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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Contact info

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

Table of content: 2012 volume:8 issue:2

Article
Acute abdomen during pregnancy in Baghdad

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BackgroundThe diagnosis and important aspects in treating acute abdomen during pregnancy tend to be delayed due to the peculiar physiological features of pregnancy and the restrictions imposed on imaging diagnostic techniques such as x-ray and CT. Aim of the studyTo identify the most common causes of acute abdomen during pregnancy and identifying the approaches for early diagnosis and to take a correct decision for surgery and assigning the complications that may occur during and/or after surgery for the mother and the fetus. Patients and Methods This is a prospective study that involves data obtained from 91 pregnant patients admitted in the surgical wards in Baghdad teaching hospital during the period from January 2008 to December 2009 .All mandated surgical intervention. ResultsTotal surgical admission in Baghdad Teaching Hospital in 2008-2009 was 13485, total number of cases operated onas acute abdomen was 3374 and the total cases of acute abdomen operated on during pregnancy were 91 cases. The most common cause of acute abdomen during pregnancy is acute appendicitis which represents 70.3%.The most common age group of acute abdomen during pregnancy is between 25-29 years .The most common gestational age is the second trimester.The most common complaint of acute abdomen during pregnancy is right lower abdominal pain.The fetal condition was normal in 91.7% of total cases operated. ConclusionAcute abdomen during pregnancy represents a small proportion of the total cases of acute abdomen.It mostly presents during the second trimester and mostly caused by acute appendicitis. With proper management, the maternal and fetal outcome is good. Key words: Acute abdomen; Pregnancy; Baghdad Teaching Hospital.


Article
Age Influence on Knee Joint Flexors

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Background : Knee flexors tightness has been documented in apparently healthy adults and in those with musculoskeletal problems, but the influence of age on the tightness has not been studied in Iraq. This study was therefore designed to determine the influence of age on knee flexors tightness in apparently healthy subjects. Methods: Knee flexors tightness was measured using the active knee extension test (AKET) in 200 apparently healthy male and female subjects, aged 13 to 59 years. The subjects were recruited into 5 age groups using the purposive sampling technique. Knee flexors tightness was compared across the age groups using one-way analysis of variance (ANOVA). The independent t-test was used to compare knee flexors tightness on both lower limbs in male and female subjects. Results: Subjects' mean age was 29.63 ± 16.72 years. All subjects had knee flexors tightness (absolute extension lag) and this increased with age up to age group 40-49 years. The male subjects had significantly higher knee flexors tightness than the females in all the age groups. Conclusion: This study suggests that knee flexors tightness increases in apparently healthy persons from adolescent up to age 40-49 years and it is higher in males than females. Key words: knee flexors tightness, age, active knee extension test


Article
Assessment of High Sensitivity C.Reactive Protein

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Background: syndrome X or metabolic syndrome is a collection of multiple diseases mainly visceral obesity , hypertriglyceridemia , decrease HDL level, hypertension and elevated fasting blood glucose that lead to accelerated atherosclerosis through multiple mechanisms, one of the most important is increase inflammation of the vessels manifested by elevated high sensitivity C reactive protein (hs-CRP). Objective: The aim of the study was to assess the prevalence of elevatedhs CRP in people with metabolic syndrome and atherosclerosis complication (IHD, Cerebrovascular disease, peripheral vascular disease) and metabolic syndrome without these complication. Patients and methods:;This is a cross sectional study carried out in Diabetic referral center in Baghdad al-rusafa extended from November 2009 to March 2010 for 84 male patients with metabolic syndrome ,aged 40-70 years, clinical features ,anthropometric and biochemical measurement (BP, Waiste circumference, BMI, HDL, LDL, TG, BG, hs CRP) were recorded and metabolic syndrome diagnosis was made according to IDF definition Results: The 84 patients with metabolic syndrome divided in to two groups the first 35 patients clinically complicated atherosclerotic group were 30 patients high risk 85% and 5 patients low risk 15%. The second 49 patients (clinically uncomplicated atherosclerotic) group were 30 patients high risk 61% and low risk 19 patients 39%, and tabulated with the p.value was (0.014). These results tabulated with the following parameters ,waist circumference (abnormally high p.value was 0.05, normal p.value was 0.49) ,blood pressure (hypertension p.value was 0.05 and normal blood pressure p.value was 0.58),age(middle age p.value was 0.007 and elderly age p.value was 0.29) and BMI(less than 25g/kg p.value was 0.39 and more than or equal to 25 g/kg p.value was 0.08). Conclusion: The values of hs-CRP are high in most patients with metabolic syndrome but are higher in patients with atherosclerotic complications than those without .specially elevated in those with hypertension ,middle age group, increasing waist/hip ratio with significant p.value,and in high BMI but with insignificant p.value. Key words : (HS-CRP metabolic)


Article
A typical clinical presentation of molluscum

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Background Molluscum contagiosum is skin disease caused by the molluscum contagiosum virus (MCV) usually causing one or more small dome shaped umbilicated papules with symptoms that maybe self-resolve. MCV was once a disease primarily of children, but it has evolved to become a sexually transmitted disease in adults. It is believed to be a member of the pox virus family. In addition to the classic presentation of the disease; it can also come in different clinical forms that simulate large number of dermatolological disease. Objective: To study different clinical forms of Molluscum contagiosum presentation in different age groups of Iraqi patients. Method:This clinical descriptive study was performed in the outpatient department of Dermatology and Venereology : Al–Kindy Teaching Hospital in Baghdad from August 2010 - October 2011A total of three hundred and thirty Patients (180 female sand150 males) recruited in this study diagnosed as Molluscum contagiosum on different sites ; both classical and non classical presentation were studied. Results: Twenty eight patients (8.48%) out of the 330 patients (14 male and 12 female) showed atypical clinical presentation, while 302 (91.52%) patients showed typical presentation. Conclusion:Molluscum contagiosum can presented with either classic or non classic presentation mulating many dermatological disease. Keywords:Molluscum contagiosum.Atypical presentation


Article
Analgesic Effect of Melatonin in Mice

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Background: Melatonin is the main hormone secreted by the pineal gland. This indole compound (N-acetyl-5-methoxytryptamine) is derived from serotonin after two biochemical steps. Melatonin has been implicated in some pharmacological effects including sedative/hypnotic, anticonvulsant activity and others. The aim of this study was to investigate the antinociceptive effect of different doses of melatonin administered i.p. to mice, and then, to find the dose- response line of melatonin in mice as analgesic agent. Methods: The dose response effect of melatonin (10, 50, and 100mg/kg) were assessed against control using tail flick test in mice as a model of nociceptive pain. In this model, all doses of melatonin were given intraperitoneally 15 min before immersion of tail in hot water 50°C, and Tail Flick Latency was measured before, and after (15, 30, 60 and 120 min ) administration of melatonin. Results: Administration of melatonin i.p. to mice significantly P ≤ 0.05 increase tail flick latency in melatonin treated groups after 30 min and 60 min compared to baseline values; while after 120 min, administration of melatonin produce significant and dose dependent antinociceptive effect following its i.p. administration. The percentage increase in tail flick latency produced by i.p. administration of melatonin doses of 10, 50, and 100 mg/kg were 86.59%, 156.05% and 169.19% respectively when compared to baseline values. Conclusions: The present study showed that melatonin produces analgesic effect in a dose dependent manner in mice, further studies are required to know the exact mechanism by which melatonin exerts this analgesic effect. Keywords: melatonin, analgesia, pain

Keywords

melatonin --- analgesia --- pain


Article
Breast Feeding and Mothers Employment

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Background: An important factor influencing duration of breastfeeding is mother’s employment status. The nutritional, immunological, psychological and economic benefits of breastfeeding are well documented. Both UNICEF and the World Health Organization recommend mothers should breastfeed exclusively for at least 6 months. Objectives: To determine how the employment and the employment variables (type of work, time of return to work and hours of work) influence the breast feeding practices. Methods: A cross- sectional study was carried out on a sample of 200 employed mothers who had their last child been completed at least tow years. Data were collected using a questionnaire form. It was carried out during the period from 1st of April to 1st of September, 2000, in Baghdad city/ AL-Risafa in 6 different places where employed mothers of young children were expected to be found. Results: The study revealed that the impact of employment status was noted on the breast feeding initiation time, breast feeding duration and complementary food initiation time. The majority of employed mothers (56.1%) who worked shorter hours breast-feed for longer durations and starts weaning after the fourth months of the infant’s age. The highest percentage of employed mothers (75.9%) with maternity leave of six months or more breast feed for a year or more and (66.1%) start weaning later than the fourth month of the infant’s life. Conclusions: The study recognizes that employed mothers who worked shorter hours and mothers with longer maternity leaves breast feed for longer durations and start weaning later than mothers who worked long hours and mothers with shorter maternity leaves. It was concluded that most work-places lack accommodations to support breast-feeding. Keywords: breast feeding, mother employment, infant feeding, work


Article
Comparison Between Different DNA and Conventional

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Background: The discriminative power of the classical WHO parameters in relation to male fertility is quite low, because they only address few aspects of sperm quality and function. This has led investigators to focus their attention on the male gamete and in particular its genome. Objective: To explore which of the sperm DNA damage parameters measured by comet assay are more reliable, and their relations with the standard semen parameters. Methods: Study was done on 40 infertile men selected from couples attending the Institute of Embryo Reasearch and Infertility Treatment at Al-Kadhimiya City/ Baghdad in the period between February 2009 and May 2009, with a history of infertility of ≥1 years; and 15 healthy volunteers of proven fertility serving as control. Samples were allowed to liquefy for at least 30 minutes at 37°C and then evaluated according to the guidelines of the World Health Organization, 1999. The single cell gel electrophoresis (comet) assay was studied in the ejaculated spermatozoa. The exclusion criteria were the presence of azoospermia and severe oligospermia. Results were compared with the standard semen characteristics (concentration, motility and morphology). Results: Compared to healthy volunteers, infertile patients had highly significantly higher values of comet parameters (P = 0.00001). In all infertile patients, comet extent did not correlate with any of the classical semen parameters; whereas, tail length (μm), % DNA in tail, tail moment and olive moment had all significant negative correlations with the standard parameters. Significant positive correlations were observed between the studied comet parameters, except for the comet extent which was not significantly correlated with tail length and % DNA in tail (P = 0.06, P = 0.7; respectively). Conclusion: Comet assay is a very useful technique in assessing sperm DNA damage. Comet tail parameters and comet extent, may clarify different aspects of DNA damage, and together give a better insight to the integrity of the male genome. Keywards: sperm, comet extent, % DNA in tail, tail moment and olive moment.


Article
Does the tertiary health care for Type 2 diabetic patients can

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Objectives: To study the effect of providing tertiary (specialized) health care for type 2 diabetic patients to meet the WHO and ADA standards and glycemic targets. Method: Six months, Jan. – Jun. 2010, cohort study was conducted on 600 adult diabetics who registered in the National Diabetes Center (NDC) / Al-Mustansiriya University, Baghdad – Iraq. They were followed for 3- 6 months; each time patients were examined physically and their blood pressure, height, weight and BMI were measured. Fasting blood samples were taken from all patients to test the FPG, HbA1c, T.Chol, TG, HDL and LDL. Results: Patients’ age was 52.85±15.56 year and the male/female ratio was 1.01, the median duration of disease was 7 years and their BMI was 28.80 ± 13.02 kg/m2. Patients’ achievement during study period, of glycemic and cardiovascular risk factors, meet the targets of ADA, NHANES and NCEP/ATP III Guidelines of FPG, PPG, HbA1c, T.Chol, TG, LDL, HDL, systolic and diastolic blood pressure by 26.74%, 29.09%, 32.78%, 61.0%, 60.86%, 76.19%, 74.35%, 52.54% and 62.50% respectively. Conclusions: We concluded that tertiary health service can help to meet the international guidelines and recommended targets for type 2 diabetes. Improving quality and coverage of tertiary health services may help in achieve and sustain targets; and afterward close adhering to the WHO and ADA standards and glycemic targets. Abbreviations: BMI=Body Mass Index, FPG= Fasting Plasma Glucose, PPG = post prandial plasma glucose, HbA1c =glycated hemoglobin, T.Chol. = total cholesterol, TG = Triglyceride, LDL = low-density lipoprotein, HDL = high-density lipoprotein, ADA= American Diabetes Association, NHANES = National Health and Nutrition Examination Survey, NCEP/ATP III = National Cholesterol Education Program/Adult Treatment Panel III. Key words: Tertiary health care, Type 2diabetes mellitus, glycemic standards and targets


Article
Factors Influence the Development of Dysrhythmia

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Objective The incidence of rhythm and conduction abnormalities during acute myocardial infarction may approaches 100%; most are seen during the pre-hospital and coronary care unit phases, leading to deleterious effect on morbidity and mortality, this study conducted to find important persistent dysrhythmia found during CCU admission of acute myocardial infarction patients. Method A retrospective observational study of 553 patients who were admitted to the Coronary Care Unit of Alkindy Teaching Hospital during Year 2011 with diagnosis of acute myocardial infarction, Information and data extracted from case sheets and associated 12 leads daily ECGs Results only 25% of our patients had dysrhythmia on examining the present 12 leads ECGs , the mean age are 64 years and 24% of female and 26% of male had dysrhythmias. Those with dysrhythmia had more shortness of breath and less chest and epigastric pain.. There is no relation of dysrhythmia to diabetes , hypertension or smoking. dysrhythmia associate inferolateral and anterolateral myocardial infarction more than anterior, lateral or inferior infarction. conclusion dysrhythmia in acute myocardial infarction, old age people had more dyrhythmia but gender had no effect, chest pain and shortness of breath also associate dysrhythmia significantly. Hypertension, diabetes ,and site of infarction had no effect on development of dysrhythmias, while size of infarction had significant effect. Key words; kindy, infarction, dysrhythmia

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kindy --- infarction --- dysrhythmia


Article
Effect of car painting vapours on pulmonary and

Authors: Ahmad Tarik Numan (MSc, PhD)
Pages: 58-64
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Background: Automobile spray painting is considered an occupation with a high risk of respiratory impairment and asthma. Exposure to organic solvents used for spraying might be of high risk for development of dysfunction in other organs. Objective: The study was designed to evaluate the pulmonary and hepatic toxicity due to exposure of automobile painters to organic solvents in work places within the Baghdad governorate area. Methods: Thirty cross sectional selected male workers employed in automobile body paint shops in two industrial areas within Baghdad city (Al-Sheikh Omar and Al-Rasheed camp regions) were recruited to the study during the period from March to May 2012. Thirty non-exposed students and employees in the college of pharmacy-University of Baghdad, age matched with workers, were included as control group. Pulmonary function test (PFT) was performed for all subjects using flow spirometry and blood samples were obtained for evaluation of serum transaminases (AST and ALT), in addition to serum levels of total bilirubin and albumin. The results were correlated with age of workers and duration of exposure. Results: The results indicated significant decrease in PFT markers (FVC, FEV1, FEV1/FVC and PEF) compared to control group, while liver function did not significantly affected. Correlation of the PFT markers with age and duration of exposure reveals non significant values. Conclusion: Spray painting is an occupation which involves the risk of respiratory impairment and also confirms the need of regular medical examinations and implementation of appropriate measures to prevent adverse respiratory effects of workplace exposure in automobile spray painters. Keywords: respiratory function, automobile painting, occupational hazards Running title: Occupational hazards of automobile painting


Article
Effect of Metformin Therapy on Reducing Leptin

Authors: Wafaa Issa Tuama*
Pages: 65-68
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Background: The relation between insulin resistance ,leptin levels and other hormones in women with polycystic ovary syndrome(PCOS) is still controversial.Metformin therapy is proved effective in reducing insulin resistance and also in some studies it was seen to be effective in reducing leptin levels. Al- Kindy Col Med J 2012 ; Vol .8 No. (2) p: 65 Objective: to study the effect of metformin on reducing leptin levels and enhancing ovulation in PCOS women. Methods:metformin 500mg 3 times daily for 3 months was was given to 36 women with proved PCOS, in addition to that, other parameters were included. Results:28 women out of 36(77.78%) showed an evidence of ovulation ovulation after 3 months of metformin therapy(p<0.01) with significant ◌ٌ reduction in leptin levels(p<0.001). Conclusion: it can be concluded that metformin can reduce leptin resistance and enhance ovulation in PCOS women. Keywords: leptin, PCOS, metformin.

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Keywords: leptin --- PCOS --- metformin


Article
Evaluation of Fludarabine, and granulocyte colony

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Background: Refractory/relapsed acute leukemia has always been a challenging problem for hematologist. Over the past decade emphasis has been made in the development of regimens containing fludarabine, combined with cytosine arabinoside for the treatment of refractory/relapsed acute leukemias. The aim of this study is to evaluate the efficacy and toxicity of the combination of fludarabine, high dose cytarabine, and granulocyte colony stimulating factor in refractory relapsed cases of acute leukaemia, Methods: a prospective study is being conducted at the national center of hematology and hematology unit /Baghdad teaching hospital from July 2008 to July 2010.Twenty Patients with refractory/relapsed acute leukemia were treated with fludarabine 30mg/m2 and cytosine arabinoside (AraC) 2 g/m2 for 5 days, and granulocyte colony stimulating factor G-CSF 300 microgram/day from day 0 till neutrophil recovery (ANC >1.0 x 109/l).Response was evaluated by bone marrow examination on day 30-post chemotherapy. Results: Patients included were refractory acute lymphoblastic leukemia (ALL) (n=5), relapsed ALL (n=4), refractory acute myeloid leukemia (AML) (n=8), relapsed AML (n=3). Complete remission (CR) was achieved in 9(45%) patients, 3 (15%) patients got partial remission. Three (15%) patients died of post chemotherapy complications and 5(25%) patient failed to achieve remission. Major complications encountered were: anemia, fever, bleeding, mucositis and bacterial infections. Conclusion: FLAG protocol is well tolerated and effective regimen in relapsed / refractory acute leukemias. The toxicity is acceptable, enabling most patients to receive further treatment, including transplantation procedures Key words: FLAG, refractory acute leukemia, relapsed acute leukemia


Article
Evaluation of Medication Errors in Hospitalized Patients

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Objectives: Many medication errors occur in the hospital, and these can endanger patients. The purpose of this study was to evaluate the incidence of medication errors in hospitalized patients, and to categorize the most frequent types of errors, and to asses the possible measures that may prevent the occurrence of such errors. Methods: A prospective, exploratory, and evaluative study, using direct observation method to detect medication errors in adult hospitalized patients in medical and surgical units in Baquba Teaching Hospital- Diyala-Iraq.. The files of 299 patients had been reviewed from July 2009 to September 2009, including medication orders and treatment sheets to detect existing errors. The detected errors were recorded and classified using special form designed according to standard classification of medication errors. Results: During the study period, a total of 299 patient's files were reviewed and identified. The incidence of medication errors was 8.7%. The most common types of errors; where incorrect medication which includes 38.46% for not indicated drugs and 19.23% for drug-drug interaction. The incorrect dose represents the second common type of medication errors which include 15.38% for over dose and 3.85% for under dose. The classification of medication errors in this study were 61.54% prescribing errors, followed by 19.23% for each of dispensing errors and administration errors. Conclusions: Medication errors occur for a variety of reasons, including inaccurate communications and deficits in knowledge and performance by and among all health care professionals. In this study we addressed and identified that prescribing errors are the most common type of medication errors followed by dispensing and admintration types, so, all health care professionals have a responsibility in identifying contributing factors to medication errors and to use obtained information to reduce further error occurrence. Keywords: medication errors, patient safety, system errors.


Article
Evaluation of Management of Closed Spinal Injury

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Objectives: to evaluate the role of conservative, decompression, spine fixation in management of closed spinal injury. Methods: The study was conducted at Specialized Surgical hospital and Al-Kadhemayia Teaching Hospital, in the period between July 2003 and July 2005.The study included 61 patients categorized Into many groups according level of vertebral injury (cervical, cervicodorsal, dorsal, dorsolumbar, Lumbar and lumbosacral), type of injury (compressed fracture, burst fracture and fracture dislocation) And according the severity into three groups as G1( complete motor paralysis and sensory loss ) G2 ( complete motor paralysis and incomplete sensory loss) and G3 ( incomplete motor paralysis And incomplete sensory loss ).The methods of treatment include (conservative, decompression, And open reduction and internal fixation). Results: no deterioration of the neural function occurred in any case .All patients who had full neural Function on admission remained so. The patients who at time of admission was completely paraplegic Or tetraplegic did not show any neural improvement .Internal fixation was done to maintain good alignment of the spine and stabilize the fracture dislocation segment for early mobilization and rehabilitation no significant improvement in the neural status has occurred in patients with complete motor and sensory loss below the level of the injury at time of admission. The value of decompression of the spinal Canal may improve neurologic recovery or rate of recovery in some patients with an incomplete deficit. Conclusion: clinical awareness is the most important diagnostic point. Other associated injuries which frequently co-exist should not be forgotten. Adequate radiological examination must be done.MRI is very helpful especially in incomplete spinal cord injury. Conservative treatment consists of immobilization. Laminectomy was performed for patients who have incomplete neural deficit. Internal fixation Performed for patients who have fracture dislocation. Key word: closed spinal injury, conservative, surgery.


Article
Human Leukocyte Antigens Assosiation with Systemic Lupus Arythematosus In Iraqi Patients

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Background: The etiology of Systemic lupus erythematosus seems to be multifactorial including environmental as well as genetic factors. The genetic predisposition was supported by the occurrence of Systemic lupus erythematosus in more than one member of a family as well as in identical twins. Aim of the study: To determine the human leukocyte antigen typing class I (A and B) in patients with Systemic Lupus Erythematousus disease. Methods: Patients group consisted of 44 Iraqi Arab Muslims patients with Systemic lupus erythematosus disease who presented to Baghdad Medical City from January 2010 to January 2012 from Baghdad Province. The second control group consisted from 80 Iraqi Arab Muslims volunteers from hospital employees and their relatives. Human leukocyte antigen typing done for them using serological method by microlymphocytotoxicity test. Results: A total of 44 patients with Systemic lupus erythematosus were studied. Patients' age ranged from 6 to 65 years with a mean of 29.61 ± 12.78. The other control group, their ages ranged from 16 to 55 years with a mean of 31.35 ± 10.02 . Females were more than males in both groups. Human leukocyte antigen typing of Systemic lupus erythematosus patients showed A2( 16, 36.36, 0.20), A3( 14, 31.82, 0.17), B4(10, 22.73, 0.12) , B12 (10, 22.73, 0.12) and B21(10, 22.73, 0.12) were the highest absolute numbers, phenotype frequencies and genotype frequencies respectively. There was a significant difference in between SLE patients and control group in the following alleles (A1, A28, A36, A43,B 6, B12, B14, B15, B16, B35, B42, B53). Conclusions: Genetic factors do have a role in the development and expression of Systemic lupus erythematosus . human leukocyte antigen -A28 , A36, B12 and B21 had an association with Systemic lupus erythematosus Iraqi patients. Key words: Human Leukocyte Antigens, Systemic Lupus Erythematosus , Tissue typing


Article
Incidence of Renal Injuries in Abdominal Trauma at Al-Kindi Teaching Hospital

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Background : The kidneys may be injured in abdominal trauma, both blunt & penetrating. Renal trauma may manifest in a dramatic fashion for both the patient and the clinician. Objectives: To evaluate the incidence, management, morbidity &mortality of renal injury in blunt & penetrating abdominal trauma. Methods: A retrospective study includes 45 patients sustaining renal injury. These trauma patients were admitted to the casualty department in Al-Kindi Teaching Hospital during the period between 1st June 2006 – 31st May 2007. The patients were analyzed regarding their age, sex, mechanism of injury & grade of injury according to Organ Injury Scaling (OIS) classification of the American Association for the Surgery of Trauma (AAST). Management, morbidity & mortality were also noticed. Results:The majority o f patients were males (35= 77.8%), the rest were females (10= 22.2%). The average age was 37 years (range= 18-56 years). The most common grades were grade1, grade2 and grade3 (40=88.9%), while 5 patients (11.1%) were grades 4 and 5.The most common associated injuries were liver, spleen, small & large bowels and diaphragm. The mortality was 20% (9 patients). The most common cause of death was multiple organ injuries in 2 patients (4.4%), kidney with injury of a second organ in 6 patients (13.3%), while delayed surgery was the cause in 1 patient (2.2%), while the most common cause of morbidity was wound infection in 5(11.1%) and wound dehiscence in 2 patients (4.4%), a total morbidity is of 7 patients (15.5%). Conclusion: Renal injuries are not uncommon injuries, but they are less common than other intraabdominal organs e.g. liver, spleen and bowel. Injury grading using the OIS system (liver, spleen and kidney) of AAST is a useful tool for comparison and to evaluate management according to injury grade. Keywords: Renal Injury, abdominal trauma, blunt trauma, penetrating trauma.


Article
Initial Recognition and Prophecy of Diabetic Nephropathy in Type I Diabetes

Authors: Dr. Wijdan Akram, , FICMs, MBChB
Pages: 94-102
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Back ground: Diabetic nephropathy is rapidly becoming the leading cause of end-stage renal disease (ESRD). The onset and course of DN can be ameliorated to a very significant degree if intervention institutes at a point very early in the course of the development of this complication. Objective: The aim of this study was to characterize risk factors associated with nephropathy in type I diabetes and construct a module for early prediction of diabetic nephropathy (DN) by analyzing their risk factors. Methods: Case control design of 400 patients with type I diabetes mellitus (IDDM), aged 19-45 years. The cases were 200 diabetic patients with overt protein urea while the controls were 200 diabetic patients with no protein urea or micro-albumin urea. Results: concurrent occurrence of retinopathy and nephropathy was the main predictors for nephropathy in type I DM patients. Disease duration more than 10 years, uncontrolled hyperglycemia, age more than 30 years and presence of hypertension were the other predictors respectively. Gender and hypercholestremia showed no predictive value in occurrence of DN. Key words: diabetic nephropathy, diabetes mellitus, case control


Article
Modified alvarado scoring system.

Authors: Dr. Raid E. Rassam DGS, FICMS
Pages: 103-111
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Background:-The Modified Alvarado Scoring System (MASS) has been reported to be a cheap and quick diagnostic tool in patients with acute appendicitis. However, differences in diagnostic accuracy have been observed if the scores were applied to various populations and clinical settings. Objectives:- The purpose of this study was to evaluate the diagnostic value of Modified Alvarado Scoring System in patients with acute appendicitis in our setting. Methods:-one hundre twenty eight patients ,were included in this study, admitted to Al-Kindy teaching hospital from June 2009 to June 2010. Patients’ age ranged from 8 to 56 years (21±10) they were divided into three groups; paediatrics, child bearing age females & adult males,. MASS was calculated for each patient included as the diagnosis & treatment were done on the bases of surgeon's clinical decision,confirmation was done by histopathological examination. Finally statistics done included negative appendectomy rate, sensitivity,specificity,positive predictive value,negative predictive value & accuracy. Results:- Our negative appendectomy rate was 19.5% (22.22% for paediatrics 40.9% for females 4.2% for males). MASS showed sensitivity of 61%(92.8% for paediatrics 38% for females & 58% for males), specificity 80% (75% for paediatrics 88% for females & 50% for males), positive predictive value 92%(92.8% for paediatrics 83% for females 50% for males), negative predictive value 33% ( 75%for paediatrics 50% for females 5% for males) & accuracy 65% ( 88.9% for paediatrics 59% for females 58% for males). Conclusion:- MASS was of limited help to junior doctors in our setting,clinical assessment & experience are still the gold standard for acute appendicitis. Keywords:-acute appendicitis,-modified Alvarado score,-preoperative diagnostic aids


Article
Metabolic syndrome in obese versus non-obese

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Background: The prevalence of obesity is continuously rising world-wide. Obesity is an important risk factor of cardiovascular disease (CVD), metabolic syndrome (MS), and type 2 diabetes (T2D). Objective: To estimate the frequency of MS in obese versus non-obese subjects in Basrah, Iraq . Methods: This is a prospective clinical study performed in Al-Sadr Teaching Hospital, Basrah, and included 86 obese subjects (with a BMI ≥ 30), 39 males and 47 females, and 132 non-obese subjects ( with a BMI < 30 ), 60 males and 73 females as a control group. Measurement of height, weight, waist circumference (WC), blood pressure ( BP ), fasting blood glucose ( FBG ), total cholesterol (TC), triglycerides (TG ) and high density lipoprotein- cholesterol (HDL-C) levels were carried out. The updated US National Cholesterol Education Program Adult Treatment Panel III ( updated NCEP ATP III ) definition was used for the diagnosis of MS. Results: The frequencies of MS were significantly higher among obese male and female persons (38.5% and 42.6% respectively) compared to non-obese male and female persons (15.0% and 19.4% respectively), (P<0.01). On the other hand, the frequencies of MS were non-significantly higher among over weight male and female subjects (19.2% and 24.3% respectively) compared to normal weight male and female subjects (11.8% and 14.3% respectively), (P>0.05). The major determinants for MS in obese persons in either sex were WC, BP and TG ( P<0.001, P<0.001 and P<0.05 respectively). Conclusions: Obese individuals are at a substantial risk for MS, and thereby, at a high risk of atherosclerotic CVD and T2D, and their complications. Key Words: Metabolic syndrome, obesity, cardiovascular disease, type 2 diabetes.


Article
Neonatal Gastoinestinal Perforations

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Background: Gastrointestinal tract (GIT) perforation in neonates is a serious problem for paediatric surgeons especially extremely low birth weight which continue to have a high mortality rate. Methods: A prospective study for 36 neonate were seen and operated upon in Al- Kadhymia Hospital for Children and Al- Mustansiria Hospital during the period 2006 – 2010. Results: There were 36 neonate proved to have GIT perforation (21(58.3%) male and 15 (41.7%) female. Their birth weight ranged from 1500 – 3600 grams with average age at presentation was 4 days. Main causes of perforations included necrotizing enterocolitis (NEC) 36%, spontaneous gastroduodenal perforations 11.1%, anterior abdominal wall defect 11.1%, spontaneous intestinal perforation11.1%, iatrogenic intestinal perforation 8.3%, Hirschsprung`s disease, ileal atresia & meconiun ileus were reported in 5.6% and volvulus & imperforate anus were reported in 2.8%. Twenty two patients (61%) were treated by primarily repair ( debridement and repair or limited resection and primary anastomosis). Overall mortality rate 47.2%. Conclusion: It is necessary to substantially improve the level of medical treatment especially for premature baby under both 1500 grams & 32 GWs to prevent secondary pathology by early recognition and management of primary pathology. Rectal temperature monitoring and herbal enemas should be discouraged. Keywords: Gastrointestinal perforation, necrotizing enterocolitis, low birth weight neonate.


Article
Swine Flu 2009, Morbidity and Mortality in

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Objective; swine flu is known to be caused by influenza A subtypes H1N1,H1N2, H2N3, H3N1, and H3N2, was first proposed to be a disease related to human flu during the 1918 flu pandemic, Iraq face the epidemic of 2009, many patients admitted to the medical word of alkindy teaching hospital, the clinical features were observed and managed according to WHO protocols. The aim of the study; is to asses some features of morbidity and mortality of swine flu epidemic admitted patients in 2009 in alkindy teaching hospital. Methods; A total 131 patients with suspected influenza admitted to Alkindy Teaching Hospital all complain of fever more than 38c, sore throat with or without cough. The admitted patients are of two main groups;a)seventeen secondary school pupils on their return from US,b)one hundred fourteen patients admitted from October till end of December 2009. History ,clinical examination and routine investigations for all patient in addition to blood samples and swabs from nose and throat were taken and sent to the central lab to test for H1N1 by PCR(real time). Results; fifty three (42%) of our patients found to have swine flu by positive test (real time PCR). It show that there is no relation of age whether young or old to being infected with swine flu or non swine flu (p>0.05). Table 2 also show that gender had no relation to possibility of infection with both non swine flu and swine flu influenza (P <0.05). We found that there was no difference of mortality between swine flu and non swine flu types (p>0.05) and pneumonia are more commonly associate influenza of negative test for swine flu virus (p<0.001). headache is more common in swine flu while chill is more common in non swine flu (p<0.05) in addition diabetes is more commonly associate swine flu than other types of influenza (p<0.05). Conclusion; This study concluded that mortality in swine flu influenza is not different from mortality in non swine flu influenza. Also age and gender had no relation to possibility of having swine flu infection. Pneumonia found to be more in non swine flu, headache associate swine flu more than non swine flu and chills associate swine flu. Diabetes associate swine flu more than non swine flu but smoking had no relation. Key words; swineflu, alkindy, mortality

Keywords

; swineflu --- alkindy --- mortality


Article
The Detection of Silent Celiac Disease In patients With Type 1 Diabetes Mellitus by the use of Anti Tissue Transglutaminase Antibodies

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Abstract

Objective: Detection the presumptive prevalence of silent celiac disease in patients with type 1 diabetes mellitus with determination of which gender more likely to be affected. Methods: One hundred twenty asymptomatic patients [75 male , 45 female] with type 1 diabetes mellitus with mean age ± SD of 11.25 ± 2.85 year where included in the study . All subjects were serologically screened for the presence of anti-tissue transglutaminase IgA antibodies (anti-tTG antibodies) by Enzyme-Linked Immunosorbent Assay (ELISA) & total IgA was also measured for all using radial immunodiffusion plate . Anti-tissue transglutaminase IgG was selectively done for patients who were expressing negative anti-tissue transglutaminase IgA with low total IgA levels & results were compared to that obtained from healthy 60 persons with mean age ± SD for them was 15.25 ± 3.85 year . Results : Fourteen out of one hundred twenty (11.66 % ) diabetic patients had expressed positivity to anti-tissue transglutaminase IgA compared to 1/60 ( 1.66 %) of non diabetic patients who had expressed such positivity , P value equals to 0.0221 & it is considered to be statistically significant. Three out of one hundred twenty (2.5 % ) diabetic patients had expressed total IgA deficiency whereas all of non diabetic patients were expressing total IgA within the normal range , P value equals to 0.55 & it is considered to be not statistically significant. All of three diabetic patients with total IgA deficiency were not showing positivity to anti-tissue transglutaminase IgG . Six mals & Eight female of those with type 1 diabetes mellitus had expressed positivity to anti-tissue transglutaminase IgA , P value equals to 0.1426 & it is considered to be not statistically significant . Conclusion : There is an increased prevalence of IgA antitissue transglutaminase antibodies ( 11.66 % ) in children & adolescent with type 1 diabetes mellitus in comparison with control group. Keywords:- Diabetes , Celiac disease , Transglutaminase.


Article
The Necessity of Teaching Diabetic Patients the Correct way of Insulin Administration: A Clinical Trial to Improve Glycemic Control

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Abstract

Background: It is important to achieve good glycemic control to avoid long-term diabetic complications. It has been largely debated about the role of correct way of insulin administration to get the desired glycemic control. Objective: To evaluate the effect of teaching diabetic patients who are on insulin therapy the correct way of injecting insulin and its effect on glycemic control. Methods: A non randomized clinical trial with 820 diabetic patients on insulin therapy on whom A1 c estimation was performed before and after three months of teaching them the right injection technique. Results : Sixty seven patients (8.17%) had A1 c 6.5% before they were enrolled in the study while the majority (753 patents, 91.82%) had A1 c 6.5% and the last group showed the best benefit of teaching them the correct way of injection when compared with first group (P= 0.0001). Also patient with age 20-40years showed the best results (P=0.0001), while the poorest results were observed in those aged 40 years and above. Conclusion: Teaching patients the right injection technique is important to achieve good glycemic control in those who already had poor one. Keywords: glycemic control, A1 c, injection technique.


Article
Validety of total laryngectomy Under local anaesthesia

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Abstract

BackgroundCarcinoma of the larynx represent 10% of head & neck malignancies. The treatment of advanced carcinoma of larynx may include partial or total laryngectomy, with or without laser , radiotherapy,and or chemotherapy . Carcinoma of the larynx usually affect old age , heavy smoker with possible risk of pulmonary diseases & ischemic heart disease , which add risk to the general anaesthetic complication operative & postoperative - Objectives this study was designed to assess the feasibility of total laryngectomy under local anaesthesia in medically unfit patients for general anaesthesia & to re-establish practice doing total laryngectomy under local anaesthesia in those patients. Methods a prospective study on 12 patients who underwent total laryngectomy under local anaesthesia in the otolaryngology department at Al-Jirahat hospital over a period from September 2007 to the end of July 2010. Results all patients tolerated the surgical procedure under local anaesthesia without disturbing the general condition of the patient, or the technique of surgery , with good postoperative recovery & early mobility of patient . Conclusion total laryngectomy can be done under local anaesthesia in case the patient is medically not fit for general anaesthesia , & in some other selected cases . Key words total laryngectomy, carcinoma , larynx, local anaesthesia .


Article
5 year-analysis of reported dog bites in Baghdad city

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Abstract

Background: Animal bites in humans are an important public health problem. Most of these bites are dog bites. Dog bites in humans are a complex problem embracing public health and animal welfare, both in developed and developing nations. . Objectives: in order to estimate the magnitude of the problem and to understand the epidemiological characteristics of dog bite victims registered in Baghdad city regarding their age, sex, number of registered dog bite victims per month and year along the studied period ( 2006-2010) and also to sniff out any seasonal variation in dog bite attacks . Methods: A across-sectional study was carried out during January (2011), in the Anti-Rabies clinic of (Pasteur Institute) .Data pertaining to victims was collected from the registered monthly reports from January 1, 2006 and December31, 2010. Results: The total number of registered dog bite victims per 5 years of the study was equal to 26795. The studied epidemiological characteristics showed highly significant differences towards male victims with monthly mean number (60.381), the age group (15-45) years as people at risk with monthly mean number (95.167) , the highest total number of registered dog bite victims during the year (2009), with a monthly mean number (56.056), also there was an evident increase in the number of dog bite attacks during the warm months (May and June) with a monthly mean number ( 50.82) Conclusion: The persistence of dog bite as public health problem in Baghdad city. Key wards: Dog bite/ Rabies

Table of content: volume:8 issue:2