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:4

Article
Endotracheal Intubation in Children Undergoing Cleft Lip Surgery.A Comparative Study Between Propofol and Halothane

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ABSTRACT: BACKGROUND: Endotracheal intubation is one of important step during the administration of general anesthesia. It is more so in pediatric patients with associated deformities like cleft lip and palate. Propofol, with its profound depressant effect on the airway reflexes, has a quick and smoother induction. Similarly, halothane is least expensive volatile anesthetic, sweaty to inhale and because of its safety profile. OBJECTIVE: The intubating conditions with the use of intravenous propofol is superior to inhalational halothane with oxygen for tracheal intubation without muscle relaxants in children who undergo cleft lip surgery. PATIENTS AND METHODS: In this prospective randomized study, 50 ASA I patients who where aged three to nine months, who were scheduled for cleft lips surgeries were included. Both group received halothane 3% by face mask with monitors attached [pulse oximeter , ECG ,NIBP ]. I.V line inserted ,first group(propofol group) once patients become sleepy &respiration became regular& stop movement they received 2mg/kg propofol &E.T.T attempt within 0ne min.2nd group inhalational( halothane Group) until pupil been central & constricted &E.T.T attempted within 5 min. The intubation conditions were assessed by using Steyn’s modification of the Helbo - Hansen intubating conditions score. RESULTS: The intubating conditions were better in group A than in group B. The group A patients (88%) significantly had more clinically acceptable intubating conditions than in group B(52%), (p=0.0015) . CONCLUSION: The intubating conditions with the use of intravenous propofol 2mg/kg is superior to inhalational 3% halothane with oxygen for tracheal intubation without muscle relaxants in children who undergo cleft lip surgery.


Article
Intrathecal Ketamine Versus Bupivacaine for Inguinal Hernia Surgery

Authors: Aimen Hameed Latef
Pages: 477-481
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ABSTRACT: BACKGROUND: Ketamine shows beside its general anesthetic effect, a local anesthetic - like action; that is due to blocking of Na+ channels mainly with other proposed mechanisms. OBJECTIVE: Comparison of ketamine local anesthetic action with that of bupivacaine in neuraxial blockage (spinal anesthesia) was done. PATIENTS AND METHODS: Hundred patients were scheduled according to American Society of Anesthesiologists (ASA) physical status classification I-II for elective inguinal hernia surgery under spinal anaesthesia, divided into 2 equal groups, the first group received 2 ml (0.5%) bupivacaine, second group received 2 ml [75 mg preservative free Ketamine (1.5 ml) mixed with 0.5 ml, 30%dextrose], comparison in the onset, duration of the sensory block and the central sedative effect between the two groups was done. RESULTS: Group II patients who received ketamine intrathecally demonstrated faster onset of block with longer duration of analgesia, 30% of them appeared sedated owing to the central sedative effect. CONCLUSION: As a new look to an old drug; ketamine can be used as a pure local anesthetic for spinal anesthesia with the advantage of longer period of analgesia and faster onset as compared with bupivacaine. Ketamine group appeared more hemodynamically stable.


Article
Comparison of the Effects of Spinal Anaesthesia Vs General Anaesthesia on Apgar Score in Neonates Born after Elective Caesarean Section

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ABSTRACT: BACKGROUND: Delivery of baby by caesarean section has become increasingly common, Caesarean section can be performed under general or regional anaesthesia like spinal or epidural technique, and both have advantages and disadvantages. It is important to clarify what type of anaesthesia is safest for the mother and baby. OBJECTIVE: To compare the effect of spinal anaesthesia versus general anaesthesia on Apgar score of neonates born by elective caesarean section in Baghdad teaching hospital. MATERIAL AND METHODS: The study was carried out in Baghdad teaching hospital from February 2011 to July 2011 .this study was performed on 60 women presenting for Elective lower segment caesarean section .thirty mothers were given general anaesthesia and other 30 mothers received spinal anaesthesia. The Apgar score was recorded at1 minute and 5 minute interval after each delivery. RESULTS: Out of 30 mothers, who received general anaesthesia, 25 patients (83.3%) give birth to neonates having Apgar score ≤ 6 at one minute after birth and the remaining 5 neonates (16.7%) had Apgar score of ≥7. On the other hand out of 30 mothers who received spinal anaesthesia only 10 mothers give birth to neonate having Apgar score ≤ 6 at one minute after birth, who improved at 5 minutes interval, and their Apgar score were ≥7. It had been found that those neonates who were born under G.A were ten folds more likely to have Apgar score less than or equal to 6 at first minute compared to those with spinal anaesthesia, the odds ratio=10 and 95%confidence interval of the odds ratio (2.94-34) and p=0.00024 which is highly significant, G.A had greater risk on infant at the first minute. CONCLUSION: There is a significant difference between the effects of general anaesthesia and spinal anaesthesia on Apgar score of neonate one minute after delivery of full term neonate by elective caesarean section, but there is no significant difference between the effect of general anaesthesia and spinal anaesthesia on Apgar score 5minutes after birth.


Article
Time to Discharge Patients From Day-Case Clinic Comparison Study between Patients Receivedspinal Versus General Anaesthesia

Authors: Raghad Hannon Shinen Alsudani
Pages: 488-493
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ABSTRACT: BACK GROUND: Day case surgery issurgery where patient returns home on same day of surgery, saving resources, money decreases in-patients number with rapid turnover. Question about the ideal type of anasthesia for such surgery is of interest of many studies. OBJECTIVE: To comparing time to discharge after perianal surgery for patient received spinal anasthesia versus patients received general anasthesia, sample was taken between February 2007,and July 2010, in a private day clinic in Baghdad. PATIENTS AND METHODS: Study included 200 patients ASA(I-II), age 18-60 years. One hundred patients had been received spinal anasthesia with small dose lidocaine 2%, other 100 were received general anasthesia with either propofol or pentothal. RESULTS: Indicate thatspinal anaesthesia with small dose lidocaine achieves shorter time to discharge patients versus general anasthesia; mean time for spinal anasthesia was 105.69min and for general was147.57 min. CONCLUSION: Spinal anaesthesia is a good option for outpatient surgery in comparison to general anasthesia regarding time to discharge patients, and we can achieve better results by simple manipulation in techniques and drug dosage which might decrease unwanted side effects of S.A.


Article
A Study of Serum Protein Electrophoresis in Patients with Multiple Myeloma

Authors: Hind Shakir Ahmed
Pages: 494-498
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ABSTRACT: BACKGROUND: Multiple myeloma (MM) is caused by the malignant proliferation of plasma cells through the bone marrow. The clinical features are due to disordered immunoglobulin synthesis and/or secretion from the cell. The amount of protein in the vascular compartment depends on the balance between the rate of synthesis and catabolism or loss. Electrophoresis is a technique that separates compounds such as proteins according to their different electrical charge. In this way, five main groups of proteins namely albumin and the α1, α2, β, γ-globulins, may be distinguished after protein staining and may be visually compared with those in a normal control serum. OBJECTIVE: To evaluate total serum protein, serum albumin, serum globulin, and serum protein electrophoresis in Iraqi MM patients. PATIENTS AND METHODS: This study was conducted during the period from August 2012 until the end of November 2012. The patients were admitted to Medical City Hospital and all the measurements were performed in the Medical Teaching Laboratories in Baghdad. Total serum protein was measured by colorimetric Biuret method, while serum albumin was measured by bromocresol green method, serum globulin, and serum protein electrophoresis were measured in 25 patients with MM; their age range was (50-70) years and compared with 25 healthy controls. RESULTS: Total serum protein and serum globulin were significantly increased (86.76±17.05 g/l and 55.36±20.54 g/l respectively) in patients with MM, as compared with their controls, (P=0.0001). While a significant decreased was found in serum albumin (29.6±8.77 g/l) and albumin to globulin ratio (0.64±0.36 g/l) for patients with MM as compared with their controls, (P=0.0001). CONCLUSION: Abnormal concentrations of total serum protein, serum albumin, serum globulin, and M-band are associated with MM


Article
Prevalence of Drug Resistance among New Cases of Pulmonary Tuberculosis

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ABSTRACT: BACKGROUND: Tuberculosis (TB) is a disease that has affected humankind throughout recorded history and before.Presently, the number of deaths caused by TB worldwide exceeds that caused by any other organism. Drug-resistant tuberculosis is a man-made problem. Poor management can lead to the selection of M. tuberculosis with mutations conferring resistance to antituberculous drugs. Drug resistance is divided into two types: primary (resistance in persons who have never received anti-tuberculosis drugs for more than 1 month. These patients are initially infected with drug-resistant strains) and secondary, acquired, (resistance to anti-tuberculosis drugs, which arises during treatment due to poor compliance or improper management.) OBJECTIVE: To identify the prevalence of drug resistance among new cases of pulmonary tuberculosis in Iraq. METHODS: A cross sectional studywhich includes, 106 patients fulfilled the criteria of inclusion throughout the duration of the study, and sputum samples were taken from all of them for direct microscopical examination and culture and drug sensitivity. RESULTS: Fifty patients (47.2%) had positive results for mycobacterial culture, none of them showed resistance to any anti- tuberculous drug that had been examined for, i.e. : all the 50 samples were sensitive to tested anti-tuberculous drugs CONCLUSION: standard first line treatment for pulmonary T.B. is recommended for all new cases of pulmonary tuberculosis in Iraq.


Article
Evaluation the Levels of IFN-Gamma , IL-10 and Concentration of Zn in Children with Visceral Leishmaniasis

Authors: Mais N. Kamil --- Sabah Al-Najar --- Nahla Ghanim
Pages: 504-510
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ABSTRACT: BACKGROUND: Visceral Leishmaniasis (VL) is a systemic infection of the reticulo- endothelial system that could affect on immune system and biochemical parameters like the concentration of trace elements which may be significantly changed . OBJECTIVE: Evaluating the level of cytokines (INF- γ ,IL-10) and concentration of Zn in Visceral Leishmaniasis in children after diagnosis . PATIENTS AND METHODS: A total of (98) child their ages rang (6m-5y) were attending to the Central Public Health Laboratory and Teaching Laboratories of Medical City suspected to be infected with kala-azar, the diagnosis was done by both IFAT technique and Rapid Kala-azar (r-K39) detecting test and evaluating the level of cytokines (INF- γ, IL-10) by ELISA and concentration of trace element ( Zn ) by Atomic Absorption Technique . RESULTS : The dipstick test ( r-K39) showed a high sensitivity of (92.1%) compared to IFAT (73.6%) with a specificity of 100% for both tests. Serum samples of 56 child with positive results in IFAT and rK39 test were used for the investigation of IL-10, IFN-γ. The mean levels of IL-10 (80.207±77.54 Pg/ml) and IFN- γ (5.426±4.599 IU/ml) were highly significant increased in patients compared to healthy controls .The mean level of serum Zn (69.71±7.97μg/dl) was significantly low in VL patients compared to healthy controls . CONCLUSION : This study showed that the ( r-K39) dipstick test could be more sensitive than IFAT technique in the diagnosis of VL with a specificity of 100 % for both test according to clinical diagnosis. Both IFN-γ & IL-10 were significantly increased in VL patients as compared to controls group. The concentration of Zinc was significantly lower in VL patients than healthy controls.


Article
A retrospective Study of Testicular Relapse in Acute Lymphoblastic Leukemia

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ABSTRACT: BACKGROUND: Testicular relapse in ALL usually appear as painless testicular enlargement mostly unilateral. Diagnosed by wedge biopsy. The testis is a frequent site of relapse. OBJECTIVE: To find out the incidence of testicular relapse in ALL, time of diagnosis of testicular relapse, age group more commonly associated with testicular relapse, the association of testicular relapse with other relapses (medullary or extra-medullary), and prognosis of patients with testicular relapse. PATIENTS AND METHODS: Aretrospective study in the central teaching hospital of children in Baghdad- unit of hematology and oncology, during January 2000 – December 2006. Two hundred-four males were studied retrospectively. Informations were obtained from patients' files. RESULTS: The incidence of testicular relapse was in 18 patients represented (8.8%) of total cases of boys with ALL below 15 years. Relapse is mainly unilateral in 15 patients (83.3%) and mostly in the right side in 11 patients (61.1%) of total cases with testicular relapse. There is no significant statistical incidence of relapse with the age of patient represented by 2 cases (6.2%) from (0-2 years), 11 cases (8.2%) from (2-10 years), and 5 cases (13%) more than (10 years). Time of diagnosis of relapse was mainly during the oral maintenance therapy (13) patients (72.5%). Testicular relapse was isolated in 8 patients (44%) and combined with other relapses in 10 patients (56%) of them 7 patients (39%) with bone marrow relapse and 3 patients (17%) with CNS relapse. The outcome of patients with testicular relapse was better after discontinuation of chemotherapy “after three years of treatment” (2 cases diagnosed with relapse both of them still alive) represented (100%), while during the maintenance therapy of 13 patients, 6 (46.2%) of them still alive, 6 patients (46.2%) of them died, and 1 patient (7.6%) with no report, while induction chemotherapy 2 cases 1 (50%) alive and 1 (50%) died). Patients with isolated testicular relapse had better outcome represented by 6 patients (75%) still alive and 2 patients (25%) died, patients with combined relapse had worse outcome, represented by 3 patients (30%) alive, 5 patients (50%) died, and 2 patients (20%) with no report.Incidence of testicular relapse significantly decreased after the introduction of more intensive chemotherapy in Jan 2004 from 9.8% to 3.1%. CONCLUSION: Incidence of testicular relapse decrease with introduction of intensive chemotherapy and had higher incidence during the maintenance therapy, associated with increased incidence with other medullary and extra-medullary relapses, and has better prognosis when it is late and isolated than for early and combined relapse


Article
HLA Class I and II Genotyping by PCR-SSO in Patients with Type-1 Diabetes Mellitus

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ABSTRACT: BACKGROUND: Type 1 diabetes mellitus is a chronic autoimmune disease that involves destruction of the pancreatic beta cells. It is well known that both genetic and environmental factors involved in pathogenesis of type-1diabetes mellitus. OBJECTIVE: This study seeks to determine whether there is any association between human leukocyte antigen class I and II alleles and type-1diabetes mellitus. SUBJECTS AND METHODS: Seventy type-1 diabetes mellitus patients compared to 30 apparently healthy individual were enrolled in this study. Human leukocyte antigens genotyping were analyzed by polymerase chain reaction sequence specific oligonucleotide technique. RESULTS: The present study revealed significantly high frequency of DQB1*0101 and DQB1*0201 alleles among patients in comparison with healthy control, while there was significantly low frequency of each HLA-A*3301, B*0826, DRB1*0701, *1101 and HLA-DQB1*0604 alleles in patients as compared to healthy controls. CONCLUSION: These findings indicate that higher frequency of HLA-DQB1*0101 and *0201 alleles may be a risk factor for type-1diabetes mellitus, meanwhile low frequency of HLA-A*3301, B*0826, DRB1*0701, *1101 and HLA-DQB1-*0604 alleles could be a protective factor.


Article
Evaluation of Closed Reduction and Percutaneous Iliosacral Cannulated Screw Fixation for Sacroiliac Disruption or Sacral Fractures; A preliminary Study

Authors: Ali Bakir Al-Hilli
Pages: 525-533
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ABSTRACT: BACKGROUND: High energy pelvic ring fractures are serious injuries result from motor vehicle accidents or fall from height, unstable pelvic ring injuries usually associated with sacroiliac disruptions or sacral fractures. The ideal treatment for unstable pelvic fractures remains a matter of debate. The main purpose of the treatment is to save the patient s life and then to achieve an excellent functional outcome. Percutaneous fixation of Sacroiliac joint disruption or sacral fractures is evolved recently as a minimal invasive technique with low complication rate and morbidities. OBJECTIVE: A preliminary study to evaluate prospectively the effectiveness of the percutaneous cannulated screws fixation of posterior pelvic ring injures in unstable fractures with associated injuries . PATIENTS AND METHOD: Six patients have been treated in Medical City/Baghdad (during the period of Jan.2012 till July 2012) by one surgeon, four males and two females with mean age 27 years (range 20-36 years), who have unstable pelvic ring injuries associated with other skeletal, neural or visceral injuries are treated by gradual closed reduction using skeletal traction through lower femur and percutaneous sacroiliac fixations using a 7 mm Cancellous partially threaded screws following the technique described by Matta and Saucedo using C-arm fluoroscopy. A data for the duration of procedure, blood loss, intra-operative and post-operative complications and post-operative rehabilitation were collected analyzed and compared to data for open reduction and internal fixation for the same injuries from other studies . pre and post-operative radiographs and CT scans of the pelvis were studied to evaluate the procedure. RESULTS: A total of 13 screw where inserted percutanously to a six patients . The duration of the surgical procedure was 30 minutes to 60 minutes including the preparation time. Wound size was 5mm-10mm, Blood loss was negligible, no anesthetic complications no intra or post-operative complications, no wound complications, and a very good post-operative rehabilitation. post-operative X-rays and CT scans show no complications and a very good reduction and fixation for the Sacroiliac joints and sacral fractures. CONCLUSION: Gradual closed reduction and Percutaneous sacroiliac fixations using cannulated screws have demonstrated a very good minimally invasive technique with no intra-operative or post-operative complications. This technique may be advantageous as it avoids using extensive approaches, bleeding, wound complications and prolonged surgeries.


Article
Evaluation of Functional Outcome of Open Reduction and Internal Fixation of Pelvic Ring Fractures

Authors: Adnan H.Hnoosh
Pages: 534-540
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ABSTRACT: BACKGROUND : Unstable pelvic ring fracture (PRF) constitute 17 – 23% of pelvic fracture , it occurs as a high – energy injuries , and usually associated with multiple concomitant injuries. The mortality has been reported between 18 – 25%. Conservative treatment carries a high rate of complication. Recent studies recommended surgical stabilization by open reduction and internal fixation (ORIF). OBJECTIVE: Evaluate the functional outcome, morbidity and mortality rate in the patients treated by anterior and posterior fixation of (PRF). PATIENTS AND METHODS: This is a prospective study on 23 patients sixteen male and seven female , age range 18 – 50 years with unstable PRF were operated upon by (ORIF) , there were 12 patients with sacro – iliac joint (SIJ) dislocation and 8 patients with SIJ fracture – dislocation , three with sacral fracture , various implants used for stabilization assessment of the outcome based on patients oriented score of Majeed scale , follow up period range 14 – 37 months postoperatively. RESULTS : The functional outcome were as follow using Majeed's scale as excellent in 12 patients (52%) good in 5 (21%) and moderate in three (13%) and poor in one ( 4.7%) . Two patients died during follow up period (8.6%). There was statistical significant relation between the severity of injury and low grade outcome. CONCLUSION: Early ORIF of unstable fracture of pelvic ring is recommended.


Article
Tip Apex Distance as a Predicting Factor for the Outcome of Femoral Intertrochanteric Fracture Fixed by Dynamic Hip Screw

Authors: Firas Abd Alhadi AL-Obidi
Pages: 541-545
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ABSTRACT: BACKGROUND: Dynamic hip screw is still one of the most widely used devices for the fixation of femoral intertrochanteric fractures. A recognized complication with this device is the screw cut-out from the femoral head. OBJECTIVE: Of this study is to assess if the tip apex distance is a reliable predicting factor for the subsequent lag screw position and so the outcome of femoral intertrochanteric fractures fixed by dynamic hip screws. Design of the study: Prospective Cohort Study. PATIENTS AND METHODS: 42 patients (27 female, 15 male), with an average age of 63 years, (ranging from 55 to 72 years),with stable intertrochanteric fractures of the femur treated by dynamic hip screws. All patients were investigated and optimized for surgery. Good and accepted closed reduction was done under fluoroscopic control with the use of orthopedic table. Dynamic hip screws were inserted by a standard technique. Tip apex distance for every case was measured by immediate postoperative plain x-ray.Patients were reviewed clinically and radiologically on 2nd, 6th, 12th, and 24th weeks. Setting: department of orthopedic-medical city complex and private job. RESULTS: There were 30 cases (71.4 %) with tip apex distance below 25 millimeters. Only 1 case of them ended with mechanical failure. And there were 12 cases (28.6 %) with tip apex distance more than 25 millimeters. 5 cases out of these 12 cases ended with mechanical failure. So the mechanical failure represented 41.7 % when the tip apex distance was more than 25 millimeters while it was 3.3 % when the tip apex distance was below 25 millimeters. The two-tailed P value equals 0.0047 CONCLUSION: it is concluded that the tip apex distance is a strong predicting factor for the mechanical failure of stable intertrochanteric fracture of the femur fixed by dynamic hip screw.


Article
The Relationship Among Otic Clinical Findings and Temporomandibular Joint Disorders Population

Authors: Marwan F.Buraa --- Hadeel S. Alazzawi
Pages: 546-550
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ABSTRACT: BACKGROUND: The otologic symptoms are frequents in temporomandibular joint (TMJ) disorder due to the proximity of the ear to the temporomandibular joint, TMJ pain can often be confused with ear pain. OBJECTIVE: To verify the frequency of otic signs and symptoms with TMJ disorder. Study design: descriptive and transversal. MATERIALS AND METHODS: Thirty five patients, with pain complaint in tragus and peritragus area from otorhinolaringology department in Aljamhori Teaching Hospital in Mosul-Iraq. Patients with ear infection, even with TMJ disorder were selected and the ones with TMJ disorder with otalgia. Then sent to maxillofacial department to examine the TMJ. The data obtained were subdivided into two groups: TMJ disorder patients with otological exam in normal condition and TMJ disorder patients with abnormal otological condition. RESULTS: Thirty five patients, 14 men and 21 women aging from 18 to 75 years .There were 19 patients had TMJ disorder with otological examination in normal condition. Otalgia and TMJ tenderness were (89.74%) masticatory muscle tenderness (78.68%) and TMJ sound (63.15%), followed by itching and tinnitus (42.1% both). In second group all 16 patients with ear problems had TMJ tenderness (100%), were otalgia and itching (81.25%, 68.75%) respectively. CONCLUSION: The signs and symptoms most frequently associated with ear and TMJ disorder were TMJ tenderness, masticatory muscle tenderness- especially lateral pterygoid and temporalis -and click associated with otalgia; itching and tinnitus respectively. The results provide additional support for the notion that a relationship between temporomandibular disorder and otologic signs and symptoms does exit


Article
Serum Anti-Müllerian Hormone (AMH) in Prediction of Oocyte Quality and in Vitro Fertilization (IVF) Outcome

Authors: Aseel N. Kamil --- Basil OM Saleh --- Nada F Hassan
Pages: 551-561
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ABSTRACT: BACKGROUND: Growing evidence indicates that serum Anti-mullerian hormone (AMH) levels could be of great importance for understanding the relationship with oocyte quality for IVF. The aim of the present study was to investigate the role of serum level of AMH in differentiation of infertile female patients with good quality oocytes, who are good responder and ready to enter the IVF cycles. OBJECTIVE: This study included 25 infertile females classified into two groups: (15) females with Tubal obstruction and 10 females with polycystic ovary syndrome (PCOS). Also, nineteen fertile females were served as controls. METHODS: Investigation included serum measurements of AMH, Inhibin B, FSH, LH, E2, Prolactin and TSH on day 3 of previous menstrual cycle, serum measurement of progesterone (P4) on day 21 of previous menstrual cycle (before starting ovulation induction). Also AMH, Inhibin B and E2 were measured on day of hCG administration (after long ovulation protocol). RESULTS: The mean (±SD) value of serum AMH was significantly decreased in female patients after ovarian stimulation protocol compared to that before ovarian stimulation,(P< 0.01). Also, the mean (±SD) value of serum AMH of female patients with good quality oocyte was significantly higher than that of those with bad quality oocyte, (P<0.01). CONCLUSION: This study revealed that measurement of serum AMH is good marker in prediction of good responder infertile females for IVF technique after ovarian stimulation protocol.


Article
Biofilm Formation on Intrauterine Device and Associated Infections

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Shafaq Tarik Burhan ABSTRACT: BACKGROUND: Intrauterine devices are highly effective methods of contraception; but considered to cause pelvic inflammatory diseases by its colonization by bacteria and /or fungi and form biofilms consisting of layers of host cells and bacteria or fungi embedded within a matrix material. OBJECTIVE: To screen the microbial biofilms on intrauterine devices, and its associated infection in vagina and cervix in intrauterine devices users. METHODS: A case series design was adopted, composed of 50 participants. High vaginal and cervical swabs were taken and intrauterine devices were removed and sent for microbiological examination. RESULTS: Eighty four percent of removed intrauterine devices were infected with biofilm containing different types of microorganisms and 92.8% of these infected IUDs were associated with high vaginal and cervical infection. E.coli was found to be most common microorganism 61.5% of the infections, staphylococcus aureus 43.6%, Pseudomonas spp. 15.3%, candida albicans 10.3%, Neisseria gonorrhoea 5.1%. CONCLUSION: There is high frequency of microbial biofilms formation on intrauterine devices and also high percentage of associated cervico-vaginal infections in intrauterine devices users. KEY WORDS: intra uterine devices, biofilm, microbiological examination.


Article
Incdence of Rheumatoid Arthritis [2001 to 2011]

Authors: Ali Mohammed Hussein Alkazzaz
Pages: 568-572
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ABSTRACT: BACKGROUND : The incidence of rheumatoid arthritis[RA] varies from country to another which not depend on genetic bases alone but can explained by environmental exposure and genetic and environmental interaction, area of military conflict ,there was stress induced pathway that elevates the risk for rheumatoid arthritis, in Iraq rheumatoid was 1% of population in 1975. OBJECTIVE: To evaluate incidence of RA in Babylon –Iraq from 2001-2011 PATIENTS AND METHODS: This study was done to examine the incidence of RA in Babylon between 2001-2011 by Retrospective cohort study in Merjan Teaching Hospital ,Rheumatology unit .Data included sex .birth year ,residency and latex test , from 2001 to 2011.All patients were diagnosed as Rheumatoid Arthritis according to American College of Rheumatology ACR 1987revised criteria of RA .the numbers of patients of RA who were received DMRADs included methotrxate therapy were recorded each year and incidence of each year was found then the cumulative incidence was calculated. RESULTS: There were1039 patients with rheumatoid arthritis from 53786 patients in rheumatology unit. 50.1% living in urban area while 49.9% in rural area. The incidence in 2001 was 1.60 while in 2011 was 3.02 for the same population and the cumulative incidence in 2011 was22.74. Latex test was 52% in2001 while in2011 was 58% in rheumatoid patients in the same year. The P value for age mean difference between female and male was [0.009]. CONCLUSION: The incidence of RA was increasing from 1.60% in 2001 to 3.02% in 2011 and the cumulative risk wasb22.74% in Babylon –Iraq. KEY WARDS: rheumatoid arthritis.


Article
Percutaneous Nephrolithotomy for Renal Calculi:A Single Surgeon Experience

Authors: Hayder M.AL-Aridy
Pages: 576-580
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ABSTRACT: BACKGROUND: Percutaneous nephrolithotomy (PCNL) for renal calculi is one of the more challenging endourologic procedures.PCNL remains the procedure of choice for most stones that are more than 2 cm in size, complex staghorn calculi, some lower-pole stones, stones in caliceal diverticuli, and larger renal stones that are refractory to shock wave lithotripsy( SWL). OBJECTIVE: The purpose of this study was to evaluate the outcomes and complications in patients who were undergoing PCNL for renal calculi at our center. PATIENTS AND METHODS: From January 2011 to December 2012, a total of 216 patients who had renal stones underwent PCNL by the same surgical team at our institution. All patients were evaluated preoperatively with intravenous urography (IVU) and/or computerized tomography(CT). Data analysis included procedure time, length of hospital stay, number of access tracts, transfusion rates, other complications, and stone-free status. Percutaneous access was performed using C-arm fluoroscopy with patients in the prone position. The access tract was dilated with a balloon dilator or Amplatz dilators. Fragmentation of the stone burden was accomplished using an Ultrasonic lithotripter. No patients in this series underwent a tubeless technique. Nephrostomy tube was placed at the end of procedure and nephrostogram done in all patients on 2nd postoperative day. RESULTS: Mean age was (42.43±13.17) yrs. The mean stone burden was (6.91±4.47)cm2 .The average procedure time was( 57.40±21.05) minutes. Mean pre and postoperative hemoglobin(Hb) levels were(13.43±1.34) and ( 11.71±1.86) g/dl respectively and Hb drop was ( 1.76±1.10) g/dl.PCNL via a single access tract was accomplished in( 93.51%) of procedures, while multiple tracts and intercostal access were used in( 4.62%) and (1.85% ) respectively of procedures.Mean fluoroscopy time during the whole procedure was (1.75±0.90) minutes.Mean hospitalization was (3.52±0.86) days. Stone-free rates at hospital discharge and at 3 months follow-up were (81.44%) and (92.07%), respectively. 30 patients received blood transfusion (13.88%). CONCLUSION: PCNL is a safe and effective procedure for the management of renal stones. It has the advantages of lower morbidity, shorter hospital stay. The full of array of endourologic equipment and expertise remains essential to achieving a successful outcome.


Article
Laparoscopic Orchiopexy for High Intra Abdominal Undescended Testis , One Stage or Two Stages Fowler-Stephens Orchiopexy ; A Comparative Study

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ABSTRACT: BACKGROUND: Laparoscopic management of the high intra abdominal testis is still a matter of controversy. Laparoscopic Fowler-Stephens orchidopexy (FSO) is performed either by one stage (laparoscopic clipping and division of the spermatic vessel and proceed for orchiopexy at the same time) or by two stages FSO (laparoscopic clipping and division of the spermatic vessel only and performing laparoscopic release of the testis along with orchiopexy 3-6 months later ). OBJECTIVE: To study the outcome of Laparoscopic one stage and two stages FSO for the management of high intra abdominal testes. PATIENTS AND METHODS: A prospective comparative clinical Study included 25 patients (21 unilateral and 4 bilateral non palpable abdominal testes , 29 testes in total) and laparoscopic surgical procedures (One stage FSO was done for 18 testicles and Two stages FSO was done for 11 testicles) were performed at the urology department ,Medical city complex, Iraq , during the period between December 2010 and March 2013 . Their mean age was 3.2 years. The comparative criteria include; Time of surgery, postoperative complications, testicular position, and testicular viability. RESULTS: Testicular Doppler study revealed four atrophied testes of one stage F.S.O. (22.2%), two atrophied testes among two stages FSO group (18 %) ,this difference was statistically non significant . The difference in the proper scrotal position also was not significant. The operative time difference was significant between both groups (86.6 ± 10.1 min. for one stage vs 122.7 ± 13.5 min. for two stages FSO). CONCLUSION: One-stage FSO avoids repeated anesthesia and the potential for extensive, sometimes tedious, dissection that is occasionally required during re operation, and shorter operative time, making it more optimal than two stages FSO.


Article
Wilson's Disease: Laboratory Evaluation of A Sample of Patients Attending Baghdad Teaching Hospital

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ABSTRACT: BACKGROUND: Wilson’s disease (WD) is an inherited defect in copper metabolism that causes accumulation of copper in various body organs. It is a treatable; if it is diagnosed promptly and treated consistently. OBJECTIVE: Laboratory; hematological, biochemical, and diagnostic evaluation of a sample of Iraqi patients with WD, and study any association between clinical presentations and studied variables. METHODS: A case series study was conducted during 2011, from the 1st of February till the 10th of June. Sampling method was a convenient non-random one, through consecutive pooling of registered WD patients. A questionnaire-form paper had been developed for data collection, and required investigations were done in qualified laboratories. RESULTS: The study had enrolled 29 patients, with a male to female ratio of (1.07:1), The mean hemoglobin level was 10.64±2.53g/dl. Hemolysis was presented in 27.6% of patients, normochromic-normocytic RBCs in blood film were seen in 3.4% patient, platelet count was 243.97±89.35ccX109/L, WBC count was 5.70±2.84ccX109/L. ESR was 24.98±17.16mm/hr., serum bilirubin was 6.17±5.18mg/dl, serum cholesterol was 146.21±44.93mg/dl, serum triglycerides was 95.34±52.23mg/dl. Total serum protein was 72.86±11.15g/L, serum Albumin 39.17±7.88g/L and serum Globulin 31.07±7.89g/L. Penicillamine challenge test was positive in 96.6% patients. Serum ceruloplasmin level was 123.38±48.48mg/L, total serum copper was 72.48±25.11µg/dl, and 24h urinary copper excretion was 174.97±109.58µg/24hr. CONCLUSION: Most patients with WD are; anemic, with low serum levels of copper and cerulloplasmin, positive penicillamine challenge test, with abnormal liver function tests. With detected hemolysis in some of them; though no statistical difference or association was approved regarding laboratory values among patients with different presentations


Article
Correlation of Her-2/Neu Expression with Conventional Clinicopathological prognostic Parameters in Breast Carcinoma

Authors: Nafea Sami AL-Esawi
Pages: 595-602
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Abstract

ABSTRACT: BACKGROUND: The prognostic biomarkers in a disease provide information regarding outcome irrespective of therapy .Her-2/neu oncogene expression is an important prognostic and predictive marker for breast cancer .Her-2 /neu expression can be determined by immunohistochemistry ,which became a routine investigation to predict the response to tamoxifen therapy. There is evidence that over-expression of Her-2 /neu is involved in breast cancer progression and there is suggestion that Her-2/neu over-expression plays a role in the early stages of breast tumorigenesis . OBJECTIVE: To evaluate Her-2/neu over-expression in breast carcinomas in the studied sample and to assess its immunhistochemicalscore status in term of accepted conventional clinicopathological parameters . PATIENTS AND METHODS: This is a descriptive study which was carried out from 2007-2012 on 64 breast carcinoma specimens. Paraffin embedded tissue of patients underwent modified radical mastectomy with axillary clearance were processed for Her-2/neu assessment from almost all breast patients in the province . Then the evaluation of the staining and assigning a score were performed which ranged from 0 -3 .The tumor grade was asses using modified Bloom-Richardson grading system .Data on the patients age , the size of the tumor and lymph node status were obtained . Statistical analysis were produced by the use of Chi square test and at the level of significant alpha < 0.05 to compare the IHC results for HER-2 expression with the prognostic clinicopathological parameters . RESULTS : HER-2 over expression was seen in 23.5% (15/64) and the lymph nodes involvement status had a significant association with the immunhistochemical score for HER/2 oncogene and no siginificant association seen between HER-2 overexpression and other clinicopathological parameters including age , tumor size and tumor grade. CONCLUSION : The study reveals that the prevalence of HER-2 overexpression in breast cancers is less in our study compared with the western world and demonstrates association of the immunhistochemical score of HER-2 /neu with some of the well-established pathological parameters of breast carcinoma , specially lymph node involvement. It justifies the use of the immunhistochemical score in assessing breast carcinoma and modified its treatment


Article
The Validity of Beck Depression Inventory –Short Version in Depressed Patients Diagnosed According to ICD10

Authors: Abdul-Rasoul Al-Yasiri --- Yasir S. AbdKarkosh
Pages: 603-613
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Abstract

ABSTRACT: BACKGROUND : Beck Depression Inventory (often abbreviated asBDI) is an instrument to measure the severity and depth ofdepression symptoms. BDI was developed in a novel way for its time by collating patients' verbatim descriptions of their symptoms and using these to construct a scale which could reflect the intensity or severity of a givensymptom. OBJECTIVE: To measure the validity of Beck depression Inventory short version using ICD 10 criteria for major depression as a gold standard METHOD AND PATIENTS : The study was carried out in IbnRushd and Baghdad Teaching Hospitals. The sample was selected purposely among patients diagnosed to have major depressive disorder according to the ICD- 10 criteria for major depressive disorder. For each patient a clinical interview was done using the ICD 10 criteria for major depressive episode after being given beck depression inventory – short version in a paper RESULTS : The overall result indicates ‘fair to good’ agreement between both Beck and ICD-10 suggesting that Beck Depression Inventory is valid in assessing the degree of severity of depression CONCLUSION: Beck Depression Inventory short version (13 item ) is adequate in assessing the severity of depression in patients with ICD-10 diagnosis of depression


Article
Patient Satisfaction with Health Services at Medical Ward in Al-Kindy Teaching Hospital

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Abstract

ABSTRACT: BACKGROUND: Patient satisfaction is generally considered as extend to which the patient feel that their needs and expectations are being met by services provided. Satisfied patient are more likely to maintain consistent relationship with their care provider leading to improved compliance and better health outcomes. OBJECTIVE: To evaluate the patient satisfaction to hospital services and identify factors that influences this satisfaction. PATIENT AND METHODS: Cross sectional study of 60 patients who were interviewed using a questionnaire that includes information under six main heading; 1) Patient general information; 2) Satisfaction about physician; 3) Satisfaction about nurses; 4) Satisfaction about pharmacy ; 5) Satisfaction about laboratory services ;6) Satisfaction about ventilation and cleanliness . RESULTS: More than half of satisfied patients were among those of ≥50 years old, female, and the majority of satisfied patients were among un-employed and those with single reason for admission. Statistical analysis showed a significant association between the reason for admission and patients satisfaction . CONCLUSION: The satisfaction of elderly was high and more in female, un- employed and less with those who admitted for more than one reason.


Article
Pregabalin in Muscular Cramps (Charely Hoarse) a New Application

Authors: Farhan Bakir
Pages: 620-621
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Abstract

ABSTRACT: Pregabalin is a newly introduced medicine which is an analogue to Gaba pentin and similar to its structure, it was approved by the FDA in 2004 and marketed by Pfizer company under the name of LARYICA. It has been described in various medical disorders among which are: neuropathic pain as that of diabetes (1,2), post herpetic neuralgia (3), seizure disorders (4) and anxiety state (5). Pregabalin the first medicine approved for treatment of fibromyalgia by the FDA (6,7) Pharmacologically Pregabalin bind to alpha 2 delta subunit of the voltage-dependent calcium channels in the central nervous system, it also decrease the releases neurotransmitters such as glutamate, noradrenalin and the substance P (8,9). Though FDA label indications are; diabetic peripheral neuropathy, fibromyalgia, Post herpetic neuralgia and as an adjunct in seizure, yet Pregabalin have been Used in many other conditions on empirical bases as a treatment of a single case Or more as in post operative Pain (10) or hot flash (11) beside other diseases. Herewith I am reporting an unusual clinical observation never been described before, the Night Muscular cramps in the Legs collegially known as "Charley hoarse" known by Iraqis as "ABU SLSHERGATE"

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Article
Thalassemia Intermedia and Extrmedullary Hematopoiesis

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Abstract

ABSTRACT: Excessive ineffective erythropoiesis in thalassemia intermedia may cause paravertebral pseudotumors of extramedullary hematopoiesis. Due to the proximity to the spinal canal, these paravertebral masses carry the risk of severe neurological damage. Treatment strategie include hypertransfusion, radiotherapy, and laminectomy.Hydroxyurea, stimulating fetal hemoglobin synthesis, may represent an alternative therapeutic approach. This presentation report a case of female known to have thalassemia intermedia who presented with abnormal gait with weakness of lower limbs. MRI study showed masses originate from thorax vertebra. Hypertransfusion therapy and splenectomy were followed by regular transfusion (baseline hemoglobin 10 g/dl) and chelation with desferrioxamine. With this treatment, clinical symptoms disappeared, paravertebral ematopoietic masses did not progress, Hydroxyurea therapy was initiated to reduce the required transfusion volume but suppressing concomitantly further expansion of extramedullary hematopoiesis, and finally leading to a reduction of transfusional iron load. Treatment was started with 4 mg/kg per day and stepwise increased to 20 mg/kg per day. . Follow up to the patient done by clinical examination and imaging study to assess the vertebral masses.

Table of content: volume:12 issue:4