separation of malignant and benign. The combination of both CEA, CA 15 – 3 improves the sensitivity by up to 11 %.
AFP has no role in the process.
Key words: malignant Pleural effusions, tumor markers, CEA, CA 15 – 3, AFP


Article
Diagnostic Value of Rk39 Dipstick in PaediatricVisceral Leishmaniasis in Baghdad

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Back ground: Visceral leishmaniasis is endemic in the middle and south of Iraq, it involves mostly infants. The disease is observed mainly among rural areas that are far from equipped medical centers. Therefore, there is a need for anon- invasive, cost- effective, reliable, easily available and fast method of diagnosis of this dngerous disease.
Objective: The aim was to compare the validity and predictive values of the recombinant K39 antigen (rK39) test with that of the indirect fluorescent antibody test (IFAT) test (the usual laboratory method) in the detection of visceral leishmaniasis.
Methods: A Cross-sectional study was done in AL-Mansour Pediatric Hospital (in AL-Rusafa), and Central Pediatric Hospital (in AL-Karkh) in Baghdad for 6 months duration (from the 1st of December 2004 to 30th of May 2005). Children less than five years who suspected to be infected with visceral leishmaniasis were selected and investigated by IFAT test and rK39 dipstick strip.
Results: The validity of rK39 test when evaluated with the standard methods IFAT test showed a sensitivity of 90.5%, specificity of 90.7%, predictive value positive of 77.9%, predictive value negative of 96.4% and 90.7% accuracy.
Conclusions: The rK39 antigen strip test is valid in the diagnosis of suspected children with visceral leishmaniasis as the test is rapid, sensitive, and specific.
Keywords: visceral leishmaniasis, rK39 dipstick,


Article
Using of Laser Therapy in the Treatment of PatientsWith Plantar Fasciitis

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Background: planter fasciitis is a common condition seen in adults and sport men, it is characterized by dull pain in the heel, especially when getting up and standing on the foot in the morning or after sitting for a long time.
Recently low level laser therapy is used as a method of treatment.
Objective: to evaluate the benefit of laser therapy in treatment of planter fasciitis.
Methods: Out of twenty five patients with planter fasciitis exposed to laser therapy. Laser used is (diode type) given in two cessions per week for four weeks, time for each cession is about (12 minutes).
Results: complete recovery seen in (32%) of patients, moderate improvement in (16%), mild improvement in (24%), no response in (28%), deterioration (0%).
Conclusion: laser therapy is safe for treatment of planter fasciitis, free of side effects, very effective as an alternative to surgery and local steroid injection, with no deterioration in the condition during or after laser therapy.
Key word: planter fasciitis, laser therapy, calcaneal spur.


Article
Psychiatric Squele of Sodium Valproate Versus CarbamazipineIn Patients with Primary Generalized Epilepsy

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Background: psychiatric and behavioral side effects are common in patients with epilepsy and it may represent an intrinsic feature of the disease itself or a side effect of the antiepileptic use. Our aim in the present study is to assess the psychiatric side effects of Sodium Valproate and Carbamazipine .as these drugs are the most commonly used antiepileptic drugs in Iraq. Methods: 80 patients with primary generalized epilepsy on Carbamazipine and 50 patients on Sodium Valproate were enrolled in the present study; all the patients were assessed for any psychological disturbances using semi-structural interview based on the tenth edition of the international classification of the diseases(ICD 10) adopted by WHO. Results: thirty percent of patients taking Sodium Valproate and (9%) of patients taking Carbamazipine were found to have depression while (16%) of patients taking Sodium Valproate and (20%) of patients taking Carbamazipine were found to have anxiety. There were no reported psychosis, suicidal attempts, cognitive deficit and mania in both groups of patients in the present study. Discussion: Carbamazipine is associated with lower rates of psychological side effects than Sodium Valproate; this result may be related to mood stabilization effects of Carbamazipine. Conclusion: Carbamazipine is preferred to Sodium Valproate when the efficacy of both drugs is comparable.


Article
Use of Ascetic Fluid Cholesterol as a Marker to Differentiate between Types of Ascetic Fluid

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Background:- Cholesterol is high in ascetic fluid due to malignancy and other causes of exudates.
Objective:-To use cholesterol as a marker to differentiate between exudative and transudative ascetic fluid and to compare that with other routine parameters.
Methods:-Twenty eight patients were included in this study 17 females with mean age of 41.9 years, 11 males with mean age of 48.2 years. The patients were divided in group I suspected transudate, and group II suspected exudate according to history and clinical examination.
Ascetic fluid samples were sent for total protein, albumin, and cholesterol measurement blood samples were sent for serum protein and albumin measurement.
Results:-In this study ascetic fluid cholesterol was fit with history and clinical examination to differentiate between exudative and transudative ascetic fluid.
Cholesterol was a good marker when compared with ascetic fluid total protein and ascetic serum protein ratio in group I, but not in the others.
Conclusion: - cholesterol can be used as a marker for the diagnosis of a cites cases but a large number of patients is important for accurate results
Key word:-Ascites, exudate, transudate, cholesterol


Article
Rate of Schneiderian First Rank Symptoms amongNewly Diagnosed Schizophrenic Patients

Authors: Twana A. Rahim --- Abdul-Rasoul Al-Yasiri
Pages: 83-90
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Background: Schneiderian first rank symptoms are considered highly valuable in the diagnosis of schneideria.
They are more evident in the acute phase of the disorder and fading gradually with time. Many studies have shown that the rate of these symptoms are variable in different countries and are colored by cultural beliefs and values.
Objectives: To find out the rate of Schneiderian first rank symptoms among newly diagnosed schizophrenic patients, to assess which symptom(s) might predominate in those patients, and to find out if there is/are any correlation(s) between the occurrence of these symptoms and the sex of the patients.
Methods: Out of twenty-four patients with no past psychiatric history and whom were diagnosed as Schizophrenia for their first time depending on Diagnostic and Statistical Manual-4th Edition-Text Revised criteria for diagnosis were evaluated for the presence of Schneiderian First Rank Symptoms by using a semi-structured interview schedule.
Results: Out of twenty -three patients (54.7%) had present with one or more Schneiderian First Rank Symptoms.' Third person Hallucinatory Voices", "running Commentary Hallucinatory Voices', and " Somatic Passivity" were present more frequently than other symptoms.
The study revealed no sex differences in regard of the occurrences of the Schneiderian (FRS). More than 82% of those who had the symptoms showed more than one symptom.
Conclusions: Many factors influence the presence or absence of Schneiderian First Rank Symptoms among schizophrenic patients including the criteria selected for the diagnosis of the disorder, the tools adopted for the detection of these symptoms, the duration of the illness, and probably patient's cultural background.
Although there are individual differences of First Rank Symptoms among different cultures, still we expect certain symptoms to be present more than others. The influence of cultural factors in altering the basic symptoms of psychiatric illnesses is of great importance.
Key Words: Diagnostic and Statistical Manual-4th Edition-ext Revised (DSM-IV-TR), First Rank Symptoms (SFRS), American Psychiatric Association (APA), International Pilot Study of Schizophrenia (IPSS), International Classification of Diseases (ICD).


Article
The Sensitivity and Specificity of Oral Tumors and Premalignant Lesions Diagnosis by Otolaryngologists

Authors: Dr. Hussien Jassim Muhsen
Pages: 96-100
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Background: Tumors of the oral cavity are under estimated in general dental and medical practice, some authors describe it as the forgetting disease, others wondering if the attention paid to this disease compared to its fatality (The 5-year survival rate is about 50%) is enough for disease control? However; this disease deserves a comprehensive assessment by all dental and medical fields assumed to examine the oral cavity regularly, especially otolaryngologist.
Objectives: To find out the sensitivity and specificity of clinical examination in diagnosing oral tumors and premalignant conditions by otolaryngologist.
Methods: Across sectional retrospective study was conducted in the:
-study design: Cross sectional.
-settings: Ear Nose Throat (ENT)departments in Al-kindy Teaching Hospital and Al-Yarmouk Teaching Hospital.
On Patients attending ENT department with oral presentation.
The outcome variables includes: The sensitivity, specificity, positive predictive value (Pv+ve), negative predictive value (PV-ve), and the accuracy of clinical examination in diagnosing oral tumors and premalignant conditions in ENT clinic.
Results: The results revealed a high sensitivity and specificity for otolaryngologist in diagnosing malignant conditions and premalignant lesions of the oral cavity.
Conclusion: The study highlights the need for fixed clinical criteria for early diagnosis of premalignant conditions and oral tumors.
Keywords: oral tumors, sensitivity, specificity, otolaryngologist.


Article
Myomectomy During Early Pregnancy(Case report)

Authors: Dr. Samar D. Sarsam
Pages: 100-102
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Myoma is a common benign uterine tumor; therefore it is common in pregnancy. One in ten women will have complications related to myoma in pregnancy. Few treatment options are available during pregnancy, conservative treatment with analgesia, reassurance and supportive therapy is almost always adequate but in carefully selected patients, myomectomy has been performed successfully without jeopardizing pregnancy outcome. The usual indications for surgery during pregnancy include torsion of pedunculated uterine myoma and obstructed labor, surgical intervention during pregnancy is occasionally necessary in uncommon cases of intractable pain.
19 years old lady presented with intractable lower abdominal pain during pregnancy. Ultrasound showed fetus of 18 weeks gestation and ovarian cyst. The pain did not respond to rest and sedation, so emergency exploration laparotomy was done; incarcerated intramural uterine myoma was the cause of the pain, it was enucleated successfully through myomectomy and the pregnancy progressed normally.
Keywords: Pregnancy, uterine fibroid, myomectomy.


Article
Bilateral Giant Fibro Adenoma of Breast(Case Report)

Authors: Dr. Mohammad Bresam
Pages: 103-105
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Abstract

Fibro-adenoma is the most common lesion of the breast, it occurs in25%of asymptomatic women (1,2 )
It is usually a disease of early reproductive life, the peak incidence is between the ages15 and 35 years.(3,4) It presents as firm highly mobile, non tender mass .(5)
Less than 5% of fibro-adenomas grow rapidly and display the clinical and histologic characteristics of giant fibro-adenoma which is defined as a-tumour either having a diameter greater than 5 cm. And /or amass weighing more than 500 grams, and are conventionally a benign tumor of breast.(6)
Giant fibro-adenomas appear as well-circumscribed but not encapsulated masses on mammography and solid and the texture is homogenous and hypoechoic with low level echoes on U/S. (6, 7)
It is hormone dependent that lactates during pregnancy and involutes along with the rest of the breast in perimenopause.(5)
Excessive estrogen stimulation and /or receptor sensitivity, or lack of estrogen antagonist havebeen implicated in the etiology. (2)
Giant fibro-adenoma is often confined to one breast as a solitary mass occupying part or the whole breast and in rare cases it may be multifocal and involve both breasts. (8)
Giant fibro-adenomas are benign and do not become malignant. (9)
Histological cut surfaces have a lobulated grey-white myxoid semitransparent to dens fibrous appearance, it consist of epithelial and fibrous components, the pericanalicular fibro-adenoma maintains round and oval dilated ductal spaces whereas in the intracanalicular type the ductal lumens are compressed by polypoid fibrous stroma creating slit –like irregular spaces , the ducts are lined by two layers of cells: epithelial and myoepithelial cells and under influence of hormones the ducts become hyper plastic with papillary formation and more than two layers of cells varies from myxoid and hypo cellular to fibrous and moderately cellular . (2)
Surgical treatment of giant fibroadenoma ranges from shelling the tumour out in case it occupies part of the breast, to simple mastectomy. (10) .

Keywords

giant fibro --- breast --- fibro adenoma

Table of content: volume:4 issue:2