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:3

Article
The Characteristics Women with Cervical Cancer Referred for Radiotherapy and /or Chemotherapy

Authors: Nada Salih Ameen --- Zeena Raad Helmi
Pages: 321-328
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ACKGROUND: Cervical cancer is the most common gynecologic cancer in women in the world, most arise from infection with human papiloma virus. Other host factors also affect the neoplastic progression following initial infection. OBJECTIVE: To determine characteristics of Iraqi women with carcinoma of the uterine cervix during the last 11 years in Iraq. METHODS: Retrospective study; done on records in Radiotherapy and Nuclear Medicine Hospital- Baghdad; 488 cases of cervical carcinoma referred for chemotherapy and or radiotherapy , from 1999 to 2009.Clinical and pathological data were reviewed and analyzed. RESULTS: The data that was obtained from the radiotherapy and nuclear medicine hospital showed that the women with cervical carcinoma constitute only 2.1% of total women with malignancies during 1999-2009. Highest ;were in 2003 and 2004. Largest proportion presented in late stage (62.32%)and only 37.67% with early stage. Squamous cell carcinoma counted 98.38 % and only 1.62% were adenocarcinoma . Median and mean age was 45-50. Median parity between 4 and 6. Majority of patients from Baghdad (43.02%) , Basra (10.93%)and lowest percentage from North; been collectively (10.46%).Only 6.55% had positive family history. (53.72%) with history of smoking; significantly associated with late stage. Most common clinical presentation was vaginal bleeding( 65.81%).The most common stage at time of presentation was stage II (36.51%). Most of referred patients had surgical interventions as total abdominal hysterectomy with bilateral salpingooophorectomy(sub optimal surgery) 60.93%. CONCLUSION: Most patients with carcinoma of cervix in Iraq presented in late stage due to absence of screening program


Article
The Corellation Between the Clinical Diagnosis & Histopathological Findings of Placental Abruption

Authors: Miami A. Ali, --- Thaeer Jawad
Pages: 329-334
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ABSTRACT: BACKGROUND: The diagnosis of placental abruption is mostly clinical, histopathological diagnosis is poorly sensitive. Acute and chronic inflammatory processes had been proposed to cause placental abruption evidences that supports this remains sparse OBJECTIVE: To assess the correlation between the clinical diagnosis and histopathological findings of placental abruption and to examine the profile of chronic and acute histological lesions associated with clinical abruption. PATIENTS AND METHOD: The study included fifty singleton pregnant women with a suspected clinical diagnosis of placental abruption compared to fifty consecutive normal pregnancies ( control group), attending AL -Yarmouk Teaching Hospital over a period of twelve months, from the first of April 2010 to the end of march 2011 . Examination of the concordance between clinical indicators for placental abruption with those of a histological diagnosis was done. The profile of acute and chronic lesions was also examined histopathologically. RESULTS: Among the fifty clinically diagnosed placental abruption cases , thirteen percent (fifteen patients) were confirmed as placental abruption based on gross and histological findings . The most common indication leading to a clinical diagnosis of abruption was evidence of retroplacental clot(s) or bleeding . Acute lesions that were associated with abruption with confirmed pathology included chorioamnionitis , and chorionic villous hemorrhage . Among the chronic lesions, chronic deciduitis, decidul vasculopathy, & dysmaturation were associated with pathologically confirmed placental abruption. CONCLUSION: The relation between clinical & histological diagnosis of placental abruption remains weak. Acute and chronic histological lesions were observed more frequently in placentas of pregnancies complicated by placental abruption than the control cases


Article
Evaluation of Immunohistochemical Staining for Hepatocyte Growth Factor and c-Met in Endometrial Adenocarcinoma

Authors: Lubab Fadhil Talal --- Mohamed Sabaa Challob
Pages: 335-342
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ABSTRACT: BACKGROUND: Endometrial carcinoma is a primary malignant epithelial tumor, usually with glandular differentiation, arising in the endometrium with the potential to invade and metastasize. Hepatocyte growth factor (HGF) and its receptor c- Met have been implicated in uterine development, pregnancy, and endometrial disorders, such as endometriosis and carcinoma. OBJECTIVE: The goal of this study was to evaluate immunohistochemical (IHC) staining patterns of HGF and cMet in endometrial adenocarcinoma and to correlate staining with the biological behavior and outcome of endometrial adenocarcinoma. PATIENTS AND METHOD: A retrospective study included 45 cases ,who underwent total abdominal hysterectomy and bilateral salpingo-oopherectomy, between 2005-2010 samples ,were taken from Teaching Laboratories at Baghdad Teaching Hospital/Medical City. Thirty cases were diagnosed as adenocarcinoma of the endometrium, an additional 15 patients diagnosed as to have uterine leiomyoma(fibroid) and who had normal endometrium were taken as a control group. The patient's age ,tumor grading ,depth of myometrial invasion, presence of pelvic and paraaortic LN metstases, vascular invasion ,and the stage of the disease were noted . The specimens were already fixed in10% formalin , and paraffin embedded. Three sections (4 micron in thickness ) were cut from each paraffin block. One section stained with Haematoxylin and Eosin (H&E) stain , and the other two stained with HGF and c-Met immunostaining antibodies using positively charged slides . RESULTS: The mean age of the patients with endometrial adenocarcinoma was 58.5years. There was no statistically significant difference between HGF/c-Met expression and age, tumor grade, stage , myometrial invasion and vascular invasion. There was a statistical significant correlation between HGF and c-Met scores with cases showing no pelvic lymph nodes metastases. There is a linear increase in HGF and c-Met expression in both the diseased and control group.A statistical significant correlation was found in HGF and c-Met scores between the diseased group and the control group. CONCLUSION: HGF and c-Met staining was significantly different between control group and diseased group. HGF and c-Met Showed Linear increase Expression in both diseased and control group . The c-Met is the high-affinity receptor for hepatocyte growth factor


Article
Serum CA-125 in Ectopic Pregnancy

Authors: Lilyan W. Sersam --- Rasha Shakir Mahmood
Pages: 343-350
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ABSTRACT: BACKGROUND: CA-125 is a glycoprotein, its origin is uncertain during pregnancy. It rises during the first trimester and returns to a non-pregnancy range in late pregnancy. OBJECTIVE: To compare CA-125 levels between tubal ectopic and normal intrauterine pregnancy, and to find it’s usefulness in differentiating intact from ruptured tubal ectopic pregnancy. METHODS: This prospective case-control study was carried out on sixty healthy women with single normal intrauterine pregnancy (NIUP) of 6-10 weeks gestation and sixty women with tubal ectopic pregnancy of same gestational age which were further subdivided into twenty-five women with ruptured tubal ectopic pregnancy (REP) and thirty-five women with unruptured tubal ectopic pregnancy (UREP). The levels of CA-125 were compared between these groups. RESULTS: The mean level of CA-125 in ruptured ectopic pregnancy group was 49.04±33.63 IU/ml and in unruptured ectopic pregnancy group was 24.3±16.89 IU/ml. The mean level of CA-125 in normal pregnant women (control group) was 53.95±31.2 IU/ml. There was a statistically significant difference between mean serum CA-125 levels of ruptured ectopic pregnancy and unruptured ectopic pregnancy group (p< 0.05), also there was a statistically significant difference between mean of CA-125 level of unruptured ectopic pregnancy group and control group (p <0.05), while there was no statistically significant difference between ruptured ectopic pregnancy group and control group (p > 0.05). CONCLUSION: CA-125 level is significantly elevated in ruptured tubal ectopic pregnancy than the intact tubal ectopic pregnancy, this increase in CA-125 levels can be used as additional test to identify tubal rupture


Article
Autoantibodies and Cytokines Levels in Type 1 Diabetic Patients

Authors: Meroj Ahmed Jasem
Pages: 351-358
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ABSTRACT: BACKGROUND: Type 1 diabetes is characterized by a complete or near-complete insulin deficiency caused by an immune-mediated selective destruction of the insulin-producing β-cells in the Islets of Langerhans. Inflammatory mechanisms play a key role in the pathogenesis of type 1 diabetes. Many findings suggest that the Islet autoantibody status in type 1 diabetes is linked to disease activity. OBJECTIVE: To investigate the hypothesis that the systemic immunoregulatory balance, as defined by levels of circulating cytokines, is associated with Islet autoantibody status. METHODS: Cytokines (IL-2, IL-4, IL-5,IL-10, TNF-β and INF-γ) and Islet autoantibodies (ICA, GADA, IA-2) were measured in 56 patients with insulin dependent diabetes mellitus (IDDM) and 20 healthy control patients. RESULTS: The three proinflammatory cytokines measured [interleukin-2 (IL-2) , interferon gamma (IFN-γ) and tumor necrosis factor-β (TNF-β)], both TNF-β (50.0 ±5.9) (63.4± 5.4) and INF-γ (13.8 ± 10.9) (13.7 ± 5.5) showed a significant increase (P <0.05) with Islet autoantibody positivity, while the other three cytokines,(IL-4,IL-5 and IL-10), only IL-4 showed a positive increase (54.4 ± 1.4) with Islet autoantibody positivity although it is non- significant association. CONCLUSION: The study reveals the possibility of the of Islet autoantibodies in the domination of proinflammatory cytokines over the immunoregulatory cytokine


Article
Diabetic Dermopathy as Marker for Early Detection of Myocardial Infarction

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BSTRACT: BACKGROUND: There are many cutaneous signs in diabetes mellitus (DM) which is the most common endocrine disorder among the general population. Diabetic Dermopathy (DD) or Shin Spots are the most common cutaneous signs of diabetes. Although they occur individually in people who do not have diabetes, if four or more are present the specificity is high for microvascular disease in other tissues. OBJECTIVE: This study was done to evaluate frequency of diabetic dermopathy among diabetic patients and use this obvious subtle clinical sign as marker for early detection of atherosclerotic changes in diabetic patients including myocardial infarction PATIENTS AND METHOD: This study was done at diabetic center in Sulaimani intensive care unit(IUC) in teaching hospital of Suliamani during the period from November 2008 to June 2009. A total of 384 patients with Diabetes mellitus were included in this descriptive case series hospital-based study. All patients were diagnosed by specialist diabetician as a case of DM depending on classic diagnostic criteria of DM. All patients were thoroughly assessed regarding the age, sex, skin color, duration of diabetes mellitus and treatment regime. Careful skin examinations has been performed for diabetic dermopathy, diabetic wet gangrene of foot. Diagnosis of myocardial infarction was done either by electrocardiographic changes or by plasma biochemical marker. RESULTS: Eighty four (21.9%) case with DD were reported in our study; fifty four (64.3%) case of them were females while the remaining 30 (35.7%) cases were male. Diabetic patients with myocardial infarction were 44(11.5%) cases, 36 cases as acute MI. while the other eight cases were old cases of MI. Of these 44 cases 16(36.4%) had DD while 28(63.6%) had no DD. CONCLUSION: There was a statistically significant association between the myocardial infarction and the frequency of diabetic dermopathy and we should use this obvious subtle clinical sign as marker for early detection of atherosclerotic changes in diabetic patients including myocardial infarction. Wet gangrene of the foot is also considered a marker of bad glycemic contro


Article
Comparative Study Between Glimepiride and Glibenclamide in the Treatment of Type 2 Diabetic Patients in Al-Yarmouk Hospita

Authors: Fadia.Y.Al-Hamdani --- Maitham.M. Al-Mefraji
Pages: 366-371
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ABSTRACT: BACKGROUND: Second-generation sulfonylureas (SU) are efficacious, generally well-tolerated, cost-effective options for the medical management of diabetes. Glimepiride which is sometimes classified as a third-generation has benefits over other in that it has a considerably lower binding affinity for the B-cell receptor, result in a modulation of insulin release, and a decreased potential for inducing hypoglycemia. OBJECTIVE: This study was designed to evaluate the outcome of using glimepiride and glibenclamide in type 2 diabetic patients. PATIENTS AND METHODS: A single blinded randomized clinical trial was adopted, in which 64 already diagnosed diabetic patients (regardless disease duration) were recruited from Al-Yarmouk hospital, and randomized into two groups; 1 INTRODUCTION: Sulfonylureas have been used for type 2 diabetes for over 50 years (1) . They act by stimulating insulin release from the beta cells of the pancreas. They bind to sulfonylurea receptors found on the surface of pancreatic β-cells and this interaction leads to closure of K -ATP channels, the cell membrane is depolarized and insulin is released (2) st group (32 patients) treated with 5 mg glibenclamide, and 2 group (32 patients) treated with 3 mg glimepride for 4 months. Fasting blood sugar (FBS), glycosylated hemoglobin (HbA1c) level, triglyceride, cholesterol, serum electrolyte (Na, K, Ca) level and pulse rate were measured at zero time (first visit)and at the end of the study (after 4 months). RESULTS: The result showed that both Fasting blood sugar, glycosylated hemoglobin, serum total cholesterol, triglyceride levels were decreased significantly in both treatment group but with greater reduction in group 2, serum electrolytes were not significantly affected, except calcium level which was increased significantly in glimepiride group only. Moreover, no significant effect observed regarding pulse rate compared to pretreatment period. CONCLUSION: Glimepride provide more potent glycemic control and better lipid profile compared to glibenclamide in type 2 diabetic patients


Article
Serum and Erythrocyte Magnesium Levels in Patients with Myocardial Infarction with or without Heart Failure

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BACKGROUND : Magnesium (( Mg (1) )) is a mineral that is involved in over 300 reactions in the body. Magnesium is a Potent vasodilation ,and plays an important role in muscle contraction. It has been early documented that Mg deficiency can precipitate ventricular arrhythmias and treatment with Mg has some anti arrythmic effect. Moreover there is an ample evidence that a significant percentage of patients with IHD suffer from Mg . The risk of IHD increases with age, smoking, hypercholesterolaemia, diabetes mellitus, hypertension (1) . Ischemic heart disease presented as stable angina , unstable angina , myocardial infarction , ischemic heart failure and ischemic cardiomyopathy . The diagnosis of ischemic heart disease depend on clinical history and investigation including: *Ministry of Health AL-Bitar Hospital,Baghdad .Iraq. **Biochemistry Dept. Collage of Medicine University of Baghdad. *** Dept. Baghdad Medicine City. deficiency. OBJECTIVE : The objective of the present study is to measure Mg (2) levels in serum and RBCs of patients with some forms of IHD. PATIENTS AND METHODS: The study was conducted in Baghdad hospital and Ibn – Al-Bitar Hospital.The 180 patients with IHD were divided into Two groups. Group I, 80 patients with Ischemic Heart Failure (IHF) (EF˂30) aged 65.75±5.97 year (50 males and 30 females), group II, 100 patients with Muocardial Infarction (MI)(EF˂50) aged 50.34±6.36 year (58 males and 42 females). Serum Mg and RBCs Mg were measured in all patient groups by Atomic Absorption Spectrophotometer. RESULTS: The(mean ±SD) value of serum and RBCs Mg in patients with both groups Ischemic Heart Disease (IHD) was significantly lower when compared with that of controls (p<0.05).The serum Mg levels (0.81±SD mmol/L) are significantly lower in the IHF group and in MI group (0.96±0.18 mmol/L) when compared with that of controls (1.00±0.17 mmol/L) (p˂ 0.001). CONCLUSION: The data obtained in present study revealed the decrease of Mg level in serum and RBCs in both patients groups, which affect the contractility of heart muscle and cardiac performance


Article
Growth Assessment in Asthmatic Patients

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BSTRACT: BACKGROUND: Asthma is a chronic disease &the chronic disease states regardless etiology can cause growth failure in infant &toddler. OBJECTIVE : To assess growth of asthmatic patients PATIENT AND METHODS: One hundred asthmatic children between (5-15 years) of age . Both asthmatic & control group studied in term of height, weight & Skin fold thickness, all anthropometric measurements of height, weight &skin fold thickness measured for both groups. RESULT: Height, weight &skin fold thickness were significantly retarded in asthmatic, the more severe the disease &longer duration the more retardation in the height & weight. The height was affected more than the weight by the disease duration & severity .The diminution in skin fold thickness was retarded both with increase disease duration & severity but the female was less retarded than male as the disease duration prolonged. CONCLUSION: All growth parameter (height, weight, SFT) affected by asthma (duration & severity), so the growth parameters can be used in asthmatic children to evaluate the effect of treatment


Article
Causes of Global Developmental Delay in Children Welfare Teaching Hospital-Baghdad

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ABSTRACT: BACKGROUND: There are wide ranges of causes behind global developmental delay in Iraqi children but most of these causes were not diagnosed as a result of unavailable diagnostic tools. OBJECTIVE: To study the etiology of global developmental delay in Children Welfare Teaching Hospital / Baghdad. PATIENTS AND METHODS: A descriptive study was done on 75 patients, their age range from 8 months to 5.5 years with global developmental delay, who consult Children Welfare Teaching Hospital/Baghdad, from 1 of May 2010 to 1 st of October 2010. A full history, thorough physical examination, and developmental assessment according to Denver Developmental Scale II were done to all cases. A group of selected investigations including neuroimaging (CT & MRI), EMG, EEG, visual and hearing assessment, screen for metabolic diseases, and thyroid function test were done as needed for the diagnosis. RESULTS: A total of 75(preschool) patients with age range from 8 months to 5.5 years were studied; 45(60%) of them were males and 30(40%) were females,9(12%) were preterm, 26(34.6%) were born with LBW, 3(4%) of patients acquired the infection with TORCH from their mothers [2(2.7%)CMV, 1(1.3%)toxoplasmosis], 8(10.7%) had their mothers complained from chronic diseases (hypertension and diabetes mellitus ), 11(14.7%) suffered birth asphyxia, 2(2.7%) with high bilirubin level exceeding 20mg/dl, 2(2.7%) patients suffered RDS and 1(1.3%) suffered sepsis diagnosed by blood culture during neonatal period .Family history of developmental delay was reported in 11(14.7%) and consanguinity was reported in 46(61.3%) of cases, in 33(43.9%) no cause could be identified, CNS infections 9(12%), Down syndrome 7(9.3%), hypothyroidism 2(2.7%), intracranial hemorrhage 2(2.7%), infantile spasm 2(2.7%), phenylketonuria 2(2.7%), Myotonia Dystrophica 1(1.3%), and Seckel syndrome 1(1.3%). CONCLUSION: Global developmental delay in pediatric practice has wide etiology. The majority of cases were not diagnosed because of deficient diagnostic tools like cytogenetic analysis. High percent of perinatal etiology raises the importance of good maternal and neonatal care. Under diagnosis of inborn error of metabolism due to lack of routine screening in neonatal period, aggravated the problem


Article
Neonatal Polycythemia: Risk Factors, Clinical Manifestation and Treatment Applied

Authors: Sawsan Sati Abbas --- Hamed Fakhri Fayadh
Pages: 390-395
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BACKGROUND: Polycythemia is defined as a venous hematocrit above 65%.Polycythemia is sometimes associated with hyper viscosity of blood .The etiology of polycythemia is related either to intra-uterine hypoxia or secondary to fetal transfusion. Increased viscosity of blood is associated with symptoms of hypoperfusion. Clinical features related to hyper viscosity may affect all organ systems. OBJECTIVE: To evaluate the prevalence of polycythemia among neonates who were admitted to the nursery care unit, to evaluate the difference between peripheral and central hematocrit (PCV) and to have an idea about the main presentation and modes of treatment of polycythemia. PATIENTS AND METHODS: A case – control study was done in the nursery care unit of AL - Kadhyimia Teaching Hospital , one hundred neonates (50 polycythemic and 50 control healthy neonates ) were taken , for each neonates , information regarding (name ,age , sex , gestational age , mode of delivery , body weight ,length, head circumference , clinical presentation and risk factors ) were taken, investigations including hematocrite (PCV) , random blood sugar and total serum bilirubin were done for all neonates. RESULTS: The prevalence of neonatal polycythemia was (2.2%) , male was affected more than female with male : female ratio equal to ( 1.5:1) . The difference between peripheral and central PCV was (4 - 15%) with a mean and standard deviation of ( 7 ± 0.33%). The main signs & symptoms were jaundice (58%), lethargy (30%) , respiratory distress (26%) and hypoglycemia (26%) . Risk factors were preterm (36%) , neonates of diabetic mother (20%) , small for gestational age (18%) , twin pregnancy (12%) and down's syndrome (10%) . Partial exchange transfusion was done to 28 cases (56%). CONCLUSION: Males were affected more than females. Jaundice was the main presentation followed by lethargy, respiratory distress and hypoglycemia .Higher risk in twin pregnancy ,neonates of diabetic mother , small for gestational age , preterm and down's syndrome while delivery by caesarian section reduce the risk of polycythemi


Article
Evaluation of Itching Sensation in Chronic Urticaria

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ABSTRACT: BACKGROUND: Itching is the main symptom in urticaria and can cause a lot of suffering in chronic urticaria. OBJECTIVE: To measure the itch threshold in patients with chronic urticaria before and after treatment and compare them with healthy control. PATIENTS AND METHODS: The study was conducted at the department of dermatology, medical city teaching hospital Baghdad in the period from December 2009 to July 2010. A total of 30 patients with chronic urticaria (patients group) and 25 healthy individuals (control group), were included in the study. The age of patients ranged between 21years and 48 years with a mean of 30.96 years ± 6.09 years (standard deviation). In control group the age ranged between 20 years and 45 years with a mean of 31.40 years ± 8.39 years (standard deviation). Regarding gender, in the patients group 19 were females and 11 were males. While in the control group 14 were females and 11 were males. Electrical skin itch threshold was measured by square wave DC electrical stimulator at 13 points on the skin surface in patients and compared to the healthy controls. Doxepin was given to patients for 2 weeks, the itch threshold was then measured again. The severity of urticaria was also assessed before and after treatment. RESULTS: Patients with chronic urticaria had significantly lower threshold than the control subjects .The lowest threshold recorded in patients group was (1.292±0.399) volts in the left cheek, while in control group the lowest electrical cutaneous threshold was recorded in the chin (1.89±0.490) volts then left cheek (1.910±0.478). The P-value was significance in all skin spots. The electrical cutaneous threshold increased after treatment in all spots tested after treatment. The increase was statistically significant in all tested the skin spots except in the back of the neck and xyphoid point. The total score decreased from 10.8 before treatment with doxepin to 1.5 after treatment. The individual parameters also decreased significantly after treatment. There were no significant side effects except drowsiness which improved after a few days even with continuation of treatment. CONCLUSION: Electrical skin itch threshold seems to be a simple test that aids in measuring the severity of itching in urticaria and may be used in the evaluation of drugs used for the alleviation of itching in urticaria and other skin diseases


Article
Herpes Simplex Labialis Virus is A Risk Factor for Vitiligo (Post- Herpes Simplex Labialis Vitiligo)

Authors: Ali M. Dhahir Elethawi
Pages: 401-403
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BACKGROUND: Herpes simplex labialis is a common disease and is the major cause of erythema multiforme. Recently post-herpes labialis leukoderma had been noticed on the lips of Iraqi patients OBJECTIVE: The aim of the present work is to assess this new pigmentary problem. METHODS: A total of 24 patients with post-herpes labialis leukoderma were included in this study. Full history and a thorough physical examination were done for all patients. RESULTS: Fourteen females (58.37%) and 10 males (41.67%) were studied. Their ages ranged between 7-53 years. Koebner phenomenon was positive in 17 (70.83%) patients. Family history of vitiligo in close relatives was positive in 13 (54.17%) of patients. CONCLUSION: The findings of the present work are in favor that this type of leukoderma is a variant of vitiligo that may be induced by herpes-simplex labialis


Article
Effect of Methotrexate on Serum Levels of IL-1α and IL-8 in Rheumatoid Arthritis

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BACKGROUND: Pathogenetic therapy of RA is a complex task, according to modern views on the development of * Dept. of Microbiology, Medical College, Al- Nahrain Univ. ** Dept. of Clinical Biochemistry, Medical College, Al-Nahrain Univ. *** Dept of Basic Science, College of Dentistry, Univ. of Baghdad. (1) . autoimmune inflammation in RA, cytokine imbalance plays a great part in RA pathogenesis Rheumatoid arthritis is a chronic systemic inflammatory disease affects many tissues and organs, but principally attacks flexible (synovial) joints. Methotrexate is the most commonly used disease-modifying antirheumatic drug for the treatment of rheumatoid arthritis. OBJECTIVE: The aim of this study was to evaluate the effect of methotrexate on serum levels of IL-1α and IL-8 in rheumatoid arthritis. SUBJECTS AND METHODS: Blood samples were collected from 50 patients with rheumatoid arthritis (25 patients without treatment and 25 patients are received methotraxate) and from 30 healthy age and sex matched individuals served as controls. Serum IL-1α and IL-8 were measured by means of enzyme-linked immune-sorbent assay. RESULTS: The present results showed that serum levels of IL-1α and IL-8 were significantly higher in RA patients than in healthy controls (P<0.01), furthermore, level of IL-1α was significantly decrease in patients treated with methotraxate as compared to those patients who have received no treatment (P<0. 01). On the other hand serum level of IL-8 did not showed any significant differences between patients treated with methotraxate and those patients without treatment (P>0. 05). CONCLUSION: These finding demonstrate that methotrexate turns out to be a good inhibitor for IL-α production. In addition, IL-1α and IL-8 may have a significant role in the pathogenesis of rheumatoid arthritis, and could be use a


Article
The Validity of Preoperative Templating inCementless Total Hip Arthroplasty: A Pilot Study

Authors: HushamAbdulkareemSalih --- MunaMuneer Ahmed
Pages: 409-415
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ABSTRACT: BACKGROUND: Preoperative templating plays an important role in orthopaedic surgery for achieving a successful outcome in THA. This includes not only selecting the type and size of implant, but also deciding on the alignment, position, and orientation of these implants, relying on anatomically defined landmarks OBJECTIVE: The first goal of this study was to evaluate the validity of preoperative templating technique in terms of determining the final implant size and position. The second goal was to investigate the interobserver and Intraobserver reliability of template readings on conventional radiographs. METHOD: In Aljumhorei hospital, Mosul city a case series; pilot study has been carried for twenty-eight patients had preoperative templating for total hip arthroplasty between 21/10/2009 to 16/5/2012 was carried by the operating surgeon. Preoperative templating by same two orthopedic surgeons carried for 12 patients from the total. Preoperative templating for Seventeen patientsout of the total were studied with the same operating surgeon after 2 years of experiences. RESULTS: 29% compatibility for shell between preoperative templating with intraoperative for the operator, P_ 0.023. While for stem 39%P_ 0.257. Second surgeon 58% compatibility with P_0.564, Stem differences represent 33% (P_ 0.248). Differences with two years experiences for the operating surgeon indicate 35% compatibility both for shell and the stem with non-significant differences. CONCLUSION: Preoperative templating appeared to be more accurate for femoral stem measurements than the acetabular templating in determining the accurate sizes. Two years experienced added no more in templating measurements. There were significant differences for interobserver measurements


Article
Epicardial Fat Thickness Obese Patients an Observational Echocardiographic Study

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ABSTRACT: BACKGROUND: Obesity currently affects nearly one-third of the population in the industrialized world. Traditionally, anthropometric measures such as body mass index (BMI) or waist circumference have been used to quantify overall adiposity; however, regional fat depots may be of greater importance than overall adiposity. Several studies have highlighted pericardial fat and abdominal visceral adipose tissue (VAT)as unique, pathogenic fat depot. OBJECTIVE: Recognize the relation of obesity to increase epicardial fat pad thickness in Iraqi patients. METHODS: Epicardial fat thickness was measured in 62 consecutive subjects (28 women 45%, 34 men 55%) mean age of 47.77 years (SD 8.03),using routine transthoracic echocardiogram. Epicardial fat was identified as the echo-free space between the outer wall of the myocardium and the visceral layer of the pericardium, and its thickness was measured perpendicularly on the free wall of the right ventricle at end-systole. RESULTS: The results show progressive increase of epicardial fat with increasing BMI which was very significant statistically. High mean epicardial fat is significantly associate with increasing waist circumference. No difference in those below and above 45 years of age in mean epicardial fat and there is gender difference in epicardial fat, where males had more epicardial fat than females. CONCLUSION: There is increase in the epicardial fat pad thickness in overweight and obese (BMI≥25) patients if compared to normal persons epicardial fat increase with increasing waist circumference more likely in male obese and independent of age


Article
he Expression of P53 in Non Small Cell Lung Cancer

Authors: Banan Burhan Mohammed
Pages: 421-428
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BACKGROUND: Despite major advances in cancer treatment in the past two decades, the prognosis of patients with lung cancer has improved only minimally. Although tumor stage is the most significant prognostic factor, the variation in survival within staging groups requires information about additional factors influencing the outcome. Among several genetic aberrations that have been implicated in lung cancer, mutations in the p53 gene are the most common. OBJECTIVE: The aim of this study was to evaluate the expression of p53 in non-small cell lung cancer. To correlate the relation of p53 with some clinico-pathological parameters. And to compare the results with that of others. PATIENTS AND METHODS: Tumor tissues from 52 patients with non small cell lung cancer (NSCLC) were assessed by immune-histochemistry for the expression of p53. The immunohistochemical study was performed on formalin-fixed, paraffin-embedded sections using LSAB immune-peroxidase method. RESULTS: Thirty nine (75%) of 52 patients revealed aberrant immunostaining for p53. No significant relation was observed between the p53 and patient age (P=0.596). A significant association (P=0.048) was found between the p53 and the sex of the patient with higher expression in males and the p53 was significantly (P=0.0345) associated with histopathological type of tumor. Comparing p53 expression with grade resulted in a strong positive correlation (P= 0.0002). The percentage of p53-positive tumors progressively increased from (2.56%) in well differentiation to (53.85%) in poorly differentiated tumor. CONCLUSION: P53 was significantly association with sex, grade and histological type, the detection of p53 may be important marker to predict the prognosis of the patients with NSCLC and for stratifying these patients into more accurate prognostic group


Article
The Effectiveness of Tramadol in Treatment of Premature Ejaculation on-Demand Basis

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ABSTRACT: *Department of Surgery, College of Medicine, University of Baghdad. **Department of Surgery, College of Medicine, University of Baghdad. ***Department of Community Medicine, College of Medicine, University of Baghdad. ****Consultant Urologist, Baghdad Medical City. BACKGROUND: Premature ejaculation (PE) is a worldwide problem. Selective serotonin reuptake inhibitors (SSRIs) are widely used “off label” as pharmacotherapeutic agents in the treatment of PE. OBJECTIVE: Assess the efficacy of Tramadol for on-demand treatment of PE. PATIENTS AND METHODS: During the period December 2008 through November 2009, 60 married men visited the surgical specialties hospital urology outpatient and consultancy clinics complaining of premature ejaculation were enrolled in this study. Intravaginal ejaculation latency time (IVELT) was used as an objective tool to assess the efficacy of the investigated treatment. Single-blind, placebo-controlled therapeutic trial was conducted on 60 patients with lifelong PE. PE was defined as IVELT of <2 minutes in at least 80% of intercourse episodes. The patients cohort was randomised into 2 equal sized groups. The intervention group (n=30) used 50 mg tablet of Tramadol hydrochloride, while the control group (n=30) used a placebo tablet for 8 weeks. Drugs were taken 1–2 hours before sexual activity, and sexual intercourse was required at least once per week. IVELT was timed by a stopwatch at each intercourse. RESULTS: The mean IVELT after tramadol and placebo significantly increased from 73.1 and 67.9 seconds to approximately 442.1 and 113.3 seconds, respectively (P < 0.001). Sexual satisfaction was used to assess the cut-off values of IVELT in defining the minimal and best clinical response to treatment. There was no withdrawal symptoms recorded following the use of tramadol or placebo, but more adverse events were associated with tramadol treatment CONCLUSION: Tramadol seems to provide significantly better results in terms of IVELT and intercourse satisfaction versus placebo. Further studies are required to draw final conclusions on the efficacy of this drug in premature ejaculation

Keywords

premature --- ejaculation --- tramadol


Article
Etiology of Referred Otalgia

Authors: Zhraa Abd-Alkader Taboo --- Marwan F.Buraa
Pages: 436-442
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ABSTRACT: BACKGROUND: Otalgia is defined as ear pain. It is one of the complaints which may occur at any age. The etiology of the pain may be in the ear, structures around the ear or other head and neck structures This is caused by the complex nervous connections in the head and neck areas, the ear, the pharynx and the nose. objective: since understanding the etiologies of referred otalgia can help in the assessment and treatment of the disease, this research was conducted to identify the etiologies of referred otalgia in patients visiting the ENT Clinic in mosul , Iraq OBJECTIVE: Since understanding the etiologies of referred otalgia can help in the assessment and treatment of the disease, this research was conducted to identify the etiologies of referred otalgia in patients visiting the ENT Clinic in Mosul , Iraq. We have reviewed the complex neuroanatomic basis of nonotogenic ear pain PATIENT AND METHODS: A prospective study of 211 patients with ear pain. During a 12 month period from 2010 to2011,two hundred and eleven patients with otalgia were studied, they were attendant of the outpatient clinic of ENT department in Al-Jumhury Teaching Hospital. Patient age ,gender ,occupation, residence were recorded in a representative questionnaire form. All patients had a normal otologic examination and diagnosed with causes for referred otalgia were categorized according to distribution of cranial nerve, gender and age. RESULTS: The majority of causes of otalgia (64%)were due to referred pain, while only(35.5)of causes were due to ear leasions. significantly referred pain affected patient above the age of 15yr more than those below the age of 15yr .The most common cause for referred otalgia in Females was Temporomandibular joint (TMJ) dysfunction (29.2%);while cervical spine lesion was commonest in male. The trigeminal nerve was the major cranial nerve causing referred pain in both gender (53.7) CONCLUSION: Since the early 1900s, referred otalgia has been a well-documented phenomenon in the ear, nose, and throat (ENT) and neurosurgical literature. However, Essentially any pathology residing within the sensory net of cranial nerves V, VII, IX, and X and upper cervical nerves C2 and C3 can potentially cause referred otalgia. A thorough understanding of the various sensorineural pathways that dually innervate the ear and other sites and ongoing dialogue with our clinical colleagues, will ensure that patients with referred otalgia will receive the best care in the head and neck.

Keywords

otalgia --- neuroanatomy --- trigeminal


Article
Comparison of the Effect of Dexamethasone and Metoclopramide in Prevention of Post-Operative Nausea and Vomiting in Laparoscopic Cholecystectomy

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Abstract

ACKGROUND: Postoperative Nausea and vomiting is Common complication depending on the type of surgery, technique and duration of anesthesia. OBJECTIVE: To evaluate the effect of Dexamethasone as antiemetic in comparison with Metoclopramide. METHODS: Is aprospective study carried on (100) patients undergone elective cholecystectomy in a period from Jan. 2009 to April. 2010 in Baghdad Teaching Hospital / Medical city/Baghdad/Iraq. The patients were allocated into two groups of 50 patients each. Group A received 8mg Dexamethasone, group B received 10mg metoclopramide intravenously, both groups monitored postoperatively for nausea and vomitting for 24 hours every 4 hours. RESULT: Regarding Nausea, for 24 hrs the results were not significant except at 24th hr., in which nausea more significant in metoclopramide group. Regarding Vomiting, there was no significant from postoperative period to 12hr, while from 16 hr. to 24 hr. there were significant fewer incidences in dexamethasone group. CONCLUSION: A single dose of Dexamethasone is effective same as Metoclopramide in prevention of PONV , and it is better in late prevention postoperativel


Article
The timing of Ondansetron Administration in Prevention of Postoperative Nausea and Vomiting A comparative Study for Female Patients Undergoing Laparoscopic Cholecystectomy

Authors: Sabah Noori Al-Saad
Pages: 449-453
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Abstract

BACKGROUND : Postoperative nausea and vomiting (PONV) is a common distressing experience in patients following laparoscopic cholecystectomy. OBJECTIVE: This study was aimed at comparing the better timing of Ondansetron administration in prevention of PONV in female patients underwent elective laparoscopic cholecystectomy done under general anesthesia. PATIENTS AND METHODS: Fifty ASA physical status I and II female patients, aged 19 to 45 years, were enrolled in this prospective study to receive 4mg IV Ondansetron preoperatively (Group A), or 4 mg IV Ondansetron postoperatively (Group B), 25 patients each. A standardized general anesthetic technique was employed. Any episode of PONV was assessed at 8 hours postoperative period, every 2 hours, starting at time zone 0 (at post-anesthesia recovery unit), and ending at time zone 3 ( hour 8 postoperatively). Complete response is defined as no PONV during 8 hours postoperative period. Incomplete response is defined as developing of postoperative nausea only during 8 hours postoperative period. Failure of prevention is defined as developing of PONV during 8 hours postoperative period. RESULTS: Complete response occurred in 60 and 64% in Groups A and B respectively. Incomplete response occurred in 12 and 4% in Groups A and B respectively. Failure of prevention occurred in 28 and 32% in Groups A and B respectively. CONCLUSION: There is no significant clinical difference between preoperative or postoperative Ondansetron administration of the same dosage in both groups in prevention of postoperative nausea and vomiting.


Article
The Role of Dexamethasone in Reducing the Severity of Postoperative Sore Throat

Authors: Hassan Sarhaan Haider --- Bashar Taha Al-Ali*
Pages: 454-459
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Abstract

ACKGROUND: Effect of intravenously administered dexamethasone in reducing the incidence and severity of post operative sore throat in patients receiving general anesthesia with endotracheal intubation. OBJECTIVE: To investigate the effect of dexamthasone administered intravenously preoperative in reducing post opretive sore throat METHODS: 80 patients receiving general anesthesia with endotracheal intubation in randomized double blinded placebo controlled were randomly assigned to two groups: group1(control) patients receiving normal saline 2 mLiv and group 2 (D) patients received dexamethasone 8 mg iv. After surgery, visual analogue scale(VAS) scores at rest and with effort (swallowing movment) for post operative sore throat were recorded. RESULTS: This study revealed that post operative sore throat during the first 24 hr following surgery was lower in dexamethasone group(D) compared to the control group(C).Nine (22.4%) patients in the dexamethasone group had postoperative sore throat, compared to 23(57.5%)patients in the control group (p<0.01). Postoperatively at one hour,threehours, six hours, 12 hours and 24 hours, the VAS scores for postoperative sore throat at rest and during effort were lower in dexamethasone group (D) compared to the control group(p<0.01) at corresponding time intervals. CONCLUSION: Preoperative administration of dexamethasone 8mh iv reduces the incidence and severity of postoperative sore throat in patients receiving general anesthesia with endtacheal intubation


Article
Multilocular Cystic Renal Cell Carcinoma, Miss-Diagnosed Clinically as Renal Hydatid

Authors: Niema Hamad Al-Heeti --- Raji H. Al-Hadithi
Pages: 460-465
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Abstract

ABSTRACT: Multilocular cystic renal cell carcinoma (MCRCC) is a rare clear cell type of renal cell carcinoma. Although cytologyically and cytogenetically MCRCC is similar to clear cell carcinoma, histology and behavior differ markedly. Prognosis in MCRCC is excellent as the tumour is of consistently low grade and surgical resection is curative. We report here a case of MCRCC in 44 year old female presented with right loin pain, was miss-diagnosed as renal hydatid cyst for 2years. Local excision of the tumor mass only was done with no recurrence after 30 months of follow up after. The differentiation between renal hydatid cyst and MCRCC may be difficult clinically and radiologically.The tumor grows very slowly.The outcome of the lesion is not affected adversely by large tumor size. There is an increasing belief that MCRCC should be renamed and reclassified to indicate much more favorable prognosis than the conventional clear renal cell carcinoma. Key Words: Multilocular cystic renal cell carcinoma, clear cell renal cell carcinoma, renal hydatid cyst.

Keywords


Article
Can Orbital Hydatid Cyst Presents With Acute Visual Loss?Case Report and Literature Review

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Abstract

ABSTRACT: Hydatid cyst (HC) disease is zoonotic disease caused by larvae of Echinococcus granulosus which is commonly affecting liver and lung or any organ or tissue in our body .central nervous system (CNS) can be involved at any place with or without brain involvement including skull ,orbit , vertebral column and spinal cord .Orbital infestation is constituting less than 1% of all hydatid disease cases .There are few reported cases of orbital HC in the literatures that presented with acute visual loss and proptosis. In this article we are reporting a case of intramuscular orbital HC that presented with sever and acute visual loss with proptosis following trivial road traffic acciden

Table of content: volume:12 issue:3