Table of content

Iraqi Academic Scientific Journal

المجلة العراقية للاختصاصات الطبية

ISSN: 16088360
Publisher: The Iraqi Borad for Medical Specialization
Faculty:
Language: English

This journal is Open Access

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Table of content: 2013 volume:12 issue:2

Article
Management of Retroperitoneal Soft Tissue Sarcomas

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ABSTRACT: Hospital , Baghdad. *Department of surgery ,Kufa Teaching Hospital , Najaf. BACKGROUND: Most retroperitoneal tumors are malignant and about one third are soft tissue sarcomas. Sarcomas are uncommon malignant tumors arising from mesenchymaltissue . Retroperitoneal sarcomas account for approximately 10%-15% of soft tissue sarcomas and less than 1% of all malignant neoplasms. Surgery is the only curative treatment for retroperitoneal soft tissue sarcomas. OBJECTIVE: To define the best extent of surgery that would optimize the safe margins on retroperitoneal soft tissue sarcomas , where the recurrence of tumor greatly depends on feasibility of complete resection and the grade of tumor. PATIENTS AND METHODS: Between June 2007 and December 2010,28 patients (female 16,male 12, mean age; 43.93 years, range18-69 years)were evaluated for survival and response to therapy by gender, age ,preoperative symptoms ,symptoms duration , primary or recurrent tumors , the extended of surgical resection, or palliative procedures .Complete resection was defined as removal of gross tumor with histologically confirmed clean resection margins. RESULTS: Eighteen patients(64%) out of 28 patients under went simple surgical resection ,5 patients(28%)underwent compartmental resection (systematic resection of noninvolved contiguous organs),1 patient (3%) underwent enucleation of tumor ,while debulking done in 4 patients (15%). The surgical resection margin was involved only in one patient (due to tumor rupture during resection) of those patients underwent compartmental resections, it’s was free in only (10/18,56%) patients underwent simple resection ,while it was involved in all tumors removed with enucleation or debulking (incomplete resection) . The recurrence of tumor greatly depends on state of surgical margin in resected sample (pvalue=0.001 , significantly associated). The histopathological grade of tumor on the other hand also proved an important factor in the recurrence of tumor where it was higher with high grade tumor versus low grade tumor (Pvalue=0.001 , significantly associated). CONCLUSION: Complete compartmental surgery without tumor rupture should be performed when possible to achieved clear margins. Wide resection lowers the local recurrence and improves survival rate. Both the state of surgical margin and grade of tumor are the most important prognostic factors which determine the survival rate and recurrence tumor.


Article
Evaluation of Clinical Parameters that Predict Difficulties During Laparoscopic Cholecystectomy

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ABSTRACT: BACKGROUND: Laparoscopic cholecystectomy(LC) may be rendered ‘difficult’ by various problems encountered during surgery e.g accessing the peritoneal cavity, dissecting the gall bladder … etc. OBJECTIVE: To identify certain preoperative clinical parameters to predict technical difficulties during (LC) . SETTING: Surgical wards of Al-Jamhoori Teaching Hospital between October 2009 to October 2010. METHODS: A prospective analysis of150 patients who underwent (LC). Prospective analysis of different preoperative data including patient's age, gender, weight, height, previous abdominal surgery and previous attack of acute cholecystitis were done. The dependent variables (outcomes) included the duration of operation, bleeding, difficult accessing, bile leak, difficult dissection of gall bladder, and conversion to open cholecystectomy. Surgeons who performed the operations had operative experience of more than 50 (LC) RESULTS: The difficulties were met in 57(38%) patients. The mean duration of surgery was 79·83 ± 1·30 minutes. Factors contributed to difficult (LC) were; male gender, previous upper abdominal surgery and BMI > 35. CONCLUSION: Preoperative clinical patient's factors including male gender, BMI > 35 and history of previous upper abdominal surgery are significant predictive preoperative parameters for difficult (LC). Knowledge of these parameters preoperatively can predict difficulties during (LC).


Article
The Effect of Perioperative Use of Prophylactic Antibiotics on Surgical Wound Infection

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BSTRACT: BACKGROUND: Surgical site infection is one of the commonest complications after surgical operations and the use of antibiotics in preventing or reducing infection is associated with many problems. OBJECTIVE: To evaluate the use of peri- operative prophylactic antibiotics in preventing or reducing surgical site infection in different types of operations PATIENTS AND METHODS: This prospective study was conducted on(560) patients from June 2002 to January 2007 in general surgical department in Baghdad teaching hospital. The patients were divided into( 3) groups according to the type of operation; clean operations which included 200 patients, clean-contaminated operations which included 160 patients and contaminated operations which included 200 patients) and they were further subdivided into 2 groups, group A of patients were treated with peri operative prophylactic Cefotaxime antibiotic while the group B patients were treated with therapeutic dose of the same antibiotic for prolonged duration (5 days). Those patients were followed up for 4 weeks after operation and when signs of wound infection appeared, swab for culture and sensitivity was taken to determine the type of bacteria, and effective antibiotics against them. RESULT: Result showed that (3) patients (3%) in clean surgery developed wound infection when using perioperative regimen as compared to( 2) patients (2%) when using therapeutic regimen. In clean contaminated wounds infection appeared in (5) patients (5%) in patients using prophylactic or postoperative regimen while in contaminated wounds, (11) patients (11%) developed wound infection when using perioperative regimen as compared to( 6) patients (6%) who developed wound infection in patients using postoperative antibiotics. Statistically, there is little difference in effectiveness of the two regimens (A and B) in both group( 1) and( 2) operations but in the group( 3) operations, although prophylactic antibiotic regimen reduced the infection rate to 11% but it was not as effective as the therapeutic regimen in reducing wound infection (6%) . CONCLUSION: Postoperative antibiotics should be resisted in clean and clean contaminated operations instead perioperative antibiotics can be used, and prolonged postoperative antibiotics should be used only in contaminated operations


Article
Postoperative Pain Reduction with Bupivacaine Instillation After Laparoscopic Cholecystectomy

Authors: Sami Hasson --- Firas AL Chalabi
Pages: 186-191
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BACKGROUND: Pain occurs frequently following laparoscopic cholecystectomy leading to increased patients distress, delayed discharge, increase the need for analgesia and delayed oral intake . OBJECTIVE: To evaluate the effect of bupivacaine instillation on pain relief in the early post- operative period following laparoscopic cholecystectomy. MATERIALS AND METHODS: Eighty patients having symptomatic gall stones were included in this study. The procedure was explained to the patients and informed consent was obtained. The patients were divided into two groups: group (A) received 40 ml of(0.125%) bupivacaine diluted in 60 ml of isotonic saline(0.9%) instilled in the subdiaphragmatic and subhepatic spaces, the remaining 40ml of (0.125%) bupivacaine were used for wounds infiltration. The post operative pain was assessed by visual analogue scale(VAS) at fixed time intervals, both patients and house officer doctor were blinded to the group of the patients. Group (B) stood as a control group. RESULTS: The two groups were comparable in age, gender, weight, and duration of operation. The male to female ratio was (1:4), the mean age in both groups were insignificantly different, their weights ranged from (58- 96) kg. Post operative abdominal pain was significantly lower in group A (bupivacaine group) than group B ( control group) in the first twelve hours. The mean abdominal pain score ranged from (3.85 to 2.55) for the bupivacaine group, and from (6.62 to 3.16) in the control group, the p value is < 0.001which is highly significant in the first 6 hours. Group A had a lower incidence of shoulder pain in comparison with the control group although statistically not significant. CONCLUSION: Intraincisional infiltration with bupivacaine is a simple and feasible procedure which significantly reduces post operative pain


Article
Skeletal Metastasis;Distribution by Age, ,Sex,and Histological Classification(Medical city)

Authors: Abdul Ridha Kh.Jabbar
Pages: 192-195
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BACKGROUND: Skeleton is the one of the commonest sites of secondary cancer, it is seen more frequently than all primary bone tumors together. Vertebrae, pelvis and proximal parts of long bone are more involved by secondary metastasis. Breast cancer is the commonest cause of primary tumor followed by Prostatic carcinoma. Despite the advances in diagnosis but still about 10 % of cases remain as secondary with undetermined primary site. OBJECTIVE: To disclose the distribution of bone metastasis and their primary site among Iraqi patients. PATIENTS AND METHOD: 102 patient were enrolled in a retrospective study conducted in medical city complex in Baghdad/ Iraq from January 1990- July 2000. Patient are either known to have primary malignant tumor and discovered to have secondary metastasis to bone as part of the routine screen or development of symptoms suggestive of bone metastasis, the other group of patients are presented with bone metastasis. All patients are subjected to intensive medical history and proved their secondary metastasis by excisional biopsy or fine needle aspiration with histopathological diagnosis RESULTS: The mean age of our patients was 41 years, with range (2-80 years), men were commonly involved than women, the peak incidence of metastasis was in 1991. Vertebral bodies are commonly involved and lungs are the most common primary site CONCLUSION: Well differentiated columnar adenocarcinoma is the commonest histopathological type of malignant tumor metastases to bones, lungs are the most common primary site. Undetermined primary tumors are still consist a diagnostic problem in our daily practice more cooperative team work is needed to disclose the final diagnosis


Article
Preoperative Prediction of Difficult Laparoscopic Cholecystectomy by Clinical Assessment and Ultrasonagraphy

Authors: Mohamed Salih Younis
Pages: 196-201
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ABSTRACT: BACKGROUND: Laparoscopic cholecystectomy(LC) has now replaced open cholecystectomy(OC) for the treatment of gallbladder diseases. However, LC may be rendered difficult by various problems encountered during surgery, such as difficulties in accessing the peritoneal cavity, dissecting the Calot’s triangle and gall bladder, or extracting the excised gall bladder. OBJECTIVE: Of this prospective study: is to determine whether preoperative clinical parameter and Ultrasonagraphy can predict difficult LC. PATIENT AND METHODS: 100 patients underwent LC in Al-Jamhuri Teaching Hospital, all had gallstone disease. Prospective analyses of different preoperative clinical and ultrasonic parameters contributing to difficult LC were performed. These included: age, gender, BMI (Body Mass Index), previous upper abdominal surgery, previous attack of acute cholecystitis , gall bladders size , gall stones size and numbers. The outcomes included the following operative parameters: access to peritoneal cavity, adhesion and difficult dissection, bleeding during surgery, bile leak, and conversion to OC. RESULTS: Of 100 patients with LC 41 patients (41%) developed difficulties during operation .Factors contributed to difficult LC were male sex, previous upper abdominal surgery ,previous attack of acute cholecystitis , BMI more than 35 and gall stones that were more than (1 cm) in diameters . The most common type of difficulties was intraoperative bile leak (14%) and the least frequent difficulty was conversion to OC (1%). CONCLUSION: Clinical and ultrasonographic findings can help to predict difficult LC .This information may be useful to both the patients and surgeons in being better prepared for the intra-operative risk including conversion to OC


Article
Comparison of the Hemodynamic & Respiratory Parameters between Smokers & Non Smokers in Lower Abdominal Surgery Under General Anesthesia

Authors: Iyad Abbas Salman --- Musrey Younis Jahn
Pages: 202-207
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ABSTRACT: BACKGROUND: Smoking is a very widespread habit , it had been proved to affect adversely on many systems of the body especially the cardiovascular (CVS) & the respiratory system, and such effects would be exaggerated perioperatively because of the effect of general anesthesia (GA) especially when there is no any period of abstinence from smoking (as when occurred during emergency procedures). OBJECTIVE: To assess the hemodynamic & respiratory effects of smoking perioperatively in patients undergoing emergency lower abdominal operations. PATIENT AND METHODS: A prospective case control study carried on 80 patients in Baghdad teaching hospital/Medical city / Baghdad / Iraq, from September 2011 to March 2012, the 80 patients have been allocated into 2 groups, (each of 40 patients): group 1 who were non smoker patients, & group 2 the smoker patients. The 2 groups were undergone emergency lower abdominal surgery under GA, all the patients received similar pre. & intraoperative managements. Pulse rate (PR), systolic blood pressure (BPsys), diastolic blood pressure (BPdias),oxygene saturation (SPO2), and airway pressure (Paw) were monitored with the standard non invasive technique, at the baseline period (preoperative); immediate postintubation; 10, 20, 30, & 40 minutes intraoperatively; immediate postextubation; & 10 minutes in the recovery period. RESULTS: Regarding the pulse rate, there were no statistically significant variations between the 2 groups apart from the immediate postextubation period (105 ± 6.95 in smokers vs 100.3 ± 8.3 in non smokers Regarding the systolic blood pressure, there was statistically significant increase in the systolic BP especially at the immediate postintubation period in smoker patients Regarding the diastolic BP, apart from the immediate postextubation period ,there was significant increase in the diastolic BP between the 2 groups especially at the immediate postintubation Regarding the SPO2%, there were no statistically significant reduction in the SPO2 readings between the 2 groups apart from the intraoperative period Regarding the P airway , there were no significant increase in the P airway perioperatively between the 2 groups CONCLUSION: There were statistically significant CVS derangements in the smoker group versus the non smokers especially around intubation period.

Keywords

smoking --- hemodynamic --- respiratory


Article
Angiotensin Converting Enzyme Inhibitors, to Continue or Discontinue on the Morning Day of Surgery

Authors: Sabah Noori Al-saad --- Arkan Muhammed Mahdi
Pages: 208-212
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ABSTRACT: BACKGROUND: Angiotensin converting enzyme inhibitors(ACEI) play a pivotal role in the management of hypertension (11) . whether to continue or discontinue them before surgery is an everyday encountered question of both surgeon & patient, this issue is continuously submitting to debate & controversy. OBJECTIVE: To compare between the incidence of intra-operative hypotension in hypertensive patients who continue to take ACEI. & those who discontinue, & are undergoing general anesthesia for non-cardiac surgery. PATIENTS AND METHOD: A comparative study consist of 40 patients presented to the Medical City, Baghdad Teaching Hospital & Surgical specialty Hospital between July 2011,to March 2012.the age of patients range from 38-70 years old, they were 10 (25 %) men and 30 (75 %) women , they were divided into two groups; according to mode of medication, cases ( who were continued taking medication ) and control (who were discontinued medication),twenty patient each, all patients underwent different surgical interventions under general anesthesia, they were studied & monitored intra-operatively regarding development of hypotension, this was done at time interval of 5 minutes & at starting point prior to induction of general anesthesia until 20 minutes after. RESULTS: By comparing the mean systolic blood pressure (SBP) and diastolic blood pressure (DBP) in between both groups of patients, those who were continued ACEI (group A) or those who were discontinued(group B), it had been found that no significant differences in mean SBP neither preoperatively nor at different time intra-operatively. P.value in all comparisons was > 0.05. CONCLUSION: Continuing or discontinuing ACEI before non-cardiac surgery under general anesthesia has no statistical significance regarding concern of developing intra-operative hypotension.


Article
Epidemiological Study of Measles in Al- Kadhimiyia Teaching Hospital

Authors: Lamia Abdul Karim --- Ali Kadhim Al-Husainawi
Pages: 213-222
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ABSTRACT: BACKGROUND: Measles is a highly communicable disease caused by the measles virus. The disease is marked by prodromal fever, conj unctivitis, coryza, cough, and the pathognomonic koplik spots followed by an erythematous maculopapular rash. Infection confers lifelong immunity. OBJECTIVE: Find out the frequency of measles in the hospital admitted cases in chi l dr en ≤ 12 year s accor di ng t o t he vaccination and nutritional status,The causes of non-vaccination and the vaccine efficiency in preventing measles.The incidence of measles in the exclusively breast fed infants.The presenting signs and symptoms, commonest complications, investigations and the outcome. PATIENTS AND METHODS: A prospective study was performed from the 1 st of January to the 1 known as rubeola and is marked by prodromal fever, conjunctivitis, coryza, cough, and pathognomonic Koplik spots, followed by an erythematous maculopapular rash on the 3rd to 7 day. Infection confers life-long immunity. st of May in the year 2009, in Al-Kadhimiyia Teaching Hospital.The data was collected through a questionnaire asked directly to the parents, and all the patients were systemically examined and followed up clinically until they discharged home or unfortunately died.The collected data was analyzed and adjusted using the SPSS version 10 statistical programs. RESULTS: The incidence of measles was (44.29 %).Most of cases were living in crowded houses, all patients had positive history of contact, mostly during a visit to a medical health facility (49.3 %).All age groups were affected by measles, mostly in the 1 st (27 %) and the nd (19 %) years of life.Higher incidence was reported in males (53.5 %).Most of the cases were nonvaccinated (86.25 %) with non-vaccinated mothers as well (85.25 %). Nineteen percent of the cases were malnourished. The incidence was lowest in the exclusively breast fed infants (1.5 %). Measles mostly presented with fever for ≥ 3 days (100 %), rash (100 %) and conjunctivitis (98.25 %).The commonest complications were pneumonia (62.75 %), diarrhea (40.25 %). The majority of patients who had developed convulsions had normal CSF analysis results (76.7 %). CXR reported pneumonic consolidation in (62.75 %) of the patients. Ninety percent of cases were discharged home and (10 %) died. CONCLUSION: Measles is higher in the crowded places, in infants and toddlers, in males, in the nonvaccinated, and less in the exclusively breast fed infants. It is more severe in the malnourished patients. Vaccination is the most important preventive measure against measles. Measles mostly present with fever, maculopapular rash, and conjunctivitis, with the most common complications are pneumonia, diarrhea, and encephalitis. The disease usually has no or little effect on the blood counts and CSF analyses, and CXR document pneumonic consolidation in the majority of cases. Measles is still a serious disease with high fatality rat

Keywords

measles --- epidemiology --- vaccination.


Article
Follow Up of Sixty Patients with Chronic Lymphocytic Leukaemia

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ABSTRACT: BACKGROUND: Chronic lymphocytic leukemia(CLL) is heterogeneous in its clinical course and typically diagnosed when patients presented with symptoms of lymphadenopathy, cytopenia ,constitutional symptoms or infection. Now 50% of patients with CLL are likely to be diagnosed when an elevated lymphocyte count is discovered incidentally . OBJECTIVE: Description of various presentation in adult patients with CLL, complications that happened during the course of their disease, cause of death and overall survival in these patients. PATIENTS AND METHODS: Sixty Iraqi adult patients with CLL were studied retrospectively and prospectively. These patients were assessed clinically and stratified with Rai staging, with follow up for any complications that occurred during their course of disease from time of diagnoses till last visit or death. RESULTS: In this study, the age group more than fifty years form 50(83.3%) patients and those less than fifty form 10(16.6%) patients. The commonest clinical feature reported was constitutional symptoms in 19(31.6%)patient. Rai staging of these patients found to be that most of patients intermediate stage II 22(36%) and advanced stage III, IV in 34(56.6%) Regular follow up of these patients revealed that autoimmune disorder occur in 6(10%) patients, in form of autoimmune hemolytic anemia (AIHA),pure red cell aplasia (PRCA)and immune thrmbocytopenia (ITP).The increase susceptibility to infection by different viral , bacterial and parasitic infection was noticed in these patients during their course of illness. Death in these patients was due to infection with HBV and liver failure in 2(3%)patients, obstructive jaundice and hepatic encephalopathy in one(1.6%)patients, sepsis in 4(6.6%), bleeding in one (2.04%) ,renal failure in two patients (1.6%),chronic sinusitis with fungal infection and renal failure in one (1.6%)patient ,Richeters transformation and disease progression in 7(11.6%) or due to co morbid illness (stroke, ischemic heart disease, heart failure ) in 3(5%) patients. The overall survival for these patients within five years was 50% . CONCLUSION : Constitutional symptoms was the commonest presentation of CLL Iraqi patients. The indolent course of the disease in CLL patients, still can be interrupted by different complications including infection, autoimmune disorder, and malignancy.


Article
The Effect of Cotton Wool Dust on Peak Flow Meter (PEF)of Textile Factory Workers in Mosul

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ABSTRACT : BACKGROUND: Byssinosis is a disease caused by long exposure to cotton, hamp, and flax dust, it differs from occupational asthma, it needs along period of exposure to develop and the worker gets adaptation on subsequent days after Monday chest tightness. The over all prevalence of byssinosis was 22.4%.Byssinosis needs at least 10 years to develop, the prevalence and severity increased with increasing duration of exposure to cotton dust. processing of cotton is more harmful to lungs, and this is due probably to high dust concentration, or the dust contains toxins and other organic substances which decrease in later manipulations. OBJECTIVE : To find out the prevalence of byssinosis among textile factory workers in mousel. To through alight on the relationship between smoking and byssinosis among workers exposed to cotton wool dust. the relationship between duration of working in a textile factory and occurrence of byssinosis PATIENT AND METHOD: Two hundred and fifty Mosul Textile factory male workers , occupationally exposed to cotton dust, aged (22-65) years were randomly selected and were interviewed to get information about age, work duration, smoking habit, and about chronic cough, phlegm, wheeze and chest tightness, and workers were examined clinically, and special considerations attended to the chest. The workers involved in this study were in good health at the time of engagement to this work, and any worker with bronchial asthma, or other chest diseases were excluded. by history .Peaked expiratory flow (PEF) was carried out for all 250 workers by Right's Peak flow meter (W18416.Harlow, England). RESULT AND DISCUSSION: All of the workers were male their age ranged 22-65 years with mean age of 45.3 years, in those between 31-40 years the incidence was 10.8%, this increased to 49.3% in those whose age was over 51 years. The mean work duration was 18.2 years, ranged (2-44) years. The prevalence was 12.6% in age groups 10-19 year work duration, 47.2% in 20-29 years, and 49.2% in those over 30 year work duration. In age group 10-19 years work duration moderate cases of byssinosis was 4.7% and no any sever case and mean PEF 106%, while in age group over 30 year work duration there was 33.3% moderate and 7.9% sever cases of byssinosis and mean PEF 94.9%.increased prevalence and severity of byssinosis in sections where the dust concentration was high. In the weaving room 12%, were byssinotic, where the dust concentration was lowest, 25%, in spinning room where the dust concentration was higher, while in ginning room where the dust concentration is highest the prevalence was 41.8%. . CONCLUSION: We have shown that the prevalence of byssinosis is still high in MousalTexitle factory- Iraq. It is statistically estimated that the prevalence of byssinosis after 8 years will be 35.2%, the reason for this may be attributed to bad occupational safety measures..


Article
The Impact of Duration of Neutropenia in the Immunocompromised Host

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ABSTRACT: INTRODUCTION: Infection is a common cause of morbidity and mortality in immunocompromised patients for *Central Public Health Laboratory-Ministry of Health. **Dep.College of Medicine University of Baghdad . whom diagnosis and management require scrupulous attention and continuing awareness of the microorganisms causing infection in a particular environment in different groups of patients , most are caused by recognized pathogen, although uncommon,some times THE IRAQI POSTGRADUATE MEDICAL JOURNAL VOL.12, NO 2 ,2013 BACK GROUND: Patients with neutropenia can be at low-or high-risk according to the duration of neutropenia, its differential count, the ANC (absolute neutrophil count) in addition to search for any causative agents to improve the diagnostic and therapeutic outcome. OBJECTIVE: This study focuses on the clinical and microbiological data in relation to the duration of neutropenia in a sample of immunocompromised Iraqi patients due to leukemia and aplastic anemia. INDIVIDUAL METHODS: 150 patients presented with pyrexia, marrow failure from oncology unit of the 7 floor of Medical City Hospital, National Center of Hematology-Iraq , Institute and Hospital of radiotherapy and nuclear medicine studied between 2008-2009 ,classified into three groups, fifty for each, with a plastic anemia, acute lymphoblastic leukemia(ALL), acute myelogenous leukemia(AML),all were investigated for WBC count, differential,ANC,Hb,Pcv,platelet count, RBC,Peripheral blood film for blast cells,ESR, specifically in those complaining from pyrexia of unknown origin. direct examination ,culture and sensitivity of the urine,stool,body fluids, sputum ,blood, tonsil and skin swab, Widal, rose Bengal tests, besides temperature recording was done for all patients with known site of infection. RESULTS : Neutropenia of a plastic anemia 5-70 days with a mean of 25 days is associated with a higher risk of infection particularly by the gram-negative enterobacter ,but with a mortality rate of 26%,while those suffered from ALL with a range of 11-40 day and a mean values of 16 days with a less mortality rate 22%.Unfortunatelly AML although gets a range of 7-35 day and a mean values 18 day and short lived neutropenia yet it was significantly have a higher mortality rate 52% presumably due to the combined effect of low neutropil count and chemo radiotherapy .However sever neutropenia (ANC < 500) is only found in 10 AA,6 AML,and 4 ALL patients, and moderate neutropenia (500 ≤ ANC < 1000) were explored in 7 AA,4 AML,10 ALL. The microbiological investigation shows that gram negative microorganism especially E.coli is positive in 19 different samples followed by Klebsiella 12 positive sample, then monilia takes place12 cases, followed by the remaining microorganisms. Lastly pyrexia of unknown origin were found to be the top problem facing immunocompromised patients with 20% AA,34%ALL,30%AML followed by chest infection 16%AA,22%ALL,15%AML, and then urinary tract infection17%AA,17%ALL,10%AML followed by other types of infections. CONCLUSION: Neutropenia is prolonged in a plastic anemia compared to acute leukemia with the risk of infection is directly related to it.G(-ve) enterobacter particularly E-coli is the commonest pathogen isolated.


Article
Post Hair Epilation Acneiform Eruption Among Females

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BSTRACT: BACKGROUND: Acneiform eruptions are common and important variants of acne vulgaris, there are many examples of acneiform eruptions like steroid acne and pityrosporum folliculitis. OBJECTIVE: To evaluate the acneiform eruption that follows hair epilation. PATIENTS AND METHODS: This case-series study was conducted in Department of Dermatology and Venereology, Baghdad Teaching Hospital during the period from January 2005 through July 2006. Forty females were included in this work, history was taken from each patient and all were clinically examined regarding all relevant points to this condition. Swabs and cultures from rash were carried out on 11 patients using blood, chocolate, and McConky agar as culture media. RESULTS: The ages of patients ranged from14-40 years with a mean ± SD of 20.85 ± 5.52 years. History of acne vulgaris was positive in 32 (80%) patients, and it was mild acne, resolved before the onset of hair epilation acne. Method of hair epilation was threading and sugaring.The time interval between hair epilation and rash appearance was 1-21 days with a mean ± SD of 4.48 ± 3.36 days. Itching was the commonest symptom complained by 18(45%) patients.The lesions morphology was mainly monomorphous erythematous papules surmounted by tiny pustules. Swabs and cultures revealed no pathogenic bacteria. CONCLUSION: Hair epilation by threading and sugaring is a common cause of monomorphous acneiform eruption and might be an important triggering and exacerbating factor for acne vulgaris in Iraqi females


Article
Treatment of Tinea Corporis by Topical 10% Zinc Sulfate Solution

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ABSTRACT: BACKGROUND: Tinea corporis is a dermatophyte infection of the glabrous skin. Multiple modalities of therapy have been used in the treatment of tinea corporis including both systemic and topical agents, such as imidazols, triazols, allylamines, ciclopirox and griseofulvin. OBJECTIVE: To evaluate the efficacy and safety of topical 10% zinc sulfate solution in the treatment of tinea corporis and tap water as placebo controlled in treatment of tinea corporis. PATIENTS AND METHODS: This opened labeled blind-therapeutic trial done in the Department of Dermatology -Baghdad Teaching Hospital, during October 2004 – March 2006.It consisted from 63 patients with tinea corporis, 33 patients treated with 10% zinc sulfate (Group A) and 30 patients received distilled water as the placebo-control group (Group B). Full history and clinical examinations were done for all patients including all demographic aspects related to the disease. Every patient was instructed to apply treatment twice daily and to be seen every 3 weeks for 2months. All patients were assessed clinically and by skin scraping test before, during and after treatment. RESULTS: Sixty three patients with tinea corporis met the inclusion criteria and enrolled in this study. Sixty patients completed the study, three patients defaulted from the study in Group A . In Group A 30 patients received topical 10% zinc sulfate solution twice daily for two months, 17 (56.7%) females and 13 (43.3%) male patients. Their ages ranged from 4-64 (27.87+17.68) years, while the duration of the disease ranged from 1-13 (3.7 + 3.249) weeks. Complete cure response was observed in 13 (43.33%) patients, partial response in 7 (23.34%) patients and no response in 10 (33.33%) patients while in in Group B, 30 patients received distilled water twice daily for two months as placebocontrol group , 10 (33.33%) females and 20 (66 .67 %) male patients. Their ages ranged from 8- 66 (30.67 + 15.66) years, and the duration of the disease ranged from 1-30 (7.48+ 6.98) weeks. The clinical response was two (6.67 %) patients with partial improvement and 28 (93.33%) patients with no improvement. No side effects reported apart from mild irritation in the beginning of treatment which resolved soon after continuation of therapy that did not require stopping the treatment. CONCLUSION: Topical 10% zinc sulfate solution is a new effective, safe and non costly formulation in the treatment of tinea corporis but it is slow in clearance of the lesions and higher concentrations of zinc sulfate like 20% might increase the effectiveness of the drug and shorten the duration of therapy


Article
Efficacy and Safety of Topical Podophyllin 5% Ointment in Patients with Mild Plaque-Type Psoriasis

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ABSTRACT: BACKGROUND: Psoriasis is a common chronic condition of the skin that is resistant to many therapies. There is a need for the development of novel non-steroidal topical drugs for the treatment of psoriasis. OBJECTIVE: To assess the efficacy and safety of topical podophyllin 5% ointment in patients with mild plaque- type psoriasis. PATIENTS AND METHODS: Sixty two patients with mild plaque-type psoriasis were enrolled in this study. They were divided into 3 groups: GroupA (21patients)were treated with podophyllin 5% ointment every other day, while Group B(20patients)were treated with clobetasol propionate 0.05%ointment twice daily and 21 patients in Group C were treated with Vaseline twice daily for 8 weeks as a control group. Efficacy was evaluated every 2 weeks for 8weeks using Psoriasis Area and Severity Index (PASI) score and relapse was recorded after cessation of treatment in those patients who achieved good response during 8 weeks follow up period. RESULTS: A total of 62patients were 44(70.9%) males and 18(29.0%) females, with: male: female ratio 2.3:1. Their ages ranged from 18-65 (37.5±12.9) years. Their baseline PASI score ranged from 1.29(5.2±2.4). At the end of 8 weeks of therapy : no statistically significant difference in PASI reduction between Group A(66.3±20.7) and Group B(68.1±34.2) treated patients, P-value =0.831 and both of them were statistically significant higher PASI reduction than patients with Group C,34.1±28.8, P-value =<0.001.Regarding the percentage of patients who achieved good response, there was no statistically significant difference between Group Aand Group B, 95.3% versus 70% ( Pvalue=0.083) and both of them achieved a statistically significant higher percentage of patients with good response than Group C,47.6%, P-value=<0.001. Although the percentage of patients with complete clearance (PASI≥90%) in the Group Awas much less, 9.5%, than that of Group B, 65% (statistically significant, P-value=< 0.001), the total relapse rate during 8 weeks follow up was much lower among Group Apatients, 25% versus 70%, P-value=0.043.On the other hand no complete clearance was achieved in the Group Cand their relapse rate was 80%. Regarding side effects: Group A, 9.5% of patients developed hypopigmentation, Group B, 10% of patients developed pyoderma and Group C, no side effects were reported. There was no statistically significant difference among the three groups regarding the frequency of side effects (P = 0.355). CONCLUSION: Podophyllin 5% ointment on every other day regimen was as effective as clobetasole 0.05% ointment twice daily at the end of 8 weeks treatment with no side effects and with a much lower relapse rate.


Article
Medico-Legal Comparative Study Between Traumatic and Spontaneous Intracerebral Hemorrhage

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BSTRACT: INTRODUCTION: Intracerebral hemorrhage may be pathological or traumatic in nature. It may be primary or secondary BACKGROUND: Traumatic intracerebral hemorrhage (TICH) is a subtype of intracranial hemorrhage that occurs within the brain tissue itself and lead to displacement or destruction of brain tissue with high rate. Spontaneous intracerebral hemorrhage (SICH) is defined as a blood clot that arises in the brain parenchyma in the absence of trauma or surgery. OBJECTIVE: The aim of this study is to determine the frequency of fatal traumatic and spontaneous intracerebral hemorrhage, and to differentiate between them in postmortem examination. METHODS: This cross-sectional study is performed in the medico-legal institute of Baghdad for (6) months duration from (1-10-2011) to (1-4-2012). Complete medico-legal history was obtained, and full proper autopsy including external and internal examination of all corpuses was performed specially the head. RESULTS: The study included (38) cases of intracerebral hemorrhage; (27) of them were (TICH). Their ages ranged between (5 –65) years, and (11) of them were (SICH) with an age ranging between (15 –75) years. Traumatic group was associated with male preponderance and younger age, while spontaneous group were females and older age. The most common cause of head injuries in the traumatic group was "missiles" followed by road traffic accidents. Comminuted fractures were the most common type of skull fracture. Brain laceration and contusion were the two most frequently observed associated lesions in the traumatic cases. The "intraventricular" Site was the most frequent in traumatic group, while the "Basal ganglia" was the most frequent in the spontaneous group. The anterior cerebral artery was the most frequently affected artery in traumatic group, while the middle cerebral artery was the most frequently affected artery in spontaneous group. CONCLUSION: we identified seven basic rules that can be used during autopsy examination in all cases of intracerebral hemorrhage to differentiate easily between traumatic and spontaneous intracerebral hemorrhage


Article
A Prospective Study of Gestational Trophoblastic Disease in Al-Mosul City

Authors: Zhraa Abd-Alkader Taboo
Pages: 268-276
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BACKGROUND: Gestational trophoblastic tumors comprise a wide spectrum of neoplastic disorders that arise from placental trophoblastic epithelium after abnormal fertilization which is characterized by trophoblastic hyperplasia and overgrowth of placental villi. There are several histologically distinct types of gestational trophoblastic diseases GTD: hydatiform mole (complete or partial), persistant/invasive gestational trophoblastic neoplasia (GTN), choriocarcinoma and placenta site trophoblastic tumors. OBJECTIVE: Of the present study is to determine the incidence, clinical presentation and some of its relevant factors among women admitted to Al-Batool Hospital in Mosul- Iraq. METHODS: The study was conducted in Al-Batool Hospital, Department of Gynecology and Obstetrics, Iraq, Mosul city, from April 2009 to January 2011 as prospective study 9500 patients were analyzed regarding their history, clinical examination, investigations, risk factor. RESULTS: During the analysis, the peak incidence of age is between 21 – 25 years (31.2%). The most common clinical presentation bleeding per vaginal (100%). The peak incidence of the disease is with para two (36%). Complete hydatidiform mole forming (80%). Partial hydatidiform mole forming (18.4%). Invasive mole forming (1.6%). The mean level of B-hCGin partial mole before evacuation is between 3000-4000 mIU/ml. the mean level of B-hCG in complete mole before evacuation is between 7000-10000 mIU/ml. CONCLUSION: Frequency of GTD was higher compared to national and international studies. The disease was common in young ages, low para and grand multiparous women. Hydatidiform mole was the commonest type of trophoblastic disease in these patients. Most common presenting complaint was bleeding per vagina followed by pain in lower abdomen. It appears that the ultrasound is moderately sensitive in the diagnosis of hydatiform mole pregnancy


Article
Presentation and Management Outcome of Eclampsia at AlElwiya Teaching Hospital

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ABSTRACT: BACKGROUND: Eclampsia is a life-threatening complication of pregnancy for both the baby and the mother. Research is underway to understand this complex condition and to improve the treatments that are currently used to control it as it is a preventable complication of pre-eclampsia. OBJECTIVE: The study reviews the cases of eclampsia managed at Elwiya teaching Hospital with respect to incidence, management, maternal and perinatal outcome. METHODS: This prospective observational study was carried out in the department of Obstetrics and Gynaecology at Elwiya Teaching Hospital – Baghdad-Iraq. Fifty two cases of eclamptic fits were dealt with from the 1 st of January till the 31 st of December 2008. Pregnant patients with other convulsive disorders and more than 7 days postpartum were excluded from the study. All the patients included were evaluated by detailed history (taken from the attendants). Management was according to basic protocol for eclampsia; stabilization of patients, anticonvulsive therapy Magnesium sulfate, phenytoin and/or diazepam and early delivery. A team of specialists and trained nurses were needed in the intensive care unit to deal with eclamptic mothers. RESULTS: During the year 2008, total number of deliveries from the 1 INTRODUCTION: Eclampsia is one of the fatal complications of preeclampsia which is a multisystem disorder; it presents a challenge to obstetricians and other physicians. Eclampsia is defined as seizure activity unrelated to other cerebral conditions in a pregnant woman with pre-eclampsia. The condition was known to the ancient Greeks, who named it eclampsia. It has been prevalent since the time of Hippocrates; it remains an important cause of maternal mortality throughout the world, accounting for about 50000 deaths worldwide. Department of Obstetrics and Gynecology at Elwiya Teaching Hospital – Baghdad . (1) st of January till the 31 An eclamptic seizure occurs in 0.5% of mildly preeclamptic pregnancies and 2% of severe preeclamptics. (2) st of December was 12154, of these patients 52 presented with eclamptic fit with incidence rate of 4.28 per 1000 deliveries. The distribution of cases regarding the seasons was more in winter. 35 patients (67.31%) had poor antenatal care, 17 (32.69%) had good antenatal care. Four patients had history of eclampsia in their previous pregnancies. All the patients gave history of imminent eclampsia; two of them had blindness also; albumin in urine was negative in two cases only. Serious maternal complications occurred in 28(53.84%) cases. Eight of the neonates died due to severe RDS. CONCLUSION: Eclampsia is still present and common in our locality; we need better antenatal care to predict pregnant ladies liable to develop eclamptic fit in order to decrease the incidence of eclampsia complicating pregnanc


Article
The Efficacy of the Antimuscarinic Drug Oxybutynin in the Treatment Women with Overactive Bladder (OAB) Symptoms

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ABSTRACT: INTRODUCTION: Overactive bladder is a symptom based syndrome and defined by the International Continence Society (ICS) as urgency, with or without urgency incontinence, usually with frequency and nocturia, if there is no proven infection or other obvious pathology (1) . * Department of Urology, Al-Karama Teaching Hospital; Baghdad. ** Department of Gynecology and Obstetrics, Ibn Al-Baladi Hospital; Baghdad. BACKGROUND: Overactive bladder (OAB) is a symptom based syndrome. These symptoms include: urgency, with or without urgency incontinence, usually with frequency and nocturia with no proven infection or other pathology. It is encountered in women visiting urodynamic units as part of mixed urinary incontinence (MUI). It greatly affects physical and social activities. Incontinence is often the key symptom for the assessment of OAB symptoms and the decision to treat patients. Antimuscarinic drugs are the main agents used to treat this condition. Oxybutynin (immediate-release) 5 mg orally is the main available form in our clinical practice. OBJECTIVE: The objective of this study is to assess the efficacy of Oxybutynin immediate-release (OXY-IR) 5 mg oral tablets, in the treatment of women with overactive bladder, i.e. reduction in episodes of urge incontinence, total incontinence, and micturition frequency. MATERIALS AND METHODS: Twenty-five patients, age range from 18-75 years, diagnosed as having overactive bladder symptoms were treated with Oxybutynin immediate-release (IR) 5 mg tablets 2-3 times daily for 8 weeks period. Homma OAB symptom score system was used for assessment of treatment efficacy. Cystometry was done in all patients to look for detrusor overactivity. RESULTS: After Oxybutynin treatments, all the parameters in micturition patterns improved significantly: frequency, nocturia, urgency (p value < 0.005). Homma overactive bladder symptoms scores also improved following the treatment (p value <0.001). Cystometric examination revealed the presence of detrusor overactivity in 20 of the 25 (80%) patients at presentation. This was reduced to 4/25 (16%) following treatment. About two-thirds (64%) of the patients reported good to great benefit from the treatment and had a positive effect on their life concerning physical and social activity, sleep and feeling of well-being. CONCLUSION: The selective antimuscarinic agent Oxybutynin (OXY-IR) 5 mg 2-3 times orally is effective in treating overactive bladder symptoms in these women by reducing incontinence attacks, urgency, micturition times and nocturia; consequently, it improves their life quality. We recommend devising a score system for OAB suiting Iraqi patients


Article
Comparison of Rate of Caesarean Section between Governmatal and Private Hospitals in Baghdad City

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BACKGROUND: Rising rates of caesarean section (CS) is a worldwide concern. OBJECTIVE: Evaluating rate and indications of CS at both public and private hospital in Baghdad. MATERIALS AND METHODS: A review of all (1354) records of CS patients during January 2009 (552 public, 802 private hospitals) was performed. RESULTS: Rate of CS was higher in private (59.2%) hospital and among mothers aged 25-29 years. Younger patients and elective CS were higher among private patients, emergency CS was higher among public patients. Most CS was performed in term pregnancy, longitudinal lie in both. The most frequent indications were pervious scar (previous CS) and fetal distress in both sectors, malpresentation in the public and failure to progress in the private hospital. Maternal request was found only in the private. CONCLUSION: According to the accepted rates of CS adopted by the World Health Organization (WHO) (5% 15%); CS rate is still high in both sectors, establishing audit committee, good training with second opinion strategy are vital to reduce i

Keywords

caesarean section --- private


Article
Localization of Human Cytomegalovirus- Late Gene DNA, Expression of P53 Gene and CD8-Tumor Infiltrating Lymphocytes in Oral Squamous Cell Carcinoma.

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ABSTRACT: BACKGROUND: Molecular DNA hybridization has confirmed an association of CMV infection with a variety of oral cancers. While cell mediated immunity is most important in controlling primary or reactivated CMV infection, this virus has one of most effective strategies in oral carcinogenesis via impairment of structure and function of P53 protein by interaction with viraloncoproteins. OBJECTIVE: 1.To determine the percentage of CMV-infected oral squamous cell carcinoma tissue specimens; 2. To evaluate the histopathological impact of the expression of mutated p53 tumor suppressor gene on CMV- related, as well as CMV-non-infected oral cancer; and 3.To through a light on some immunological microenvironment of OSCC,by assessing CD8-positive tumorinfiltrating cytotoxicT- lymphocytes. METHODS: This study was designed as retrospective research. A total number of seventy (70) formalin-fixed paraffin-embedded oral tissues were collected; 60 patients with oral squamous cell carcinoma, and 10 individuals with apparently-healthy oral tissues. The molecular methods for CMV DNA detection was performed by sensitive version of in situ hybridization, whereas the phenotype of cell surface antigen marker, namely CD8+ marker of tumor infiltrating lymphocytes and TP53 protein were detected via relevant immunohistochemical methods. RESULTS: Well differentiated grade constituted 81.7% of oral squamous cell carcinoma. Positive in situ hybridization reactions for CMV-DNA were observed in 43.3% of the total screened tissues. Thirtythree out of sixty (55%) oral squamous cell carcinoma showed positive immunohistochemical reactions indicating P53 over-expression, and 18.3% showed presence of CD8-positive tumor infiltrating lymphocytes. None of those control group showed positive reaction for CMV-DNA, p53, or CD8 marker. CONCLUSION: The detection of high percentage of cytomegalovirus-DNA in OSCC could mark for a parentral way of spreading of such important and well-known sexually transmitted infection among Iraqi general population.The obvious high percentage of mutated p53 over-expression indicates for an important role of such genetic events in the oral carcinogenesis.A little role for CD8-positive tumor infiltrating lymphocytes could be played in the immunological microenvironment of OSCC


Article
Occurrence of CTX-M-I Type β-lactamases Gene in Certain Gram Negative Bacteria

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BACKGROUND: The CTX-M-type β-lactamases represent a group with a typical extended-spectrum β-lactamase (ESBL)-resistance phenotype. These enzymes, encoded by transferable plasmids. They have a preferential hydrolysis of Cefotaxime over Ceftazidime. The CTX-M-type β-lactamases have been described in species of Enterobacteriaceae and Pseudomonas aeruginosa. OBJECTIVE : This study was designed to investigate of the occurrence of CTX-M-I type in some Gram negative bacteria species isolated from clinical cases of in Iraq. METHODS: A group of Gram negative bacteria were isolated from different sources.Plasmid DNA extraction, and electrophoresis were performed. Using specific primers, CTX-M-I enzyme genes were amplified by PCR. RESULTS: Plasmid profile of the tested isolates reveals the presence of relatively large plasmids, their Wight was more than 10 kb some isolates posses’ 3-4 kb plasmids. The results of PCR amplification showed the presence of CTX-I genes. All isolates of Salmonella enterica serovar Typhimurium (100%) are negative for CTX-M-I gene as well as most of P. aeruginosa isolates (86.7%). In contrast, all of E. coli (100%) and most of Proteus Spp isolates were positive for CTX-M-I gene. CONCLUSION: CTX-M genes are predominant in E.coli followed by Proteus Spp. while Salmonella enterica serovar Typhimurium and P. aeruginosa isolates showed low incidence of blaCTX-M genes occurrence. The alarming situation with dissemination of CTX-M producing isolates highlights the need for their epidemiological monitoring and prudent use of antimicrobial agents


Article
Delay Neurological Development in Two Children with Megaloblastic Anemia

Authors: Abbas A. Alrabaty --- Azhar H.ALsaqy
Pages: 312-314
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Vitamin B12 deficiency in infants often produces haematological and neurological deficits, including macrocytic anaemia ,neurodevelopmental delay or regression, irritability, weakness ,hypotonia , ataxia, apathy, tremor, and seizures. The diagnosis of vitamin B12 deficiency can be difficult when the typical macrocytic anaemia is absent ) Infantile vitamin B-12 deficiency with ineffective haematopoiesis and degeneration of nervous tissue has been reported in breast fed infants of mothers on strict vegetarian diets 2) ) Adults may tolerate vitamin B-12 deficient diets for many years without apparent symptoms due to their endogenous stores. In contrast, infants have very limited hepatic reserves of vitamin B-12 and so may develop symptoms of deficiency within month's 2) ( . we report two cases in which they were diagnosed as cerebral palsy in early life. first case was 9 month old female baby presented with pallor for last 3 months of age, floppiness ,regress of acquired millstone ,exclusive breast feed for a vegan mother ,diagnosed as megaloblastic anemia second case was 16 months old male baby presented with apathiness , he was exclusively breast feed till this age with minimum complementary food. KEY WORDS : megloblstic anemia ,breast feed

Keywords


Article
Dermoid Cyst of the Spermatic Cord : a Rare Case of Benign Inguinal Lump

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Dermoid cyst of the spermatic cord is an extremely rare pathological state seen at the general surgery and the urological clinic. We present a case of a 19-year old male who presented with a painless left groin lump, irreducible, and no cough impulse from childhood, both testes presented in the scrotum and normal in size and shape. From the history, physical examination, ultrasound examination, we thought it was a lipoma , a hydrocele of the spermatic cord, or irreducible inguinal hernia. During the operation , suspicion of a dermoid cyst of spermatic cord occurred from a sebum and hair which discharged from the cyst during dissection of the cyst from spermatic cord. The final histopathological analysis established the diagnosis of dermoid cyst of spermatic cord.

Table of content: volume:12 issue:2