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:supplement

Article
A Prevelance of Drug- Resistance in Previously Treated Tuberculous Patients in Baghdad

Authors: Muhammed.W. AL-Obaidy
Pages: 626-631
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ABSTRACT: BACKGROUND: Multi drug resistant tuberculosis (MDR-TB) is a majorpublic health problem because treatment is complicated;cure -rates are below those for drug-susceptible T.B., and patients may remain infectious for months or years despite receiving the best available therapy. The phenomenon of resistance was detected soon after the introduction of streptomycin for treatment of T.B. OBJECTIVE: To identify prevalence of MDR- TB patients in Baghdad. PATIENT AND METHOD : Across-sectional study, over a period of 1 YEAR (from January to December2012) had been carried out in Baghdad in order to identify the prevalence of drug-resistant tuberculosis in previously treated patients. 168 patients (112male and 56female) sputum smear positive patients were investigated at Chest and Respiratory institute by questionnaire about previous treatment then sent for drug susceptibility testing byegg-based solid medium of Lowenstein. RESULTS: An isolated drug resistance to streptomycin,isoniazid,Rifampicin and Ethambutul of 2.4% , 2.4% , 14.3% and 1.1% respectively. But MDR.TB.Of8.3 %( for more than one drug resistance). CONCLUSION : The high prevalence of M.D.R.T.B. and high prevalence of Rifampicin are the most alarming because of badmedical and social situation in Iraq now.


Article
The Effect of Low to Medium Dose Inhaled Beclomethasone Dipropionate on Blood Glucose Level in patients with Bronchial Asthma

Authors: Abdulla Janger Minshed Alfarttoosi
Pages: 632-636
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ABSTRACT: BACKGROUND: Although inhaled corticosteroids (ICSs) are the mainstay of therapy in asthma, their use raises certain safety concerns. OBJECTIVE: This study aimed to evaluate the effect of inhaled Beclomethasone dipropionate on glucose level in patients with bronchial asthma . PATIENT AND METHOD: Ninety patient with new diagnosis of bronchial asthma were included in this study. Patients divided into two groups: 1st group includes those who are controlled with inhaled salbutamol only (30 patients). The 2nd group includes those who required also regular beclomethasone (60 patients). Fasting blood glucose and HbA1c was measured for all patients in both groups before and after three months of starting treatment. RESULTS: There was significant elevation of both FBS and HbA1c in group 2 patients after starting inhaled beclomethasone dipropionate in comparison to their baseline levels and the levels in group 1. CONCLUSION: The findings indicate that inhaled beclomethasone dipropionate in asthmatic patients may disturb blood glucose level


Article
Common Ictal Patterns in Patients with Documented Epileptic Seizures

Authors: Ghaieb Bashar ALJandeel
Pages: 637-642
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ABSTRACT: BACKGROUND: The ictal EEG patterns are the electrical triggers of 'epileptic seizures' and they are different from the familiar 'inter-ictal' discharges that are encountered during the normal 'non-seizing' states of epileptic patients. This study concentrates on the 'seizing discharges' among in-patients with documented seizures through a 'simultaneous EEG-Video' monitoring (telemetry) facility OBJECTIVE: To identify the common ictal patterns in patients with documented epileptic seizures METHODS: Two hundred consecutive telemetries at King's College Hospital in London over the period of nine months starting from Jan 2007 back to May 2006 were reviewed and the common ictal patterns were evaluated by using 'simultaneous EEG-Video' monitoring (telemetry) facility RESULTS: Three main ictal patterns were observed in the 81 patients with documented epileptic seizures. 'Rhythmic theta ictal pattern' was observed in 46.9% of patients, all showed focal seizures whereas 26.1% of patients showed the 'decremental ictal pattern' (fast activity). Focal seizures were presented in 81.8% and 18.2% with generalized ones. 'Polyspike-wave' activity was observed in 9.8% of patients and all of them have genrralized seizures CONCLUSION: At least three commonly encountered ictal patterns were identified. They are distinct, may be readily recognizable and showed their prevalence in King's telemetry.


Article
High Sensitive C-Reactive Protein Levels in Patients with Acute Coronary Syndrome

Authors: Yildiz Hassan Tahseen
Pages: 643-649
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ABSTRACT: BACKGROUND: Patients with ischemic discomfort may present with or without STsegment elevation on the ECG. The majority of patients with ST-segment elevation ultimately develop a Q-wave AMI (QMI). Patients who present without ST-segment elevation are either experiencing unstable angina (UA) or a non-STsegment elevation MI (NSTEMI). Most patients with NSTEMI do not evolve a Q-wave and are subsequently referred to as having sustained a non-Q-wave MI (NQMI). The spectrum of clinical conditions ranging from acute myocardial infarction through minimal myocardial injury to unstable angina comprises the acute coronary syndrome (ACS). Measurement of C-reactive protein (CRP) may have practical clinical significance in the management of patients hospitalized for suspected ACS. OBJECTIVE: To study different follow up measurements of high sensitive C-Reactive Protein (hsCRP) levels in ACS patients and to compare the difference between (NSTEMI) and (STEMI) patients. METHODS: 122 patients with ACS participate in this study through years 2006-2008. Three serial hsCRP levels at baseline on admission to hospital before 12 hours of symptom onset, peak levels at 3 days and follow up levels after 5 days were analyzed and compared between non-ST elevation AMI, ST elevation AMI and UA elevation. RESULTS: The results were compared with those of healthy groups as controls. The results showed a significant elevation in serum CRP levels on 1st, 3rd and 5th reaching optimum value on day 3 post infarction in QMI and NQMI patients, While there was a non significant increase in serum CRP level in patients with UA on day 1, and day 3 post attack. CONCLUSION: STEMI patients have significantly higher peak CRP levels compared to NSTEMI patients. These data suggest that inflammatory processes play an independent role in the pathogenesis of myocardial infarction. Thus, CRP assessment may assist in risk stratification after myocardial infarction.

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Article
Interleukin-8 and Interleukin-10 in Patients with Ischemic Heart Disease

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ABSTRACT: BACKGROUND: Ischemic heart disease is the main cause of death throughout the world. Cytokines are key regulatory glycoproteins . They are intimately associated with atherogenesis and modulate plaque morphology and stabilization. OBJECTIVE: To study the role of pro-inflammatory Interleukin-8 , and anti-inflammatory interleukin-10 in patients with Acute coronary syndromes (ACS)(acute myocardial infarction and unstable angina). METHODS: This study included (55) patients with acute coronary syndrome, (30) patients with acute Myocardial infarction ( 24 males and 6 female) and 25 patients with unstable Angina (11 males and 14 females). This project has been carried out on patients at the coronary care unit (CCU) of Baghdad teaching hospital/ Medical City/ Baghdad, during the period from April to June 2010. A twenty five, apparently healthy individuals were taken as a healthy control group. Venous blood sample was taken from each subject. Levels of interleukin-8 and Interleukin-10 were estimated by using enzyme linked immunosorbant assay . {ELISA-kit for detection of IL-8 (BioSource Europe S.A. /catalogue number; KAP1301)} and {ELISA-kit for detection of IL-10 (BioSource Europe S.A./ catalogue number; KAP1321)} RESULTS: Plasma level of pro-inflammatory cytokine (interleukin-8) showed a significant elevation in patients with acute myocardial infarction (Mean ± SD =95.26 pg/ml ± 102.89 ;P value=0.004) and unstable angina (Mean ± SD =146.43 pg/ml ± 154.45 ;P value=0.019) in comparison to control group (Mean ± SD =47.75 pg/ml ± 36.67). Serum level of anti-inflammatory cytokine (interleukin-10) showed a significant decrease in unstable angina patients (Mean ± SD =16.95 pg/ml ± 11.92 ;P value=0.012) in comparison to control group (Mean ± SD =30.29 pg/ml ± 21.17),however, it showed no significant differences among acute myocardial infarction patients (Mean ± SD =27.73 pg/ml ± 23.16 ;P value=0.500) in comparison to control group. The ratio of pro-/anti-inflammatory cytokines (interleukin-8 / interleukin-10) was significantly elevated in acute coronary syndrome; acute myocardial infarction and unstable angina patients (P=0.001, P=0.019, P=0.001 respectively) . CONCLUSION: Interleukin-8 is an important pro-inflammatory cytokine in coronary artery disease which may contribute to the plaque destabilization in acute coronary syndrome especially unstable angina, and low level of anti-inflammatory interleukin-10 which is considers as a risk factor of development of acute events in unstable angina


Article

Authors: Muataz Fawzi Hussein
Pages: 659-667
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ABSTRACT: BACKGROUND: Percutaneous coronary intervention for chronic total occlusion lesions is technically difficult despite equipment advances. Changes in electrocardiographic patterns such as Q wave during total occlusion can provide information about procedural success and myocardial viability. OBJECTIVE: The aims of study are to investigate clinical, electrocardiographic and procedural characteristics of chronic total occlusion and the relation of these variables to the procedural success rate. PATIENTS AND METHODS: In this study, clinical, electrocardiographic and coronary angiographic data of (100) patients with chronic total occlusion lesions who underwent percutanous coronary intervention between May 2010 and March 2011 at the Iraqi center for heart diseases were analyzed. The clinical data were collected using the patients’ files and angiographic data by the observation of their films. Chronic total occlusion was diagnosed from clinical events including myocardial infarction or worsening of their symptoms or previous angiography. RESULTS: There were 100 patients with chronic total occlusion. Successful recanalization with stent deployment was accomplished in 65 patients (65%), while unsuccessful recanalization was found in 35 patients (35%). No major cardiovascular events occurred among both groups. The success rate of PCI was significantly more in lesions shorter than 15 mm, presence of tapered stump, angulations less than 45 degree, duration less than 3 months and TIMI 1 flow grade (p values were significant). Presence of Q wave was associated with severe angina , decreased left ventricular ejection fraction, critical lesions other than chronic total occlusion, T wave inversion and more regional wall motion abnormalities ( p values were significant). The most common cause of procedural failure was inability of guide wire to cross through the totally occluded segment. CONCLUSION: Percutaneous coronary intervention is a safe and useful procedure for revascularization of coronary chronic total occlusion lesion. The procedural success rate was related to certain features of the totally occluded lesions


Article
Clinical, Electrocardiographic, and Angiographic Characteristics as Predictors of Procedural Success in Patients with Coronary Chronic Total Occlusions A Single-Center Experience

Authors: Muataz Fawzi Hussein
Pages: 659-667
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ABSTRACT: BACKGROUND: Percutaneous coronary intervention for chronic total occlusion lesions is technically difficult despite equipment advances. Changes in electrocardiographic patterns such as Q wave during total occlusion can provide information about procedural success and myocardial viability. OBJECTIVE: The aims of study are to investigate clinical, electrocardiographic and procedural characteristics of chronic total occlusion and the relation of these variables to the procedural success rate. PATIENTS AND METHODS: In this study, clinical, electrocardiographic and coronary angiographic data of (100) patients with chronic total occlusion lesions who underwent percutanous coronary intervention between May 2010 and March 2011 at the Iraqi center for heart diseases were analyzed. The clinical data were collected using the patients’ files and angiographic data by the observation of their films. Chronic total occlusion was diagnosed from clinical events including myocardial infarction or worsening of their symptoms or previous angiography. RESULTS: There were 100 patients with chronic total occlusion. Successful recanalization with stent deployment was accomplished in 65 patients (65%), while unsuccessful recanalization was found in 35 patients (35%). No major cardiovascular events occurred among both groups. The success rate of PCI was significantly more in lesions shorter than 15 mm, presence of tapered stump, angulations less than 45 degree, duration less than 3 months and TIMI 1 flow grade (p values were significant). Presence of Q wave was associated with severe angina , decreased left ventricular ejection fraction, critical lesions other than chronic total occlusion, T wave inversion and more regional wall motion abnormalities ( p values were significant). The most common cause of procedural failure was inability of guide wire to cross through the totally occluded segment. CONCLUSION: Percutaneous coronary intervention is a safe and useful procedure for revascularization of coronary chronic total occlusion lesion. The procedural success rate was related to certain features of the totally occluded lesions. .


Article
A Prospective Randomized Controlled Study of Phototherapy Using Blue LED and Conventional Phototherapy in Neonatal Hyperbilirubinemia

Authors: Nada Ail Ahmed AL-Ali --- Ghaith Wadah Hamdoon
Pages: 668-674
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ABSTRACT: BACKGROUND: High intensity light emitting diodes (LEDs) are being studied as possible light sources for the phototherapy of neonatal jaundice, as they can emit high intensity light of narrow wavelength band in the blue region of the visible light spectrum corresponding to the spectrum of maximal bilirubin absorption. We used a new blue gallium nitride LED phototherapy unit with high intensity, and compared its efficacy to commercially used halogen quartz phototherapy device. The prototype device with two focused arrays, each with 20blue LEDs, generated greater irradiance than the conventional device tested. OBJECTIVE: To determine the efficacy of blue LED light versus conventional phototherapy lamp in treatment of neonatal jaundice. PATIENTS AND METHODS: A total of 101 jaundiced otherwise healthy, term and preterm neonate who had hyperbilirubinemia were prospectively randomized to either LED (n=57) or conventional phototherapy (n=44). Entry criteria to phototherapy followed the American Academy of Pediatrics’ Practice Parameter. RESULTS: One hundred and one neonate were included in this study , the mean rate of TSB lowering increase with increase age was significant in LED group (p value =0.000), according to the maturity the mean rate of TSB lowering increase with increase age also was significant in LED group (p- value= 0.000), no significant correlation was found in regarding birth weight and rate of lowering of TSB (P=0.263),there where a significant correlation between mean rate of TSB lowering and initial TSB level in LED group(P-value= 0.000 )and lastly there was a significant higher rate of lowering of TSB in LED group than those with conventional one. CONCLUSION: A blue LED phototherapy unit showed higher efficacy in bilirubin photodegradation compared to that of commercially used halogen quartz phototherapy device. And a significant correlation between the rate of lowering of TSB and each of (age, maturity , weight and initial TSB level) in the two groups. Additional studies will be necessary to prove its clinical efficacy. .


Article
The Role of Lumbar Puncture in Children Less Than Five Years Who Presented with Fever and Fit a Hospital Based Study

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ABSTRACT: BACKGROUND: Lumbar puncture is a procedure that is commonly performed to diagnose meningitis, encephalitis, and subarachnoid hemorrhage and it is helpful in evaluating demyelinating, degenerative and collagen vascular diseases and the presence of tumour cells within the subarachnoid space. It is the test of choice to diagnose pseudo tumor cerebri. OBJECTIVE: To highlight the important role of lumbar puncture in excluding serious central nervous system infections in patients presented with fever and fit. PATIENTS AND METHODS: A prospective study was carried out on 67 patients who were less than five years of age, presented with fever and fit from the 1st of April 2011till thirty first of October 2011, who were admitted to the Children Welfare Teaching Hospital/ medical city / Baghdad for evaluation and management. All the patients underwent lumbar puncture. RESULTS : There were 67 patients with male predominant (52%) , the common age of presentation was between one month to one year ; 42 (62%) , 38 (56%) of patients presented with high grade fever and fit , 42 (62%) patients presented with simple fit , 25 (38%) presented with complex fit , 40 (59%) presented with generalized fit , 27 ( 41%) presented with focal fit , 28 ( 42%) patients presented as first attack and 39 (58%) presented as a recurrent attack ,in 11 (17%) the result of gram stain was positive while 56 (83%) the results were negative , 9 (14%) the results of cerebral spinal fluid culture showed growth of bacteria while 58 (86%) showed no growth. CONCLUSION: The lumbar puncture is necessary in patients presented with fever and fit especially in infancy and those presented with high grade fever and recurrent and complex fit to exclude central nervous system infection. .


Article
Outcome of Neonatal Jaundice In ABO Incompatible Pregnancies

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ABSTRACT: BACKGROUND: Blood group mismatch between the mother and newborn carries substantial risk for neonatal jaundice OBJECTIVE: To study the outcome of neonatal jaundice due to ABO hemolytic disease of the newborn (ABO HDN) and study the relation of epidemiological risk factors and laboratory findings with it´s severity. PATIENTS AND METHODS: In this prospective study, 64 neonates with neonatal jaundice associated with ABO incompatibility were studies. Cases of ABO HDN were diagnosed as those with anemia, reticulocytosis and spherocytes or polychromasia on blood film with or without positive direct Coombs test. Severity of jaundice was regarded according to the type of treatment (phototherapy or exchange transfusion). RESULTS: Forty two patients (65.6%) were males, 46 patients (71.9%) were full term infants, 6 patients (9.4%) had family history of neonatal jaundice treated by exchange transfusion. Only 9 patients (14.1%) presented with TSB level ≥ 20 mg/dl, 8 patients (12.2% ) had PCV level < 45%, 8 patient (12.5%) had reticulocyte count ≥ 5%. Direct Coombs test was negative in all the patients. Twelve patients (18.8%) had abnormal blood film findings . Eight cases (12.5%) had the features of ABO HDN and represented 2.9% from the total admitted cases of neonatal jaundice. Full term babies, positive family history of exchange transfusion, abnormal blood film findings and reticulocyte count were found as significant risk factors for the severity of the jaundice, while gender, body weight, blood group, mode of delivery and parity of the mothers had no significant effect on the severity of the jaundice. CONCLUSION: Not all the cases of ABO incompatibility developed ABO HDN, so laboratory confirmation is required.


Article
Calculation of the Amount of Fluids Given During Neonatal & Pediatric Surgical Operations (New Formula: Ry Formula)

Authors: Riyadh Khudeir Hamed
Pages: 688-692
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ABSTRACT: BACKGROUND: A new formula (RY formula) for calculation of intra operative fluids given in neonatal & pediatric life threatening surgical operations was enrolled in this study. OBJECTIVE: To find a correct , simple ,easily applicable & understandable formula to avoid all unwanted dangerous mistakes in calculation of fluid requirements in all types of neonatal& pediatric surgical operations . PATIENTS: (Five Thousands Patients) including neonates , infants & pediatric age group presented to CWTH /Medical city /Baghdad for different types of surgical operations were enrolled in this study divided to 3 groups ( Group A ) Life threatening conditions 2300 patients , (Group B) Major& super major operations 700 patients &( Group C ) Different types of elective surgical operations 2000 patients . METHODS: In this new (RY formula) intra operative fluid requirements calculated as : Pre existing deficit (Fasting) : 20 ml/kg this amount is divided over 3 hours : ½ the amount given in the 1st hour of operation , and ¼ the amount is given for each the 2nd& 3rd hours of operations. Maintenance fluid requirements : 4 ml/kg/hr for all weights. 3rd Space replacement : 8 ml/kg/hr for major& super major operations & 4 ml/kg/hr for minor operations . RESULTS : By comparison of this new (RY formula) with most of other anesthesia text books fluid formulas and anesthetic references regarding this aspects the results is that the difference in the amounts of fluid requirements was minute and regarded as negligible difference . CONCLUSION: This new formula has been used for the last six years(2005-2010) in neonatal & pediatric anesthetic department in CWTH/ Baghdad Medical City complex for 5000 neonates ,infants & pediatric patients without any complications.This new formula is correct, simpler, safer ,easily applicable understandable than other formulas. The most important point in this new(RY formula) is that it can be summarized by just 2 numbers( 22- 17) 22 ml/kg for the 1st hour & 17 ml for the 2nd&3rd hour of operation for major operations.


Article
Clinical and Sequential Histopathological Study of Scabietic and Postscabietic Nodules

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ABSTRACT: BACKGROUND: Scabietic nodules are common problem seen before and after effective therapy of scabies that might persist for months. OBJECTIVE: To evaluates the clinical and histopathological features of these nodules during their sequential course. PATIENTS AND METHODS: Patients with scabietic nodules were enrolled in this study. Five (14.7%) patients had active scabies at the time of consultation. All recruited patients had personal and family history of treated scabies with persistent itchy nodules. Patients were fully examined for: sites, numbers and sizes of the persistent scabietic nodules. Histopathological evaluation was done from nodules in patients with active scabies before therapy and at different times during the course of the post-scabietic nodules . RESULTS: Thirty four male patients were studied with mean age (34.41±16.72) years. The lesions were more prevalent in young adult age group 20-29 (24.5±2.9) years. The nodules had persisted for a period ranged from 1-52(13.47±14.29) weeks. Intolerable itching was evident in all these nodules but without the nocturnal accentuation. The number of nodules ranged from 1-35(8.5±6.8) lesions. These nodules were more heavily involving: scrotum in 20(28.57%) patients and penile shaft 19 (27.14%), and less commonly involving the upper thigh, lower abdomen, axilla and penile corona. Differential white blood cells count revealed normal eosinophilic count in all patients with post scabeitic nodules, while high values were observed in 4out of 5 patients with active scabies.The histopathology of scabietic and post-scabietic nodules revealed: acanthotic epidermis with mild spongiosis, pseudoepithelial hyperplasia present in 2(5.8%) nodules. The infiltrate was mainly diffuse (papillary and reticular dermis) dense lymphocytic in 29 (85.2%) nodules and even in early stages, the density of the infiltrate decline when the nodules persisted more than 6 months. Scattered eosinophils were present in the dermis of all nodules regardless the age of nodule. Mild lymphocytic vasculitis recognized in 3 (8.8%) nodules in patients with short duration (3-9 weeks). Granulomatous reaction with Langhans giant and epitheliod cells was another important finding in4 (11.7%) nodules. CONCLUSION: Scabietic nodules tend to affect male adult with a predilection to the scrotum and penile shaft. The histopathological pictures consisted mainly of acanthotic epidermis and diffuse dense dermal lymphocytic infiltrate in 85% of scabietic nodules. No mites or mite parts could be detected. Lymphocytic vasculitis and granulomatous reactions present in few nodules.


Article
Comparison between Total Intravenous Anesthesia (TIVA) and Conventional General Anesthesia in Day Case Surgical Procedures

Authors: Iyad Abbas Salman --- Ali Yousif Mohammad
Pages: 700-705
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ABSTRACT: BACKGROUND: Day case surgery should be of short duration, rapid recovery, and with low incidence of postoperative complications. For long time was done with conventional inhalational based anesthesia, in last year's, TIVA began to be used in these surgeries. OBJECTIVE: To evaluate total intravenous anesthesia (TIVA), as an aesthetic technique for day case procedures and to compare it with conventional inhalational based technique in terms of intra and postoperative hemodynamic and respiratory changes, postoperative recovery and postoperative vomiting. PATIENTS AND METHODS: This is a prospective randomized study has been done on 100 patient who underwent general anesthesia for short duration surgical procedure in AL- Jumhory teaching hospital in Al-Mosul city in Iraq, during the period between Nov 1st, 2011 and March 1st, 2012 , All patients were allocated into either TIVA or inhalational (INH) groups, of 50 patient each. In TIVA group: induction and maintenance of anesthesia done by propofol. While in INH group: maintenance of anesthesia done by halothane. Blood pressure, pulse rate, respiratory rate were monitored at a specific time. Recovery time was recorded according to Aldrete score. Any episode of vomiting was recorded. RESULTS: Aldrete score of ≥ 9 was achieved earlier in the TIVA group than in the INH group. It was also observed that there was initial fall in HR, MAP and respiratory rate in the both group, and post operative vomiting was less in the TIVA group. CONCLUSION: The time needed for recovery and episodes of postoperative vomiting in TIVA is less than in inhalational anesthesia. KEYWORDS: TIVA, propofol, day case surgery.


Article
Factors Affecting Intra-Cytoplasm Sperm Injection (ICSI) and Pregnancy Outcome in the Fertility Center of Al – Najaf City

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ABSTRACT: BACKGROUND: Knowing predictors of pregnancy in IVF is helpful for clinicians to individualize the treatment plans and improve patient counseling and for patients to decide whether to undergo infertility treatment. OBJECTIVE: A prospective and retrospective study to determine the factors affecting results and outcome of Intra-Cytoplasm Sperm Injection (ICSI) ICSI in the treatment of sub-fertile patients and the pregnancy outcome. PATIENTS AND METHODS: 140 couples underwent IVF cycle in the form of intra-cytoplasm sperm injection ICSI enrolled in the study, pregnancy rate was analyzed according to the age, type, cause and duration of sub-fertility, hormonal assay, endometrial thickness, type of treatment protocol, number of retrieved oocytes, number of embryos transferred and sperm parameter. RESULTS: From the total of 140 women, 23 (16.43%) were cancelled, among 117 cycle, the pregnancy rate was 25.27%, fertilization rate was 39.87%. Factors which significantly affect the outcome of ICSI included the age of the women as fertility decline with advanced age, type and causes of sub-fertility. Sperm quality was more important than sperm number, and the number of embryos transferred also affect pregnancy outcome. CONCLUSION: Multiple factors affecting ICSI outcome, the most important one is female age, The cause and type of sub-fertility also affect the outcome. KEY WORDS: intracytoplasm-sperm injection (ICSI)


Article
Complications of Bone Marrow Aspiration and Biopsy: a New Unexpected Ris

Authors: Najlaa Badr Alawadi
Pages: 712-715
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ABSTRACT: BACKGROUND: Bone marrow examination represents an essential tool for diagnosis and monitoring of haematological and non-haematological disorders. Although some hazards are recognized, bone marrow aspiration and trephine biopsy are generally thought to be safe procedures. OBJECTIVE: The aim of this study is to identify the possible complications associated with the bone marrow aspiration and biopsy procedures. METHODS: In this study, 2156 cases of bone marrow aspiration with or without trephine biopsy were done in Merjan Teaching Hospital, Babil governorate, Iraq during a five year period from 1st Feb 2006 to 1st Feb 2011. These procedures were done under local anesthesia. The complications associated with these procedures were reported. RESULTS: A new previously unreported complication was seen in 2 patients as they developed sudden apnea and loss of consciousness. The final diagnosis in both patients was acute lymphoblastic leukemia with huge mediastinal widening and they were lying in prone position during the procedure. Bleeding was seen in 2/2156 (0.09%) cases. Prolonged pain was documented in one case. No infection was reported. CONCLUSION: Bone marrow examination is generally safe, however apnea and loss of consciousness can occur in patients with a huge mediastinal mass compressing trachea and/or major chest vessels when the procedure is done in prone position. KEY WORDS: Bone marrow aspiration.


Article
Non Union of Diaphysial Humeral Fractures

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ABSTRACT: BACKGROUND: Humeral shaft fractures represent 3-5% 0f all fractures mostly heal by conservative methods ,frequently few fractures fail to unite , several fixation modalities have been used with types of bone graft . OBJECTIVE: To analyze the local and environmental factors of 44 patients having non union of diaphysial humeral fractures and the result of treatments by open reduction and fixation with plate and screws and autogenous bone graft application . METHODS: Retrospective and prospective study of forty four patients had non union of the daiphysis of the humerus, 34 males ,10 females, age ranged from 18-61, 29 had open injuries , 15 had closed injuries . All patients treated by rigid fixation with plate and screws and ample amount of autogenous bone graft. Follow up from 6-24 months . RESULTS: 40 patients had good results in clinical and radiological union of their humeri , in four patients the bone fail to unite ,graft resorbed with or without plate failure. CONCLUSION : Sever injuries with soft tissue damage is a major cause of nonunion and rigid fixation by plate and screws with autogenous bone graft is a good optional method of treatment when other modalities are not available . .


Article
Aiming For Emmetropia after Cataract Surgery

Authors: Ahmed Majeed Rasheed
Pages: 721-726
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ABSTRACT: BACKGROUND: Emmetropia after cataract removal and posterior chamber intraocular lens implantation is vital for the achievement of a clear postoperative vision . Any significant deviation from this target leads to patient dissatisfaction. OBJECTIVE: The aim of this study is to evaluate the importance of various factors in causing deviation from post-cataract surgery emmetropia. Design: prospective non comparative observational study. METHODS: 114 eyes from 114 patients with uncomplicated cataract were enrolled for this study, biometry was done for the patients then they were operated on by phacoemulsification and foldable posterior chamber intraocular lens implantation .After one month from the surgery retinoscopy and manual refraction was done for all patients. RESULTS: Operated patients had a mean age of 61.4±5.6 years. Of the 114 eyes, 73 eyes (64.03%) were within 1 diopter (D) spherical equivalent (SE) of emmetropia. The number of eyes with postoperative astigmatism was 104 (91.22%); the mean absolute postoperative astigmatism amplitude was 1.346 D±0.421(SD). The mean absolute biometry prediction error was 1.007 D±0.246 (SD). The number of eyes with biometry error was 65 eyes (62.5%). CONCLUSION: Emmetropia is the goal in most cataract surgeries but only 64.03% of eyes were within 1.0 D (SE) of this target. Factors precluding emmetropia include postoperative astigmatism and biometry prediction errors.


Article
Salvage of Extruded Cochlear Implant By Interposing Pericranial Flap

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ABSTRACT: BACKGROUND: Cochlear implant has become a routine procedure for management of severe sensorineural hearing loss. Cochlear implant extrusion is one of the most devastating complication of this procedure. A double layer closure of pericranial flap and scalp rotational flap has being showed to decrease the rate of late implant extrusion. OBJECTIVE: The purpose of this study is to evaluate the use of the pericranial flap as second layer coverage after cochlear implant extrusion. PATIENTS AND METHODS: Eight patients with cochlear implant extrusion in Al-Shaheed Gazi Al-Hariri hospital were operated on by using two layer closure ; the pericranial flap as salvage layer used to cover the cochlear implant and scalp rotational flap as a routine coverage, with mean postoperative follow- up period of 6 months. RESULTS: Eight patients with late cochlear implant extrusion where operated on by using double layers closure, seven of them had no evidence of extrusion during the 6 months follow-up period. No complications were notice apart from one case who developed flap necrosis and the implant was removed later on, and another patient who had postoperative hematoma, which was surgically evacuated and the flap healed uneventfully. The results show that using pericranila flap as salvage second layer coverage in patients with cochlear implant extrusion had significant role in prevention of secondary cochlear implant extrusion. CONCLUSION: We concluded that the use of combination of pericranial flap as first layer with scalp rotational flap as secondary coverage of implant had superior result in prevention of secondary cochlear implant extrusion.


Article
Chemical Peeling in the Treatment of Xeroderma Pigmentosum

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ABSTRACT: BACKGROUND: Xeroderma pigmentosum is a rare autosomal recessive disease characterized by abnormal sensitivity to ultraviolet radiation with early appearance of variable premalignant and malignant skin lesions leading to a reduction in life expectancy because of tumor metastasis . OBJECTIVE: To assess the role of chemical peels in clearing the skin background in patients with xeroderma pigmentosum. PATIENTS AND METHODS: To achieve the objective of the present study, a case-series design was adopted covering 14 patients with xeroderma pigmentosum. They were treated in the Plastic Surgery Unit at Al-Jumhori Teaching Hospital in Mosul, for the period from March 2011 to May 2012. Surgical excision was done first for the malignant skin lesions then chemical peeling of the face, using 30% trichloro- acetic acid was done. Assessment of the results was performed by the patients or their caregivers and by two plastic surgeons, depending on the number of lesions and the degree of pigmentation which were classified into 3 degrees, as poor, (no changes occur), moderate and good (depending on the improvement in skin background by the decrease in freckling and lightening of the pigmentation. RESULTS: Fourteen patients with xeroderma pigmentosum were enrolled in this study, 9 males and 5 females, their age range was 1 to 30 years. Malignant lesions were treated by excision and split- thickness skin graft or local flaps. The evaluated results of facial skin improvement after chemical peeling were poor in 2 patients, moderate in 7 patients and good improvement was shown in 5 patients. No significant complications developed, except scarring in one case and hyperpigmentation in 2 cases. CONCLUSION: Chemical peel is a simple procedure which was tolerated by the patients and can be used to improve the facial skin background and eliminate all subclinical premalignant lesions .


Article
Endoscopic Sinus Surgery of Chronic Rhinosinusitis Results and Complications

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ABSTRACT: BACKGROUND : The technique of Endoscopic Sinus Surgery (ESS) has been widely accepted and applied to many diseases of the paranasal sinuses with internationally reported results of this technique having been very good. OBJECTIVE: To assess the results & complications of E.S.S. for chronic rhinosinusitis. PATIENTS AND METHODS: Forty three patients underwent ESS at Al-Kadhymia Teaching Hospital (Baghdad) for one year period. A thorough history and ENT examinations, endoscopic examinations and CT-scan imaging of the nose & paranasal sinuses were performed. These patients diagnosed as having chronic rhinosinusitis and prepared for E.S.S. after failure of maximal medical treatment to improve their symptoms. The post operative follow-up period was 3-6 months and evaluated subjectively regarding the outcome of their endoscopic sinus surgery. RESULTS: The age ranges from 17 to 53 years, the mean age was (32.44 years ±9.83 STDEV ), the commonest age group affected was between 31-40 years (34.88%),male to female ratio was 1.15:1 The commonest symptom were Headache in 30 patients (69.76%) ,Nasal obstruction in 29 patients (67.44%),Post nasal drip in 18 patients (41.86%).The duration of symptom was 1-5 years in (44.18%) of patients. During surgery all the patients underwent uncinectomy& anterior ethmoidectomy. Major complication not occurred in our study commonest minor complication was synechia 8 patients (18.60%) .Commonest symptoms that improved were ; nasal obstruction 24 out of 29 patients ( 82.75%) which is significant {p-value=0.02} , postnasal drip 7 out of 18 patients ( 38.88%) which is significant {p-value=0.002},while headache 21 out of 30 patients (70%) not significant {p-value=0.077 } CONCLUSION : ESS is efficacious in treatment of chronic rhinosinusitis with few minor complications and rare major complications.


Article
Extracorporeal Shock Wave Therapy for Chronic Planter Fasciitis Associated with Enthesophytosis

Authors: Nizar Abdul Lateef --- Sami Salman --- Ahmad Fahim
Pages: 745-750
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Abstract

ABSTRACT: BACKGROUND: Painful heel is a common syndrome characterized by severe pain in the inferior or posterior aspect of the heel, which is aggravated by weight bearing, becoming progressively worse and often incapacitating, with evidence of a spur in about 50% of cases. OBJECTIVE: To evaluate the efficacy of extracorporeal shock wave treatment (ESWT) in calcaneal enthesophytosis (heel spur). PATIENT AND METHODS: Ninety four patients (66 women, 28 men) were examined who had heel pain associated with heel spur. A double blind randomised study was performed in which 52 patients underwent a standardized treatment (group 1) and 42 patients had sham treatment (group 2). Variations in symptoms were evaluated by visual analogue scale (VAS). Variations in the dimension of calcaneal spur were evaluated by x ray examination. RESULTS: A significant decrease of VAS was seen in group 1. Examination by x ray showed morphological modifications (reduction of the larger diameter >1 mm) of the enthesophytosis in 25 (48.1%) patients. In the control group no significant decrease of VAS was seen. No modification was observed by x ray examination. CONCLUSION: Extracorporeal shockwave therapy is an effective, safe method that improves the signs and symptoms of most patients with a painful heel. KEY WORDS: extracorporeal shock wave, plantar fasciitis, enthesopathy, heel pain, enthesophytosis.


Article
Topical Nitroglycerin in Treatment of Plantar Fasciitis

Authors: Qais A. Adi --- Sami Salman --- JewadIbraheem Resheed
Pages: 751-759
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Abstract

ABSTRACT: BACKGROUND: Planter fasciitis is the most common cause of inferior heel pain in adults; it is a degenerative process of the planter fascia at its origin on the calcaneus. Many treatment modalities are used including NSAIDs, orthotics, local steroid injection, extracorporeal shock wave therapy and others. Recent studies have shown that topical nitroglycerin has a healing and analgesic effect in other tendinopathies like: tennis elbow, suraspinatus tendinitis and Achilles tendinitis. OBJECTIVE: We want to establish the role of topical nitroglycerin in treatment of plantar fasciitis. PATIENTS AND METHODS: A double blind placebo controlled study included 54 patients, after taking medical history they were subjected to physical examination. Nitroderm TTSR 5 patches were used in the treatment group, similar placebo patches were used in the placebo group. The severity of the symptoms was quantified initially for each patient using the visual analogue scale (VAS). By using SPSS (statistical package for social sciences) software for windows, data of all patients were entered and analyzed with appropriate statistical tests according to the types and distribution of variables (Chi square test and Students’t test). RESULTS: Response to topical treatment was (76.7%) in the GTN group most of them with moderate and good response compared to (41.7%) in placebo group most of them with mild response. CONCLUSION: It was clear that NGT patches were superior to placebo patches in improving the symptoms of patients, so that topical NGT can enhance healing of planter fasciitis. This may be a useful alternative to the current modalities of treatment used for this common


Article
Molecular Analysis of Class II HLA-DRB Polymorphism

Authors: Haider Hashim Zalzala
Pages: 760-764
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Abstract

ABSTRACT: BACKGROUND: Major Histocompatibility Complex (MHC) system is a polymorphic system and the extensive polymorphism of MHC gene in human and the allelic distribution in different ethnic population become a key component in investigating the genetic relations between populations. Geographical variety is one of the factors that affect HLA polymorphism. OBJECTIVE: This study is designed to study class II HLA-DRB polymorphism in Iraqi populations by molecular method. METHODS: Seventy four healthy Arab Iraqi populations were enrolled in this study during the period between November 2012 till April 2013. Direct interview was done with the populations and HLA typing was done by molecular method using Sequence Specific Primer (PCR-SSP) method using One Lambda Kit-USA. RESULTS: The most frequent alleles are DRB1*03,*11,*07 with a frequency of (0.47, 0.41, and 0.26) respectively. There are no significant difference between male and female regarding non-DRB1 alleles. CONCLUSION: 1- The most frequent alleles in Arabic Iraqis populations are DRB1*03,*11, and *07. 2- Gender is not a significant factors affecting the frequencies and hetro- or homozygosity for the nonDRB1 alleles in adults. KEY WORDS: HLA-DRB1, HLA polymorphism .


Article
Chylous Ascites Following Choledochal Cyst Excision

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ABSTRACT: Chylous ascites is accumulation of triglyceride rich fluid in peritoneal cavity. Apart from spontaneous causes, the iatrogenic type usually result from retroperitoneal operations. This is a case report of an eleven year old girl, who developed chylous ascites after choledochal cyst excision and roux-en- y hepatico-jejunostomy. The condition discovered in the seventh post-operative day and treated by percutaneous drain, low-fat diet, and octreotide . The condition was resolved after two weeks.


Article
Bilateral Nephrone Sparing Surgery for Patient with Bilateral Wilms Tumor

Authors: Saad Dakhil Farhan
Pages: 768-770
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Abstract

ABSTRACT: Synchronous bilateral Wilms tumors occur in 5% to 7% of children with Wilms tumor , Children with bilateral tumors should not undergo initial radical nephrectomy. These children should receive preoperative chemotherapy with the goal of tumor shrinkage and renal-sparing surgery. Preservation of renal tissue is important to decrease the incidence of renal failure.(1,2) We report the case of bilateral renal sparing surgery for 5years old child with bilateral wilms tumor (Stage 5) nephroblastoma. KEYWORDS:wilmstumors,nephroblastoma, partial nephrectomy.

Table of content: volume:12 issue:supplement