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: 2010 volume:6 issue:1

Article
Planning a Medical Lecture

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Abstract

The aims of the lecture should be clearly defmed. These will help to define the teaching methods and the structure. If, for example, the purpose of the lecture is to introduce new knowledge and concepts, then a classic lecture structure might be most appropriate. On the other hand, if the purpose is to make the students aware of different approaches to a particular clinical problem, a problem oriented design in which alternative approaches are presented and discussed might be a more appropriate fonnat. Lectures are still a common teaching methOd in both undergraduate and postgraduak medical education. Properly done, the lectwe is a creative and personal work by the teachll:l modeled upon his intellectual scaffolding. Few other fonns of instructional method demand such a high degree of originality from tire teachers, making it both challenging adtl rewarding for them. Their continued popularity is due to the fact that they represent cr;; effective and efficient means of teaching net' concepts and knowledge.

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Article
Towards More Objective Teaching Curriculum

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T~.~re have been notable developments in the field of r.ldical education in the country and in the region. The most significant of which is a general awarness that has been created about the need for and relevance of changes.There is however a basic question that posses itself and becomes clearly relevant in the context of effort .Today, to recognize health care services in the developing countries in the light of realigned priorities This ensure to bring about learning outcomes as a tocurriculum changes to meet this demand.

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Article
Is co2 laser Hemorrhoidectomy superior to conventional open Hemorrhoidectomy?

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Background: Hemorrhoids are one of the most common surgical conditions .Conventional haemorrhoidectomy was the traditional operation for the treatment of hemorrhoids. Other modalities of treatment had been used as an alternative operations including CO2 laser haemorrhoidectomy. Objectives: To determine the outcome of treatment of hemorrhoids by using CO2 laser haemorrhoidectomy and its advantages over conventional surgery Methods: This is a retrospective comparative interventional study of 1024 case of third degree haemorhoids selected out of 1300 case of hemorrhoids of different degrees, admitted to ALKINDY, ALYERMOUK teaching hospitals and ABD ALMAGEED private hospital, from May 1998 to July 2002,they were treated by CO2 laser haemorrhoidectomy and conventional surgery. They are divided into 2 groups randomly, 512 cases treated by CO2 laser (group A), 512 cases treated by conventional surgery (group B). Both groups were studied regarding operative time, hospital stay, healing time, post operative complications and cost effectiveness. Results: In GROUP A, the operative time ranged from 10 to 20 minutes with an average of 13 minutes. The hospital stay ranged from 4 to 12 hours with a mean time of 10 hours as all cases were treated as day cases. Post operative pain was minimal in 50% of patients and required simple analgesia for treatment while 50% had no pain. Bleeding occurred in less than 1% of cases, anal stenosis 3.3%, Infection recorded in 0.58% of patients.In GROUP B, The operative time ranged from 15 to 25 minutes with an average time of (19) minutes, hospital stay ranged from 24 to 48 hours with a mean time of 28 hours .Post operative pain recorded in all the patients (100%) and required narcotic analgesia for treatment, 25 patients (4.8%) had varying degrees of bleeding, 40 patients (7.8%) had infection, 25 patients (4.8%) had anal stenosis.In group A due to shorter hospital stay, earlier healing of wounds, earlier return to work which was within 7 to 10 days, the surgical treatment proved to be cost effective. Conclusion: CO2 laser Hemorrhoidectomy was found to be easy and safe procedure with lower rate of complications, shorter hospital stay and cost effective.

Keywords

Co2 --- Laser --- Hemorrhoids


Article
Assessment of workplace hazards among working children in al amen city, Baghdad

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Back ground: One out of six children in the world today is involved in child labor, doing work that is damaging to his or her mental, physical and emotional development. Objective: Assessment of some health problems among the studied working children. Method; A cross-sectional study was conducted in Al Amen Primary Health Care (PHCC) during the period from January to August 2009, a sample of 6048 children were selected randomly(3218girls and2866 boys age between 5-17 years ) and interviewed to collect information using a structured questionnaire form, information related to different aspects of child labor prevention were included in the form as well as a general medical examination and laboratory assessment. Results:. The frequency of child labor was 10.95% among the children study, and the detection of work related illnesses among working children was observed in 402 working children(60.36%).While work related accidents was 264(39.63%).Both sexes showed difference in frequency of labor (77% boys and 23% girls).there was association between malnutrition and child labor(x2=64.11 ,df=1,p-value<0.05)also such a association with smoking habit (x2=98.53,df=1,p-value <0.05) .The highest frequency of child labor (32%)was found among 15-17 years age group of boys. While the highest frequency of child labor (11.71%)was found among 9-11 years age group of girls. Out of 666 working children there are 26 child with lead poisoning(3.90%). Conclusion: Child labor can induce many health problems among the studied working children


Article
Re-evaluation of lunation of the activity of somantibacterial drugs against clinical isolates of Escherichia coli in al- najaf al- ashref governorate

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Background: Escherichia coli is one of the most important bacterial pathogen that can cause several disease to human being . In our study we try to investigate the sensitivity resistance pattern of Escherichia coli against three antibiotics ( Amikacin, Nalidixic acid and Cephalexin). Methods: For this purpose we collected 51 clinical isolates of Escherichia coli from stool and urine of outpatient and inpatient patients from different wards of AL-SADER Teaching Hospital in AL-NAJAF AL-ASHRAf, IRAQ, and tested by culture and sensitivity test . Results: The results appeared that Amikacin show the highest percentage of sensitivity ( 66.66 % ) , while Cephalexin show the lowest percentage of sensitivity ( 6.34 % ) . Conclusions: we conclude that Amikacin is the most sensitive antibacterial drug for Escherichia Coli as compared with Nalidixic acid and Cephalexin, while Cephalexin is the most resistant antibacterial drug for Escherichia Coli as compared with Amikacin and Nalidixic acid.


Article
Comparative study of the renoprotective effects of captopril and aminophylline against cainst cisplatin – induced nephrotoxicty in rats

Authors: Adel .H .Sheeh عادل شيح
Pages: 28-32
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Background: Cisplatin is one of the most commonly used anti-cancer drugs , but its clinical use was limited by its nephrotoxicity . Methods: In this study we try to investigate the renoprotective effect of captopril and aminophylline against cisplatin induced nephrotoxicity .For this purpose a 36 Sprague Dawley rats was divided randomly to 6 groups , each group consist of 6 rats. The first group given normal saline and act as control group, while the other 5 groups given cisplatin ( 7.5 mg/kg ) , captopril ( 60 mg/kg ) , aminophylline ( 24 mg/kg ) , captopril with cisplatin and aminophylline with cisplatin respectively. All drugs are given as single dose through intraperitonial route. After 6 days blood urea and serum creatinine, malondialdehyde and glutathione are measured and compared with control group. Results: The data show that both captopril and aminophylline posses renoprotective effect against cisplatin – induced nephrotoxicity, also the data show that captopril renoprotective effect is more than that produced by aminophylline. Conclusions: This data can help in increase the dose of cisplatin in clinical uses together with use of renoprotective agent , specially if the patient already need such renoprotective drugs for treatment of disease a way from cisplatin as hypertension .Also more clinical studies required for more assessment of the clinical pattern of this renoprotective effect


Article
Prevalence of bacterial infection and their sensitivity in patients undergoing an infertility eval

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Background: Infection with sexually transmitted diseases is broad and includes bacterial, viral and protozoa infection. Large number of infected people goes untreated because of symptomatic or unrecognized infections. Patients and methods: Forty five patients was complaining from infertility (primary or secondary), consulting Kammal El-Sammari Hospital for infertility from May - 2008 to February - 2009. Control group consisted of twenty fertile women that consulting private clinic for checking. Four swabs were taken from each woman in two groups. Two swabs were taken from posterior fornix of the vagina (High vaginal swab) and the last two were taken from endocervical canal. First swab (vagina and cervix) was examined directly under light microscope (wet mount) and stained by Gram stain. The other swab was cultured on Blood and Chocolate agar. Results: The patients group consisted from forty-five female patients, their aged ranged from (22-45 years), (X= 32.9). Direct examination (wet mount) and Gram staining of high vaginal swab showed significant increased in leukocyte (pus cells) and epithelial cells in infertile group than normal one. The isolated bacteria from culture of high vaginal swab were Streptococcus agalactiae (group B streptococci) which was significantly increased than fertile group. This bacteria was sensitive to Cephaloxtin and Cephotaxime and resistant to Penicillin Conclusions: The isolated bacteria from culture of high vaginal swab were Streptococcus agalactiae (group B streptococci). This bacteria was sensitive to Cephaloxtin and Cephotaxime and resistant to Penicillin .

Keywords

:Infertility --- bacteria --- antibiotic


Article
Electron Microscopic Study of the Effects of Preeclampsia on the Placental Endothelial Cells Ultra Structures during Pregnancy

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Background: Preeclampsia occurs in 3-5% of pregnancies and is a major cause (12-20 %) of maternal mortality in developed countries. It is the leading cause of preterm birth and intra-uterine growth restrictions (IUGR). Objective: The study was designed to determine and demonstrate the ultra structural changes of endothelial cells in placenta of women suffering from hypertensive disease. Patients & Methods: Placental samples were obtained from two groups of pregnant women groups (preeclamptic and normal pregnant women). The specimens were fixed in 2.5% gluteraldehyde and preceded for electron microscopic examination. Results: Placenta of women with preeclampsia has shown marked degenerative changes in both endothelial and trophoblastic cells. These changes were represented by precipitation of fibrin with the accumulation of platelets in capillary lumen. Abundance of collagen fibers precipitate in the apical region of both endothelial cells and trophoblasts, with thickening of endothelial basement membrane. Conclusion: All histological changes or lesions obstruct the continuous conduction from maternal surface of the trophoblasts through fetal capillary endothelium causing endothelial dysfunction.


Article
Evaluation the Effectiveness of Impregnated Net in Reducing Leishmaniasis Incidence: Diala-Iraq

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Background: Leishmaniasis is important public health problem owing to its impact on morbidity and mortality and difficulties in application of effective control measures. Objective: The aim of the study is to evaluate the using of impregnate bed nets in the control of leishmaniasis. Methods: The study was conducted throughout the years 2004 and 2005, in Diala Governorate (about 60km north-east Baghdad). This is the first study in Iraq for evaluation of the impregnated bed net in control of leishmaniasis. Two villages were selected to achieve this aim. The nets were distributed for the first village to be used by their population. The second village was served as control. Results: The results revealed that there was a significant decline in the incidence of cutaneous leishmaniasis from 19.23 per 1000 (before net distribution) to 3.34 per 1000 (after net distribution). On other hand, there was no significant difference in the incidence in the second village (control) as it was 13.42 to 12.46 per 1000. Conclusions: Impregnated bed net is effective in the reduction of leishmaniasis incidence when used properly as a control measures.


Article
Human Leukocyte Antigens class II influence the expression of Glutamic Acid Decarboxylase auto antibodies in Type Diabetic children and their Siblings

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Background: The immunogenetic predisposition may be considered as an important factor for the development of Type 1 Diabetes Mellitus (T1DM) in association with the HLA antigens. Objective:This study was designed to investigate the role of HLA-class II antigens in the etiology of type T1DM and in prediction of this disease in siblings, and its effect on expression of glutamic acid decarboxylase autoantibodies (GADA). methods:Sixty children who were newly diagnosed type 1 diabetes (diagnosed less than five months) were selected. Their age ranged from 3-17 years. Another 50 healthy siblings were available for this study, their ages range from 3-16 years. Eighty apparently healthy control subjects, matched with age (4-17) years, sex and ethnic backgrounds (Iraqi Arabs) underwent the HLA-typing examination. Finally 50 healthy individuals were selected randomly to undergo GADA test. Results:At HLA-class II region, DR3 and DR4 were significantly increased in patients (53.33 vs.26.25% and 50.0 vs. 12.5% respectively) as compared to controls. In addition to that, T1DM was significantly associated with DQ2 (33.33 vs.15%) and DQ3 (40.0 vs.20%) antigens as compared to controls, suggesting that these antigens had a role in disease susceptibility, while the frequency of DR2 and DQ1 antigens were significantly lowered in patients compared to controls (6.66 vs.25% and 6.66 vs.22.5% respectively). These molecules might have protective effect. In siblings a significant increase frequency of DR4 antigen (34.0 vs.12.5%) was observed in comparison to controls, suggesting that it might be much useful for predicting T1DM in affected families.Anti-GAD autoantibodies were present in 50% of Type 1Diabetic children, and in 16% of their siblings. High proportion of GADA was found in the patients carrying HLA-DR3/DR4 heterozygous. conclusion:Both the T1DM patients and their siblings shared the HLA- DQ1 as protective antigens, while DR3 and DR4 were susceptible one, and high proportion of GADA was found in the T1DM patients and siblings carrying HLA-DR3/DR4 heterozygous.


Article
The Influences of Aminophylline and Indomethacin in Glycerol-Induced Acute Renal Failure in Rats

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¬ Background: Adenosine mediates homodynamic changes and resulted in the production of acute renal failure (ARF) in female Albino-Wister rats, therefore, adenosine level increases highly in ARF. Objective: This experiment was designed to investigate the effect of the adenosine antagonist aminophylline and the adenosine agonist indom-ethacin on glycerol-induced ARF. Method: Glycerol induced ARF was produced by a single dose (10ml/kg, 50%v/v with distilled water i.m) in rats, which were restricted to drinking water. Aminophylline was used in our study in a dose of 25mg/kg, i.p) while the dose of indomethacin was 10mg/kg, i.p), assessment of renal function was done by measuring blood urea nitrogen (BUN), serum creatinine (Scr), and creatinine clearance (Ccr) Results: Aminophylline exert its protective effect against glycerol induced-ARF by lowering the elevation in concentrations of BUN, Scr, and mortality rate with a markedly attenuation of the sever impairment Ccr. On the other hand, indomethacin potentiates glycerol induced-ARF by significantly increase the elevation in concentrations of BUN, Scr and mortality rate with severely suppressed the decrement in Ccr. Conclusion: Aminophylline has ameliorating effect on glycerol induced ARF while the prostaglandin inhibitor indomethacin has reversed effect.


Article
Hypomagnesemia in Iraqi Diabetic Patients and Healthy Controls: An Exploratory study

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BACKGROUND: Diabetes mellitus has been suggested to be the most common metabolic disorder associated with magnesium deficiency, and because available data suggest that adverse outcomes are associated with hypomagnesemia, it is prudent that routine surveillance for hypomagnesemia be done and the condition be treated whenever possible. AIM OF THE STUDY:To explore the serum Mg concentrations of diabetic patients and healthy controls in our locality. MEHTODS: One hundred and forty four diabetic patients (22 with type I and 122 with type II diabetes mellitus) recruited from the outpatient diabetes clinic at the Specialized Center For Endocrine Diseases-Baghdad (62 patients), National Diabetes Center-Al Mustansiria University (20 patients), and from private endocrinologic practice clinics in Baghdad (62 patients), during the period from 1st October 2005 to 30th April 2006. Ninety non-diabetic healthy controls matched for age and sex were participated in this study. Exclusion criteria for both groups included diarrhea and loop diuretics. None were taking Mg supplements. Level of Mg and Albumin were determined spectrophotometerically in the same serum samples. RESULTS:Mean serum Mg concentrations of the diabetics was significantly lower than in controls (p<0.001). Serum albumin was not a significant predictor of serum Mg neither among diabetic patients (r = 0.005) nor control subjects (r = 0.139). In 88.9% of the diabetic patients and 11.1% of the control subjects serum Mg concentrations were below the normal reference range of 0.70 mmol/L. The prevalence is increased when hypomagnesemia is defined by a reference limit of 0.75 mmol/L (98.6% and 28.9 % for diabetics and controls, respectively), a further higher prevalence among controls (91.1 %) was noted when 0.80 mmol/L is adopted as the lower normal limit. All diabetics (100%) and controls (100%) were identified as hypomagnesemic with a lower reference limit of 0.90 mmol/L. CONCLUSION:The tremendous hot climate of ours, can be suggested as an influential cause for increased Mg losses, and may provide a coherent explanation for the exceedingly high prevalence of hypomagnesemia observed in diabetic and control subjects participated in this study. Which therefore may suggest an inevitable requirement for magnesium supplementation to avert hypomagnesemia, not only among diabetics, but as well for controls, particularly through the hot summer episode

Keywords

Hypomagnesemia --- Albumin --- Diabetes --- Iraqi.


Article
Effect of Very Early Atorvastatin Initiation for Acute Myocardial Infarction on Creatine Kinase release

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Background : It has been suggested that pre-treatment with a statin agent prior to myocardial infarction limits myocardial creatine kinase release, and thus may act to limit myocardial infarct size in humans. Objective : To examine the effect of very early statin initiation for acute myocardial infarction (AMI), to the extent of myonecrosis as manifested by peak serum creatine kinase levels. Methods : Patients with AMI admitted to Al-Kindy teaching hospital cardiac care unit from 1st February 2007 to 28th February 2008, who fulfilled the inclusion criteria cited in the present study, were randomly assigned into two study groups. The statin group patients have received a single oral dose of 40 mg atorvastatin at time of admission and repeated for the next days until discharge, patients not receiving statin were considered as controls, blood samples were obtained on admission and every 8 h for another three consecutive samples to identify peak creatine kinase levels. Results : Patients who had statin therapy initiated immediately after hospital admission have similar peak creatine kinase concentrations as compared to those not receiving statin therapy ( P= 0.332). Conclusion : statin initiation in AMI patients fails to show any observable effect on creatine kinase release, the need of an extended period for the statin agent to achieve the predictable outcome may suggest the necessity of statin pretreatment in patients at high risk for AMI.


Article
Prevalence of bacterial infection and their sensitivity in patients undergoing an infertility eval

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Background: Nosocomial infections are still a serious problem with prevalence more than 10% in developed countries and it's higher in developing one. International Labor Organization had developed a chick list to overcome this condition. Objective: To find out the prevalence of nosocomial infections in Al-Kindy Teaching Hospital, and its relation to the control technique. Method: A cross- sectional study design was used, for a period from 1st of December 2007 to 30th of February 2009 A sample of 206 case sheets were reviewed, for diagnosis of nosocomial infections, a constructed questionnaire was used to assess the preventive techniques. Result: The prevalence of nosocomial infections was 16.7% and 6.3%, and it's significantly associated with the lack of preventive methods. Conclusion: Scores need to be changed, more control need to be adopted in the hospital.


Article
Prevalence of Nosocomial Infection as an indicator of good patient care practices

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Background: Nosocomial infections are still a serious problem with prevalence more than 10% in developed countries and it's higher in developing one. International Labor Organization had developed a chick list to overcome this condition. Objective: To find out the prevalence of nosocomial infections in Al-Kindy Teaching Hospital, and its relation to the control technique. Method: A cross- sectional study design was used, for a period from 1st of December 2007 to 30th of February 2009 A sample of 206 case sheets were reviewed, for diagnosis of nosocomial infections, a constructed questionnaire was used to assess the preventive techniques. Result: The prevalence of nosocomial infections was 16.7% and 6.3%, and it's significantly associated with the lack of preventive methods. Conclusion: Scores need to be changed, more control need to be adopted in the hospital.


Article
Frozen Shoulder in Type 2 Diabetes Mellitus

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Background: Frozen shoulder affects 2-5% of the general population, and around 10-30% of diabetic patients. It affect mainly the non-dominant shoulder, and has more incidence in patients with poor glycemic control. Objective: To detect the incidence of frozen shoulder in type 2 diabetic patients attending the Specialized Center for Endocrinology and Diabetes in Baghdad.Patients and methods: One hundred patients with frozen shoulder were included in the study from a total number of 580 type 2 diabetics over a period of six months. 70 patients were females and 30 patient were males. All were investigated for fasting blood glucose and HbA1c. Results: The non-dominant shoulder was involved in 60 patients (60%), the dominant shoulder in 35 patients (35%) and bilateral involvement in 5 patients (5%). 60 patients (60%) had poor glycemic control (HbA1c > 8%). Conclusion Diabetes mellitus is one of the predisposing factors for the development of frozen shoulder which affect 17.2% of type 2 diabetic patients in our study, most of them were overweight- obese and had poor glycemic control.


Article
A prospective study of colonoscopic examination at al-kindy teaching hospital

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Background: Fiber-optic endoscopy is an important investigation of the large intestine, whether or not the radiologist (barium enema) has discovered a lesion in the bowel. Colonoscopy affords a unique opportunity to direct visualization of entire colonic mucosa. At the same time, the physician can obtain biopsy specimens, remove polyps, and decompress volvuli. Most experienced endoscopists and well prepared patients can reach the cecum in over 90% of patients. If colonoscopy is properly performed, it has a low risk of complications, such as perforation and bleeding. Methods: A total of 70 consecutive patients admitted to Endoscopy department at Al-Kindy Teaching hospital from September- 2008 to July-2009. Bowel preparation was achieved with Polyethylene glycol lavage solution and 165 cm Pentax colonoscope EC_3385FK 4.2 was used in all cases. All patients were not sedated or given any other medication Results:Seventy colonoscopies were performed in this study. Forty of them were male and the rest were female. The mean age was 42 years ranging from 4 years to 85 years. The most common indication for colonoscopy was rectal bleeding (44%) Polyethylene glycol lavage solution was used in all patients for bowel preparation. All patients did not receive pre-medications. Complete colonoscopy examination was done in (12.8%) of patients, the most common cause of incomplete examination was poor bowel preparation (50%). No complications were reported. Conclusions: Rectal bleeding was the most common indication for colonoscopy. Poor bowel preparation was the main cause of incomplete colonoscopy.


Article
MATERNAL AND FETAL OUTCOMES IN EMERGENCY VERSUS ELECTIVE TWO OR MORE PREVIOUS CAESAREAN DELIVERIES

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Background: Women with previous two or more caesarean deliveries are usually managed by elective cesarean section to avoid the possible risks of labor. Objective: To compare the relative risks of maternal and fetal outcomes in emergency versus elective previous two or more caesarean deliveries Design: Randomized prospective clinical study Setting: Al-Elweya Maternity Teaching Hospital, from 1st of March to 31st of September 2008. Methods: The study groups, those who had previous two or more caesarean deliveries, were included from the hospital admissions. The 1st group (102 women) presented in labor and was managed by caesarean delivery as soon as it was possible. The second group (78 women) was admitted for elective cesarean delivery. The main maternal outcomes were intra operative complications, including hysterectomy, scar dehiscence, bladder injuries, uterine and internal iliac arteries ligation, and blood transfusion. Postoperative maternal outcomes were severe morbidity including bleeding, fever, urinary tract infection, blood transfusion, the need to Intensive Care Unit admission and readmission. The fetal outcomes measures were Apgar score at one and five minutes, respiratory distress syndrome (RDS), admission to the neonatal intensive care unit and fetal loss up to hospital discharge. Results: Both groups were comparable in demographic, social and past obstetric history characteristics. Intra operative complications showed significant difference in bowel adhesions (RR 0.35, 95% CI 0.14- 0.88), and blood transfusion (RR 0.51, 95% CI 0.28-0.94). There was statistical significant difference in the mobilization time 7.2 hours and 9.3 hours in emergency and elective groups respectively (p= 0.0009), also in feeding time, it was shorter after emergency caesarean section (P=0.0224), and in the hospital stay 24.6 and 32.6 hours respectively (p=0.0001). There was no statistical difference in post operative complications. Fetal outcomes showed no statistical significant difference in fetal loss, respiratory distress and readmission. Conclusion: Women with previous two or more caesarean deliveries can wait until starting labor for doing cesarean delivery without increasing risks to the mother and fetus.


Article
Manifestation and response of Laryngopharygeal reflux to treatment in Kurdistan -IRAQ

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BACKGROUND: In 1972 complete description of the inflammation of posterior third of the vocal cords was done, with barium swallow confirming Gastro Esophageal Disease [CRED] & subsequent successful symptomatic treatment with antacid. The possible association between GERD & chronic laryngitis was initially known as acid laryngitis .2 OBJECTIVE: To record the common presentation symptoms of laryngopharyngeal reflux LPR in Kurdistan- Iraq. To study the significance of fibro optic laryngoscope in diagnosis and improvement of laryngopharyngeal reflux [LPR] and to evaluate the effect of medical therapy on these nonspecific symptoms and Laryngoscopic finding. METHODS : A prospective study was conducted over a two year period at Rizgary teaching hospital, Kurdistan/lraq; on 132 patients who presented primarily with Laryngopharyngeal symptoms .They were evaluated using special questionnaire for recording these symptoms: persistent chronic cough, globus sensation, throat clearing, voice change, regurgitation, heartburn, symptoms of peptic ulcer disease, and any other non specific respiratory symptom. These symptom and Laryngoscopic findings pre and post anti-reflux therapy were recorded. Esophagogastro - duodenoscopy findings were also recorded but only on presentation. RESULTS: A total of 132 patients were evaluated over a two year period .Respiratory symptoms at presentation were persistent irritative cough [92%], itchy throat [85%], globus pharynges [83%], and cricopharngeal spasm [57%]. Endoscope findings revealed gastroduodenitis in 5%, non specific gastritis in 9%, duodenal ulcer in 2%, and normal findings in 62.7%, while Laryngoscopic finding were mainly posterior commissure injection 82%, vocal cord edema 74%, laryngeal erythema 77% and subglottic edema 24%. Patients were treated medically with antacids, H2 antagonists, proton pump inhibitors and were followed up and reexamined by laryngoscope; all data about improvement in symptom and in the laryngeal sign by Laryngoscopic findings were collected following anti-reflux therapy and showed significant improvement in both ,all were analyzed in special figures and tables. CONCLUSION: Reflux laryngitis and LPR should be a differential diagnosis in patient with pharyngeal and laryngeal symptoms not associated with upper respiratory disease in the presence or absence of GERD or peptic ulcer symptom, dyspepsia, regurgitation. The management should be multidisciplinary. Laryngoscopic finding were of value in the diagnosis of the changes in laryngeal mucosa pre and post medical treatment by Proton Pump Inhibitors empirical therapy.


Article
Electrical stimulation for the treatment of Knee joint osteoarthritis

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Abstract 20 patients with osteoarthritis of the knee joint were treated by electrical stimulation in the form of 6 sessions every other day each sessions of diphase fixe (DF) for 4 minutes followed by rest for 4 minutes then treated with a monophase fixe (MF) for 2 minutes. By clinical & statistical analysis ( P value < 0.05) we conclude that the electrical stimulation is effective as one method in the treatment of osteoarthritis.

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Article
Has exogenous melatonin induce histological changes in collecting tubules and ducts of rat's kidney?

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Back ground; Selective re-absorption and secretion are the functions of the collecting tubules and ducts, in addition to concentrate urine through ADH-regulated and ADH-independent water channels. Method; twenty four male rats were used, they were divided into two groups of animals: Group (A) included twelve rats of five weeks old age (before puberty) that were divided into three subgroups, four rats in each subgroup. Subgroup I was control one, subgroups II and III were treated orally with melatonin in a dose of 250 & 500 µg/kg body weights subsequently. Group (B) included twelve rats of seventeen weeks old age (after puberty) that were divided into the same subgroups and treated with the doses of melatonin as in the rats of group (A). Result; the exogenous melatonin induced structural changes on the collecting tubules, in dose dependent manner as well as onset-dependent manner whether used in pre- or post-puberty of male albino rats.


Article
Puetz-Jeghers Syndrome Involving Appedix

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Abstract

This is an autosomal dominant disease. The gene STK11 on chromosome 19 has been found in proportions of patients with this condition, this consists of: A- Intestinal hamartomatosis. B- Melanosis of the oral mucous membrane and the lips.

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Table of content: volume:6 issue:1