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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E-mail:IPMJ2000@yahoo.com

Table of content: 2012 volume:11 issue:supplement

Article
Prevalence of Hepatitis B virus Infection Among Premarital People in Sulaimani Governorate

Authors: Mohammed Omer Mohammed
Pages: 535-641
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ABSTRACT: BACKGROUND: The magnitude of chronic infection with hepatitis B virus (HBV) varies substantially between the countries. Previous study in Sulaimani revealed that 2.3% of blood donors were positive for HBsAg. A better understanding of incidence and/ or prevalence of HBV infection and associated risk factors provides insight into the transmission of this infection in the community. Transmission of hepatitis B virus results from exposure to infectious blood or body fluids containing the virus. Possible forms of transmission include unprotected sexual contact, blood transfusions, re-use of contaminated needles, and vertical transmission from mother to child during childbirth. OBJECTIVE: To know the prevalence of HBsAg among premarital people in Sulaimani governorate, and to identify the associated risk factors responsible for seropositivity. PATIENTS AND METHODS: This prospective study was conducted in the premarital consultation clinic in Sulaimani city from November 2008 to February 2009, 1500 premarital people(750 males,750 females) from age 18 years and above of either sex. RESULTS: The prevalence of HBsAg among premarital people was 0.67%. In multivariate analysis, factors associated with an increased HBsAg risk were occupation, history of surgical operation, blood transfusion and tattooing. CONCLUSION: The prevalence of HBsAg among premarital people in Sulaimani province is lower than that previously reported, with male predominance. A positive relationship between HBsAg with occupation, history of surgical operation, blood transfusion and tattooing was reported.

Keywords

hepatitis B --- risk factors --- elisa --- premarital


Article
Characteristics of Extra Pulmonary TB Cases in the Specialized Center for Chest and Respiratory Disease

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ABSTRACT: BACKGROUND: Tuberculosis (TB) is a serious global problem. It remains the number one killer infectious disease in developing countries. The clinical manifestations of TB could be either Pulmonary or Extra pulmonary (EPTB). Extrapulmonary tuberculosis involves relatively inaccessible sites, and often, because of the vulnerability of the areas involved, much greater damage can be caused by fewer bacilli..In 2007 in the United States, 20% of newly reported cases of tuberculosis involved extrapulmonary sites only In order of frequency, the extrapulmonary sites most commonly involved in TB are the lymph nodes, pleura, genitourinary tract, bones and joints, meninges, peritoneum, and pericardium. However, virtually all organ systems may be affected. OBJECTIVE: This study was done to identify the Characteristics of extra pulmonary TB cases. METHODS : A cross sectional study was done in the specialized center for chest and respiratory disease in Baghdad and respiratory department in the early cancer detection center during the period 9th of January 2011 – 9th of June 2011. Any patient attending the specialized center for chest and respiratory disease in Baghdad during the study period diagnosed as a new case of extrapulmonary TB was enrolled in this study, also Any patient attending respiratory department in the early cancer detection center during the study period diagnosed as a new case of extrapulmonary TB was enrolled in this study. A total number of 70 TB patients were enrolled in this study. 35 male TB cases and 35 female TB cases RESULTS: In the male group 20 cases (57%) with pleural TB, 2 cases (5.7%) with uveitis-eye TB, 2 cases (5.7%) with pericarditis TB , 2 cases (5.7%) with orchitis TB , 2 cases (5.7%) with meningitis TB , 2 cases (5.7%) with miliray TB , 2 cases (5.7%) with skin TB , 2 cases (5.7%) with LN TB , and 1 case (2.85%) had osteoarticular TB. In the female group 17 cases (48.5%) had pleural TB , 7 cases (20%) with LN TB , 4 cases (11.4%) with osteoarticular TB , 4 cases (11.4%) had peritonitis TB , 1 case (2.85%) had thyroid TB , 1 case (2.85%) had salpingitis TB , and 1 case (2.85%) with breast TB. CONCLUSION: Pleural TB cases consist of more than half the extrapulmonary TB cases , and LN , osteoarticular and peritoneal TB cases consist of about quarter of the extrapulmonary TB cases , while all other cases form the remnant quarter


Article
Chronic Obstructive Pulmonary Disease; an Pidemiological Prospective Study

Authors: Muhammed .W.Al.Obaidy
Pages: 600-607
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ABSTRACT: BACKGROUND: COPD is preventable and treatable disease state characterized by airflow limitation that is not fully reversible, The airflow limitation is usually progressive and is associated with an abnormal inflammatory response of the lung to noxious particle or gases. Primarily caused by cigarette smoking (1)..COPD is the fourth leading cause of death worldwide and estimated to be the third cause of death by 2020(5 ). OBJECTIVE : *To describe sample of COPD patients by important parameters recommended from GLOBAL INITIATIVE FOR COPD & COPD PROFESSIONAL ORGANIZATION, (wwwgoldcopd.com &www COPD professional .org). * To have an enough idea about the prevalence of disease in Iraqi patients, study risk factors, , methods of diagnosis & management . PATIENTS AND METHODS : A cross sectional study of 200 patients that were recruited from outpatients & inpatients at medical city Those patients diagnosed as COPD according to ; -Age more than 35 years History of cough or productive cough, or. history of shortness of breath with.FEV1/ FVC less than 0.7 & FEV1 is 80% of predicted (MILD COPD) by spirometry Exclude patients-Patients with mixed obstructive & restrictive ventilator defect byspirometry. The study conducted from March 2005- March 2006 (about 1 year). to evaluate & compare the different way of presentation ,diagnosis, management & therapeutic measures. A total number of 200 patients were seen, examine,A send for important (available) tests needed & their medical records . RESULTS: Diseases are more prevalent in male 162 patients (81%) than female 38 patients (19%) & M;F about (4/1).Also COPD are more common in those who lived in rural area 127 patients(63.5%)than those in urban area 73patients(36.5%). show smoking are the most important risk factor in COPD patients recruited in this study about 177 patients( 88.5%) are smokers than 23 patients (11.5%) are never smoke. smokers about 117 patients ( 58.5% ) are current smokers( 94 patients 47% male & 23 patients 11.5% female) than 36 patients (18%) are ex smokers ( 29 patients 14.5% male & 7 patients 3.5% female) than 17 patients(8.5%) are passive smokers ( 12 patients ( 6%) male & 5 patients 2.5% female, than 7 patients ( 3.5%) all of them male are pipe smokers, In analysis cough presentation, we noticed 20 patients (10%) have dry cough and 140 patients (70%) have had productive cough. In those complaints from productive cough show 34 patients (17%) are scanty amount of sputum than 27 patients (13.5%) have moderate, and 79 patients (39.5%) large amount. . CONCLUSION: Cough and age are the most important predictors of the disease..tobacco smoking is the most important risk factors for COPD&smoking cessation is the single most effective important preventive steps cost effective in COPD management... Air pollution either indoor or outdoor plays an important role in development of COPD


Article
The Duration of Symptoms in Transient Ischemic Attacks

Authors: Nawfal M. Sheaheed --- Akram M. Almahdawi
Pages: 608-615
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ABSTRACT: BACKGROUND: The better understanding of the pathophysiology of brain ischemia ,the newer look provided by the increasingly available imaging techniques ,and the promising thrombolytic therapy have made the classical 24 hours time limit definition of Transient Ischemic Attack(TIA) outdated. A newer 1 hour time limit has recently been proposed and seems to be reasonable. OBJECTIVE: This study was designed to show the different aspects of TIA in relation to risk factors and imaging findings. DESIGN AND SETTING: A prospective study, patients were received at the neurology consulting clinic, examined clinically and by a set of investigations. PATIENTS AND METHODS: 32 consecutive patients with TIA of variable duration and presentation were clinically examined within variable intervals from onset of symptoms by means of a specially designed questionnaire followed by a list of investigations including imaging of the brain within 4 weeks of the onset of symptoms. RESULTS: Most TIAs last less than ten minutes (18/32, 56.25% of all). Patients with longer duration TIAs found to have higher incidence of abnormalities in brain imaging than short duration ones .Most of patients with TIA have more than one attack of TIA on presentation and patients with multiple TIAs have less incidence of cardiac disease than those who have single prolonged TIA. CONCLUSION: Most TIAs last less than 10 minutes. The longer the duration of the symptoms, the higher the frequency of recent infarcts detected by brain imaging. MRI of the brain is much more sensitive than head CT-SCAN in the detection of changes in patients who present with TIA .Patients with brief duration TIAs may not seek for medical help until they are recurrent while those patients with longer duration TIAs ask for medical advice early

Keywords

TIA --- CVA.


Article
The Impact of Inflammation on Adiponectin, IL-6 and CRP in Acute Myocardial Infarction Patients

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ABSTRACT: BACKGROUND: Adipose tissue is increasingly recognized as a key regulator of energy balance, playing an active role in lipid storage and buffering, and synthesizing and secreting a wide range of endocrine products that may be directly involved in the pathogenesis of the complications associated with obesity. Adiponectin is adipocyte derivate hormone that has important effect as anti-inflammatory factor. Inflammation contributes across the spectrum of cardiovascular disease, including the earliest steps in atherogenesis. IL-6 is one of the most important mediators of fever and of the acute phase response. C-reactive protein (CRP) is a protein found in the blood, the levels of which rise in response to inflammation (an acute-phase protein). Myocardial Infarction (MI) or Acute Myocardial Infarction (AMI), is the interruption of blood supply to part of the heart, causing some heart cells to die. OBJECTIVE: To investigate the level of adiponectin and its effect on IL-6 and CRP in patients with Acute Myocardial infarction. SUBJECTS AND METHODS: The study included 50 patients with Acute Myocardial infarction and forty healthy subjects as control group. Levels of adiponectin , CRP and IL-6 were measured. RESULTS: The levels of adiponectin, IL-6 and CRP were significantly elevated with (p<0.001), there was negative correlation between adiponectin with CRP and IL-6 in acute myocardial infarction patients. CONCLUSION: The significant increase in adiponectin in AMI may be related to inflammation. Adiponectin inversely correlated with inflammatory marker (CRP and IL-6) so it has anti-inflammatory properties and that make us consider it as cardiovascular protective factor


Article
Coronary Artery Ectasia in Ischemic Heart Disease Patients Referred to aTertiary Cardiac Center

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ABSTRACT: BACKGROUND: Coronary artery ectasia represents a form of atherosclerotic coronary artery disease seen in 1-5% of patients undergoing coronary angiography. OBJECTIVE: This study was conducted to verify the clinical characteristics and angiographic patterns of patients with coronary artery ectasia (CAE) among ischemic heart disease patients. METHODS: Coronary artery ectasia was identified in 62 patients by using coronary angiography. Patients were divided into 2 groups: Group A, included patients with isolated CAE (CAE and non flow limiting narrowing < 50%). Group B, included 51 patients with coexistence CAE with obstructive coronary artery disease (CAE and >70% narrowing of coronary artery). Then we compared these two groups with a control group (group C) which included patients with obstructive coronary artery disease in absence of CAE. RESULTS: In the study, 122 were analyzed; the mean age of patients was 56.1 ± 9.6 years. There were 99 (81.1%) males and 23 (18.9%) females. There were no significant differences regarding (age, hypertension, smoking, diabetes mellitus, body mass index and family history of ischemic heart disease) among three groups, but there was significant difference regarding gender in which males constituted (54.5%), (90.2%), (78.3%) of patients in group A, group B and group C respectively. There was significant difference in mode of presentation among these groups in which typical ischemic chest pain was found in (27.3%), (72.5%), (83.3%) of patients in group A, group B and group C respectively. Also there was significant difference in the electrocardiographic changes in which the changes were found in (45.5%), (84.4%), (58.6%) of patients in group A, group B and group C respectively. In patients with isolated CAE, right coronary artery was most frequently involved (91%) and by diffuse type of ectasia (50%) while in patients with coexistence of CAE and obstructive coronary artery disease, the left anterior descending artery was most frequently involved (72.5%) and by focal type of ectasia (45%). CONCLUSION: Male gender was more prevalent in patients with obstructive coronary artery disease than patients with isolated CAE. Also typical ischemic and electrocardiographic changes of myocardial ischemia were more prevalent in patients with obstructive coronary artery disease.


Article
Correlation Between Regional Wall Motion Abnormalities via 2-Dimensional Echocardiography, and Coronary Angiographic Findings

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ABSTRACT: BACKGROUND: Ischemic heart disease induce changes in myocardial performance and there are different ways to study this performance as using echocardiography and cornary angiogram OBJECTIVE: Correlate the findings of regional wall motion abnormalities assessed by 2D echocardiography, to the coronary artery lesions detected by coronary angiogram. METHODS: This study included 101 patients who attended the Iraqi Center of Heart Disease between March 2010 and April 2011. In addition to routine investigations, echocardiography and coronary angiography were done to them.Patients were grouped according to segments of regional wall motion abnormalities into 3 groups :group A (segments 1,2,7,8,13,14), group B (segments 3,4,9,10,15), and group C (segments 5,6,11,12,13,16).These groups were correlated according to the score of regional wall motion abnormalities, with each coronary artery lesions detected by coronary angiogram. RESULTS : (47.5%) of patients in group(A) had hypokinesia, Akinesia in (14.9%), and dykinesia in (21.8%), majority of these abnormalities were correlated with LAD lesions (P-value 0.0001).(44.4%) of patients in group(B) had regional wall motion abnormality in form of hypokinesia(35.6%), akinesia(7.9%), and dyskinesia(1%) .There was a strong correlation between group(B) and LCX lesions (P-value=0.0001) (27.8%) of patients in group(C) showed hypokinesia ,(5% ) Akinesia, and (8 % ) dyskinesia ,majority were associated with RCA lesions in form of critical and total occlusions. CONCLUSION: Regional wall motion abnormalities detected by 2D-echocardiography can be correlated with the lesions of the affected coronary vessel, in terms of the site and severity.


Article
Frequency of HLA-A and B Antigens in Iraqi Patients with End-Stage Renal Disease Preparing for Transplantation

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ABSTRACT: BACKGROUND: The likelihood of developing end-stage renal disease in an individual is determined by interactions between genetic and environmental factors. Human leukocyte antigen is the most polymorphic genetic system in man. Genes of this region influence susceptibility to certain diseases. OBJECTIVE: The purpose of the present study is to investigate the association of HLA class I (HLA-A and HLA-B) with the end-stage renal disease in Iraqi patients (Arab and Kurd). SUBJECTS AND METHODS: HLA-typing was assessed in 200 patients with end-stage renal disease and 110 healthy controls by microlymphocytotxicity assay. RESULTS: A survey of the distribution of HLA-A and HLA-B antigens frequencies yielded a significant variation between patients and healthy control group. Arab patients have significant increase in frequency of HLA-A2 as compared with healthy control (P=0.005). Whereas Kurdish patients revealed significant increase in frequency of HLA-B35 when compared with healthy control (P=0.033). CONCLUSION: The current study suggests that high frequency of HLA-A2 in Arab patients and HLA-B35 in Kurdish patients might be associated with susceptibility to risk of end-stage renal disease


Article
Flowcytometry for Estimating Efficient Transfection of Bone Marrow Cells with BCR-ABL Gene

Authors: Rihab Nasr --- Manal Adnan Habib --- Ahmad Iskandarani
Pages: 649-653
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ABSTRACT: BACKGROUND: Chronic myeloid leukaemia can be accurately modeled in laboratory mice by the retroviral transfer of a BCR-ABL gene into murine hematopoietic stem and progenitor cells, followed by transplantation of these cells into irradiated recipient mice. OBJECTIVE: The use of Retroviral vector for transfer of BCR-ABL gene into murine bone marrow cells (BMC) and measurement of efficiency of transfection by flowcytometry. METHODS: Murine bone marrow cells obtained from mice were cultured in a medium containing the supernatant of BCR-ABL (p210) transfected platinum E cells which is rich in retroviral vector carrying the BCR-ABL (p210) gene.The vector express green fluorescent protein (GFP) as well so that the efficiency of transfection of murine BMC with the target gene was able to be measured using flowcytometry. RESULTS: The use of the retrovirus packaging cell line enhanced the transduction of BMC with the retroviral vector and efficiency of transfection was 72% as measured by the flowcytometry. CONCLUSION: Transfer of BCR-ABL gene into murine BMC by retroviral vector that carry GFP marker which allowed the estimation of transfection efficiency by the flowcytomery


Article
Effect Nigella Sativa (Black Seed) on Liver Enzymes in Ischemia Reperfusion Injury

Authors: Mustafa Taha Mohammed
Pages: 654-657
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ABSTRACT: BACKGROUND: Hepatic ischemia-reperfusion (I/R) injury may occur in a variety of clinical settings and this remains a significant problem. Oxygen free radicals, produced on reperfusion have been shown to play a major role in hepatic I/R injury. Various therapeutic effects have been described for Nigella sativa. Additionally, it has been presented that Nigella sativa (orientalis) oil has protective effect against ischemia reperfusion injury to various organs. Therefore, it seems possible that the administration of Nigella sativa (orientalis) oil might protect the liver against the ischemia reperfusion injury . OBJECTIVE: To determine whether Nigella sativa (orientalis) oil prevents hepatic ischemia-reperfusion injury to the liver. METHODS: Thirty-six rats were divided into three groups as control (Group 1), I/R group (Group 2), and Nigella sativa oil (NS) treatment group (Group 3). All rats underwent hepatic ischemia for 60 min followed by 60 min period of reperfusion. Rats were intraperitoneally infused with only 0.9% saline solution in group 2. Rats in group 3 received NS oil (0.2 mL/kg) intraperitoneally, before ischemia and before reperfusion. Blood samples were harvested from the rats, and then the rats were sacrificed. Serum aspartate aminotransferase (AST), alanine aminotransferase (ALT), and lactate dehydrogenase (LDH) levels were determined. RESULTS: The levels of liver enzymes in group 3 were significantly lower than those in the group 2. CONCLUSION: Our results suggest that Nigella sativa oil treatment protects the rat liver against to hepatic ischemia-reperfusion injury.


Article
Single Stage Surgery for Treatment of Congenital Vertical Talus in Children 1 – 4 Years old

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ABSTRACT: BACKGROUND: Congenital vertical talus is an uncommon foot deformity that is present at birth and results in a rigid flatfoot deformity if left untreated and is more commonly associated with other neuromuscular conditions which have more rigid deformity and less favorable outcome. OBJECTIVE: To find the extent of radiological and clinical improvements after using a single stage surgical treatment for children aged 1 to 4 years having congenital vertical talus. METHOD: Single stage surgery was performed on 15 patients (19 feet) with congenital vertical talus starting from October 2008 to September 2010; all the patients were evaluated clinically and radiologicaly by measuring talocalcaneal and tibiocalcaneal angles, and categorized into 2 age groups for sake of treatment selection. Patients younger than 2 years were treated by soft tissue release, tendon lengthening and k-wire fixation of talonavicular joint, while in patients aged 2 years to 3 years and 6 months of age we added a tibialis anterior transfer to the surgery. Postoperatively the cases were evaluated in a way similar to that used prior to surgery. Analytic studies were performed, comparing the postoperative scores to those scores prior to surgery. RESULTS: Clinical improvements by increasing of the mean of clinical score from (12.79) preoperatively to (18.50) on last follow up evaluation and radiological improvements after single stage surgery showed by highly significant decrease in mean of lateral talocalcaneal angles with difference of (14.53°) and the highly significant decrease in mean of lateral tibiocalcaneal angles with difference of (35.06°). CONCLUSION: Single stage surgical treatment is very useful for treatment of congenital vertical talus in children 1 – 4 years old and can help to avoid the need for two-stage surgical correction and excisional surgeries.


Article
Evaluation of Holmium: YAG Laser Versus Pneumatic Lithotripsy for the Intra Corporeal Lithotripsy of the Ureteric Stones

Authors: Saad Dakhil Farhan
Pages: 668-674
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ABSTRACT: BACKGROUND : Ureteroscopy (URS) is a precise, minimally invasive surgical intervention that can assess the entire collecting system to treat a stone using intracorporeal lithotripsy.The implication of laser technology in the development of lithotripter fibres has revolutionised intracorporeal lithotripsy. OBJECTIVE: To compare the efficacy and safety of Holmium: YAG laser and pneumatic lithoclast in treating ureteric calculi. METHODS: The study included total of 65 patients divided into two groups of laser lithotripsy (LL) (25 patients) and pneumatic lithoclast (PL)(40 patients). Inclusion criteria were patients with a single ureteric stone of size 0.7cm-2.0 cm. Stone size was determined with pre op CT scan. A 8 French rigid ureteroscope was used for all cases. Holmium: YAG laser with 600 μm wide fiber size was employed in laser group and frequency was set at 8 Hz at a power of 1.2 joule.Pneumotic lithoclast with used in PL group. Postoperatively patients underwent radiography and helical CT as required to asses stone clearance. RESULTS: The mean patient age , the male to female ratio , stone size and site were similar between the two groups. Mean operative time in LL group was 35.5 minutes as compared to 25.7 minutes in PL group, the Stone migration up in pelvicalyceal system occurred in one patients(4%) of LL group while in nine patients(22.5%) of PL group. Double J (DJ) Stent was placed in 9 (36%) patients in LL group where as 17(42%) patients required it in PL group. Stone free rate at 4 weeks was 84% in LL group as compared to 72.5% in PL group. CONCLUSION: Holmium: YAG laser lithotripsy is a superior technology compared to pneumatic lithoclast in terms of rate of stone clearance and complications especially in upper ureteric stones.


Article
Evaluation of Modified Alvarado Score in the Diagnosis of Acute Appendicitis at Baghdad Teaching Hospital

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ABSTRACT: BACKGROUND : Acute appendicitis is one of the most common causes of abdominal surgical emergencies. It is associated with high morbidity and occasionally mortality related to failure of making an early diagnosis. Modified Alvarado Scoring System is a clinical score which aid in the diagnosis of acute appendicitis. OBJECTIVE : To evaluate the overall diagnostic value of Modified Alvarado Scoring System in patients with suspected acute appendicitis and to determine gender differences. Study design and Setting : A prospective study was conducted in the surgical emergency unit of Baghdad Teaching hospital in a period of five months extending from 18th February to 18th July 2011 PATIENTS AND METHODS : (100) consecutive patients above the age of (14) years old and of both genders with provisional diagnosis of acute appendicitis were subjected to interview questionnaire covering sociodemographic and clinical characteristics revealing 7 variables based on the Modified Alvarado Scoring System , summation of all scores were calculated for each patient before underwent surgery and all operated appendices were sent for histopathology. RESULTS: The total number of included sample were (100) patients , (57%) were females and (43%) were males , (60%) were in the age group of (15-24) years old , (49%) were admitted to hospital within (6-12) hours after onset of symptoms . (87%) had Modified Alvarado Score of ≥7 (57.5% females, 42.5% males) while (13%) had Modified Alvarado Score of <7 (53.9% females, 46.1% males) . Out of those (87%) patients with Modified Alvarado Score ≥ 7 , (92%) patients had acute appendicitis and (8%) patients had normal appendix on histopathological examination. The negative appendectomy rate for patients with score ≥ 7 was 8.1%. While patients with Modified Alvarado Score < 7 were (13%), only (46.1%) of them had acute appendicitis on histopathological examination giving a negative appendectomy rate of 53.9%. The sensitivity , specificity , accuracy and positive predictive value in males were ( 85.4%) , (0%) ,(81.4%) and (94.6%) respectively while in females were (100%) , (58.3%) , (91.2%) and (90%) respectively . The overall sensitivity , specificity , accuracy , negative appendectomy rate and positive predictive value were (93%) , (50%) , (87%) , (14%) and (91.9%) respectively . CONCLUSION: Modified Alvarado Scoring System is helpful in the diagnosis of acute appendicitis.

Keywords

alvarado --- appendicitis


Article
The Rate of Non Union in High Velocity Missile Open Limb Fractures and the Factors Influencing It: a 5 Year Retrospective and Prospective Study from Medical City in Baghdad(part 1)

Authors: Ali Bakir Al-Hilli
Pages: 684-693
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ABSTRACT : BACKGROUND: High velocity missile injuries (HVMIs) are increasing among civilians, the mechanism causing such injuries are totally different from blunt trauma. These injuries associated with complications such as soft tissue injury, vascular injury, infection and nonunion. in addition to systemic, economic and psychological complications. OBJECTIVE : A retrospective and prospective review of case series aimed to conclude the rate of non union in HVM fractures, and to explore the important factors that increase this risk (timing, severity, Infection, and non-steroidal anti-inflammatory drugs). In this part of the study we will discuss the effect of severity, timing of wound debridment and infection. PATIENTS AND METHOD: A 109 limb injuries in 97 patients (victims of high velocity missiles) treated at Orthopedic department in Medical City in Baghdad/Iraq in the period 2004-2008 were studied. Data for timing of surgical management, severity, deep infection rate, nonunion, drug administration and smoking were collected from medical city records, patient questionnaire and follow up in outpatient department both clinically and radiologically for a minimum of one year. RESULTS: The rate of non union was 29.36%, and the rate of deep infection was 28.44%, the most important factor affecting non union is infection, nonunion associated with infection in 50% of nonunion (infection increases the risk of nonunion three times), Severity(minor, moderate and severe) is another important factor the rate of nonunion was 26.51% in moderate and 38.46% in severe injuries, infection was 25.30% in moderate and 38.46% in severe injuries. Timing of debridment in our study showed no effect on the rate of non union or infection (nonunion rate was 28.57% and infection was 30.35% if debridment done less than 6 hours after injury and 30.19% nonunion and 26.41% infections for more than 6 hours after injury treated group). CONCLUSION: HVMIs causing severe types of open fractures, with high rate of non union and infection. Severity of the injury increases the risk of nonunion and infection. Infection increases nonunion risk three times, and there is no effect of timing of surgical management on the rate of nonunion or infection.


Article
Non Leukaemic Chidhood Anaemia in Mosul

Authors: Sana M. Taib
Pages: 694-697
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ABSTRACT: BACKGROUND: Anaemia is not a disease by it self but it is a sign not diagnosis of many disease and anaemia is very common among children. OBJECTIVE: To assess the frequency of anaemia among childen METHODS: This study include (408) anaemic children (243 male and 165 female) with ratio (1.4:1) their haemoglobin level was below 10g/ dL . They were admitted to paediatric hospital in Mosul . Routine haematological tests were done and some special haematological tests were performed when indicated. RESULTS: Three hundred children (300) out of 408 (73.5%) were admitted because of infection. The most common type of anaemia was normochromic normocytic (53.18%) , the second type of anaemia was hypochromic microcytic (32.11%), haemolytic anaemia represented (8.83%), the rest type of anaemia were normochromic macrocytic anaemia (5.14%) and dimorphic anaemia was (0.74%). CONCLUSION: Anaemia is a common paediatric problem and iron deficiency anaemia is the commonest cause of childhood anaemia so that the main focus for prevention of this needs to be on education around childhood nutrition


Article
Zinc Status In Children With Bronchial Asthma

Authors: Tiran Abdulsttar Kakarash --- Abbas Al-Rabaty
Pages: 698-703
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ABSTRACT: BACKGROUND: Bronchial asthma is a chronic inflammatory disease of the respiratory tract. The rise in asthma and allergic disease among children is a matter of worldwide concern. Many authors have argued that the changes in diet may have been an important determinant of increased susceptibility to asthma. Free radicals have been proposed to be responsible for the pathogenesis of many diseases because of their harmful effects on the cells and tissues. The enzymes responsible for antioxidant defense have trace elements like zinc. OBJECTIVE: To evaluate the relation between bronchial asthma and zinc serum level, and the relation between serum zinc level and the duration and severity of asthma. PATIENTS AND METHODS: A Case control study was conducted at Raparin pediatric teaching hospital in Erbil city. Fifty children from ages 1 to 12 years of both sexes who were known cases of asthma and had visited Raparin teaching hospital were enrolled in this study, another sample of 50 healthy children matched for age and gender, without history of chronic disease were taken as a control group. The zinc concentrations in serum were measured in both cases and controls. RESULTS: This study shows that there were significant difference in the values of serum zinc between asthmatic and control group (p<0,01 and p<0,01 respectively).The mean concentrations of zinc are lower in asthmatic children(70.02μg/dl) in comparison to controls(84.04μg/dl). CONCLUSION: Children with bronchial asthma have a great risk of zinc deficiency, and serum zinc level has significant relation to the severity of asthma and the use of steroid

Keywords

asthma --- serum zinc


Article
Neonatal Intestinal Obstruction in Mosul City

Authors: Sinan Nief Lotfi Aljarrah --- Kais Alwattar
Pages: 704-711
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ABSTRACT: BACKGROUND: Intestinal obstruction is the most common surgical emergency of the newborn. Those cases require specialized care and facilities for survival. It may be caused by several embryonic and functional anomalies. we studied the causes of neonatal intestinal obstruction in mosul in the north of Iraq to get data that was not available about this subject. OBJECTIVE : To study the causes of neonatal intestinal obstruction and the pattern of their distribution in Mosul city and its drainage areas in the north of Iraq. METHODS: A prospective study of 156 cases with neonatal intestinal obstruction ,all of our patients were managed in Al-Khansa' teaching hospital in the period between( February 2001-2003). RESULTS: The male:female ratio was 1.9:1. Mean duration of symptoms 4.33 days. The most common cause was imperforate anus(22.4%), followed by intestinal atresia (15.4%), meconium plug syndrome (13.5%), medical causes (12.2%), congenital megacolon (11.5%), neonatal perforation (4.5%), necrotizing enterocolitis (NEC) and simple meconium ileus (3.9%) malrotation (2.6%), respectively and other rare causes (< 2%). The overall mortality was 22.2%. the mean duration of hospital stay 5.4 days. CONCLUSION: The causes of neonatal intestinal obstruction and the percentage of each cause are in variance with other studies. Imperforate anus and functional causes (e.g. ileus, sepsis) were higher, while intestinal artesia , meconium ileus and malrotation were lower than recorded by others.The mortality is near to that in developing countries with higher mortality in cases of necrotizing enterocolitis, meconium ileus and other rare causesof obstruction; delayed presentation and the lack of neonatal intensive care units at the time of the study being the main problems, that resulting in high mortality rate


Article
Emergency Obstetric Hysterectomy in Elywia Maternity Teaching Hospital Baghdad

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ABSTRACT: BACKGROUND: Emergency obstetric hysterectomy is a life saving procedure in severe obstetrical hemorrhage. OBJECTIVE: To review frequency, indications, associated risk factors and maternal morbidity and mortality associated with emergency obstetric hysterectomy done in Al- Elwiya maternity teaching hospital-Baghdad PATIENTS AND METHODS: A prospective study carried out from January the 1st 2010, to December 31st 2010.Maternal parameters analyzed were age, parity, booking status, setting, anemia& pre existing diseases, history of traditional birth attendants interference, mode of delivery, history of caesarean section, time of arrival to hospital and postpartum state of on arrival, frequency ,indications of emergency obstetric hysterectomy, associated maternal morbidity and mortality. RESULTS: During the study period ; 200 cases developed postpartum hemorrhage out of 17150 deliveries. Thirty-one cases ended by emergency obestetric hysterectomy and 169 cases were conservatively managed medically or surgically, giving an incidence of 1.8/1000 deliveries.Emergency obestetric hysterectomy following vaginal delivery was 0.11% and following cesearean section was 0.27%. Majority of patients were un booked 77.41% and their age group 25-42years. Common parity was 3 and 4. Morbidly adherent placenta was commonest indication of emergency obestetric hysterectomy ; 51.61% , rupture uterus 22.60% , atony of uterus 12.90% , broad ligament heamatoma 9.67% .Out of 31 cases; 15 cases had traditional birth attendant interference 48.38%.All cases required blood transfusion and admission to intensive care unit. Out of 31 cases; 2 maternal deaths 6.45% . Total hysterectomy performed in 20 patients, and subtotal in 11 . CONCLUSION: Emergency obstetric hysterectomy is a life saving, surgical procedure to arrest intractable obstetric hemorrhage .It brings down maternal mortality when performed in selected cases at appropriate time. Identification of risk group , planned delivery and timely referral of risk parturient; can minimize its performance .


Article
A comparison Between the Transversus Abdominis Plane (TAP) Block Versus Traditional Parentral Analgesia Post Caesarian Section

Authors: Iyad Abbas Salman --- Hayder Saad Kamel
Pages: 718-723
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Abstract

ABSTRACT: BACKGROUND: Postoperative pain, especially when poorly controlled, results in harmful acute effects (i.e., adverse physiologic responses) and chronic effects (i.e., delayed long-term recovery and chronic pain). The transversus abdominis plane (TAP) block is a new method of providing postoperative analgesia in patients undergoing lower abdominal wall incisions OBJECTIVE: To compare the effectiveness of TAP block versus traditional parenteral analgesia post caesarian section. PATIENTS AND METHODS: A prospective randomized double blinded placebo controlled clinical trial conducted in the department of obstetrics & gynecology of medical city complex. over a period of four months from 1st of November to 1st of march. Fifty women patients were selected to be enrolled in this study who were scheduled for C.S. via pfannenstiel incision, all patients were of ASA I- II physical status. Twenty five of them were given TAP block with (bupivacaine 0.25%) & placebo i.v saline (0.9%) , the other twenty five were given i.v tramadol & i.m diclofinac sodium & placebo TAP block with normal saline 0.9%.Numerical rating scale was used to follow up the patients postoperatively at 2,6,12,16 hours. RESULTS : By comparing the means of numerical analogue scale score over the time there was a significant difference in mean score over the time, the traditional treatment had better effect on relieving pain only at the 1st 2 hours where TAP block was better on the rest time with a highly significant difference P.value < 0.05 in all comparisons. CONCLUSION: TAP block is not effective as sole analgesic, but is effective in reducing the frequency of doses of incremental analgesia. TAP block is more effective than traditional analgesia in reducing the mean of pain score .The traditional parentral analgesia require more frequent dosing.


Article
Isolation and Identification of Isolation and Identification of Isolation and Identification of Isolation and Identification of Isolation and Identification of Isolation and Identification of Isolation and Identification of Isolation and Identification of Malassezia Malassezia Malassezia Malassezia Species in Patients Species in Patients Species in Patients with Pityriasis Versicolorwith Pityriasis Versicolor with Pityriasis Versicolor with Pityriasis Versicolorwith Pityriasis Versicolor with Pityriasis Versicolor with Pityriasis Versicolorwith Pityriasis Versicolorwith Pityriasis Versicolorwith Pityriasis Versicolor with Pityriasis Versicolor with

Authors: Jasim M. Karhoot --- Adil A. Noaimi --- Warkaa F. Ahmad
Pages: 724-730
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ABSTRACT: BACKGROUND: Malassezia are unipolar yeasts that comprised from eleven species and recognized as commensally skin flora that may be pathogenic under certain conditions. OBJECTIVE: To isolate and identify different species of Malassezia in Iraqi patients with pityriasis versicolor. MATERIALS AND METHODS: This case investigative study was done in Microbiology and Dermatology Departments, College of Medicine, University of Baghdad- Baghdad, Iraq during the period from April 2008 - October 2008. One hundred patients had pityriasis versicolor were evaluated regarding all points related to the disease. Wood's light and skin scraping for mycological examinations were done. Methylene blue stained samples were examined for the presence of clusters of yeasts, budding cells, and hypha. Tween assimilation and splitting of esculin tests were carried out. RESULTS: The most common isolated species were Malassezia globosa 40(51%), followed by Malassezia furfur 24(30%), Malassezia symbodialis 8(10%), Malassezia obtuse 5(6%) and Malassezia restricta 2(3%). CONCLUSION: Malassezia globosa was the most predominant species involved in etiology of pityriasis versicolor lesions followed by Malassezia furfur.


Article
Acute Dysentery Due to Free-Living Amoebae of the Genus Acanthamoeba

Authors: Sami Y. Guirges
Pages: 731-733
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ABSTRACT: BACKGROUND: It is well known that diarrhoea is caused by intestinal infection with parasites, bacteria, fungi or viruses. OBJECTIVE: This study was carried out to detect free living parasitic amoebae as a cause of diarrhoea . MATERIALS AND METHODS: Stool specimens from 120 patients suffering from severe diarrhoea with abdominal cramps were examined directly and cultured on special media for the isolation of free-living amoebae. RESULTS: In 120 patients with diarrhoea, 14(11.6%) showed presence of motile cells suspected to be free-living amoebae of the genus Acanthamoeba. These amoebae were isolated in culture in 4(28.6%) of the cases. CONCLUSION: Fourteen cases of non-fatal acute dysentery due to free-living amoebae without symptoms of meningoencephalitis is reported. Isolation of Acanthamoeba sp. from diarrhoeic stool was successful in (4) cases


Article
Study of H.Pylori in a Group of Iraqi Patients with Inflammatory Bowel Disease (Histological and Molecular Study)

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Abstract

ABSTRACT: BACKGROUND: Helicobacter pylori is one of the commonest bacterial pathogens in human. The organism is associated with development of peptic ulcer diseases, lymphoproliferative disorders and gastric cancer. Helicobacter pylori could be isolated from patients with inflammatory bowel disease (IBD) but still the possibility of etiological link need further study therefore OBJECTIVE: Is to assess the possible causal factor of H.pylori in development of inflammatory bowel disease, in addition to assess Cytotoxic associated gene A(CagA) gene status in H.pylori positive samples. PATIENTS AND METHODS: Study involved 120 patients of colonoscopically determined normal colon (n=90) & patients with IBD (n=30) including both Ulcerative colitis(n=16) and Crohn’s disease(n=14). Those patients is further divided into three age groups including <20 years group, 20-40 years group and >40 years group of Iraqi patients. Endoscopic specimens after histopathological confirmation of diagnosis will be tested for Biopsy Urease Test (BUT) and Hematoxylin & Eosin (H&E) methods (for detection of H. pylori) also detection of CagA mRNA using In Situ Hybridization technique with a biotin labeled probe (to specify pathogenic H. pylori) RESULTS: H.pylori detected in 36.7% (using BUT) and 30% (using H&E) in the colon of IBD patients and 33.3% (using BUT) and 26.7% (using H&E) in patients with normal colon (NC patients) as a control. Among our H.pylori positive patients, there was significant difference (P=0.036) regarding CagA status in which 25% were CagA positive of NC patients and 66.7% CagA positive H.pylori in IBD patients using In Situ Hybridization technique. CONCLUSION: H.pylori was isolated from nearby or the site of lesion of patients with inflammatory bowel disease although there was no statistical relationship between H.pylori and IBD. In addition CagA genes were more prominent in H.pylori that isolated from IBD patients than H.pylori of normal colon. Also there was no possible relationship between age and infection rate of H.pylori in both IBD & NC patient


Article
Isolated Renal Hydatid Cysts: A New Series from an Endemic Area

Authors: Niema H. Al-Heeti
Pages: 742-747
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ABSTRACT: BACKGROUND: Hydatid disease is a zoonotic infection caused by the larval stage of a tapeworm particularly Echinococcus granulosus. It is considered an important public health problem in many areas of the world. It is one of a serious endemic parasitic diseases in Iraq. OBJECTIVE: We report our experience in management of 29 case of isolated hydatid cysts of the kidney over an 18-year period in Anbar Governorate- West of Iraq . PATIENTS AND METHODS: Twenty- nine patients with isolated renal hydatid cyst were surgically treated from 1994 to 2011 in Al-Ramadi teaching Hospital, Anbar / Iraq. Clinical, laboratory, radiological data, and surgical findings are analyzed. RESULTS: Out of the 29 patients included in this series;15 were males and 14 were females. Mean age was 22.5years.The main clinical symptom was flank pain in 24patients (82.7%),hydatidurea in 3 patients(10.3%),and palpable flank mass only in one(3.5%). The cyst was asymptomatic in one (3.5%) .All patients were treated by open surgery. Nephrectomy was performed in one patient, partial nephrectomy in 2, and total cystopericystectomy in 2 . All others 24 cases were treated by modified partial cystopericystectomy. No recurrence reported during the follow up period from 19 to 28 months(mean :23 months) in18 patients, and 11 patients were lost from follow up after 6months of surgery. CONCLUSION: The exact incidence of isolated renal hydatid cyst is unknown in Iraq. It is of equal incidence in both sexes, and more in young age .Preoperative diagnosis could be done depending on ultrasonography ,intravenous urography ,and computerized tomography. The pressure difference between the renal pelvis and inside the cyst will determined the fluid movement at site of communication. Subtotal cystopericystectomy (Modified partial cystopericystectoy) is kidney-sparing surgery with minimal morbidity


Article
Vomiting, Weakness, and Skin Discoloration in a 10Year Old Child

Authors: Mustafa Alqaysi
Pages: 748-750
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CASE PRESENTATION A 10 year old Pakistanian boy presented to my OPD pediatric clinic with complaints of protracted vomiting and weakness , for the last few days and that his weakness had progressively worsened to the point that he was not able to bear weight on the day of presentation. The emesis was no bilious and none bloody and was associated with vague, diffuse abdominal pain. His mother reported no fever, diarrhea, travel or exposures. No medication had been given for his symptoms. Medical history The patient’s mother described him as an otherwise healthy boy, with normal birth history and no medical problems in the past. The mother reported that the patient’s visual acuity started deterioration before one year for that reason she consult ophthalmologist and prescribed glasses for his visual impairment. The ophthalmologist showed pigmentary retinopathy (retinitis pigmentosa) and retinal flat with hyper pigmented geographic macular lesion, lens clear, squint with refractory error showed in his both eyes. And diagnosed as (Non accommodative Esotropic) Physical Examination: Vital signs: Afebril, heart rates from 94- to 113 beats per minute- -Blood pressure,from 91/48- to 80/40 mmHg,-respiratory rates 20-30 breathe per minute -oxygen saturation% =100%.-weight 23.7 kg BMI 23 General: Thin, weak, and dry tongue, alert and awake but listless Head, eyes, ears, nose, and throat, normocephalic;Squint and pupils equal& reactive at 3 mm, mucus membranes dry and dark Neck: supple with no adenopathy; no signs of meningismus. Zulekha Hospital /Dubai UAE. Cardiovascular: tachycardia, regular rhythm, no murmurs, rubs, or gallops. Lungs: lungs clear to auscultation bilaterally Abdomen: soft & flat with diffuse tenderness no rebound or guarding, no organomegaly, masses, or hernias Extremities: thin but with nail dystrophic changes and bluish discoloration no joints swelling. Skin: tanned skin, no rash, bruises, purpura, or petechie Capillary refill delayed at> 3 sec. Neurological examination: Glasgow coma scale score=15, generalized weakness but with normal muscle strength, tone, sensation and coordination Management -the child was admitted in the hospital -Intravenous access was obtained and fluid resuscitation was started with normal saline boluses 20ml/kg .and initial laboratory workup included- Venous blood gas analysis, complete blood count CBC, c-reactive protein-CRP,-ESR,-Peripheral smear,-metabolic paneland tissue transglutaminase, glygated haemoglobin (HBA1c),-Hormonal assays: 1-thyriod Function tests 2-parathyroid hormone 3- 9 am cortisol 4- ACTH 5-Aldosteron 6- rennin 7- 17 hydroxyprogesteron Laboratory and radiographic studies Venous blood gas pH 7.33 PCO2 40mmHg -CBC, WBC : 12 000 Cells/ mm3 Hb, 16/dl, Heamatocrit 48%, Platelets 401000 cell/ml,differential counts (59% neutrphils, 32% lymphocyte, 8% monocytes, 0% eosinophils).coagulation normal. Hormonal assays: thyroid function test and 17 hydroxyprogesteron 0.06 ng/mL within normal and parathyroid hormone 5ng/ml (10-65ng/L) and 9 am cortisol 1.5ug/dl (4.3-22.4 ug/dl), aldosteron <10 ng/L (40-310 ng/L) were low and ACTH 19.5pg/ml (<10pg/ml), and plasma renin 4.9 ng/mL/hr (1.31-3.95) were high.

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Table of content: volume:11 issue:supplement