Table of content

Karbala Journal of Medicine

مجلة كربلاء الطبية

ISSN: 19905483
Publisher: Kerbala University
Faculty: Medicine
Language: English

This journal is Open Access

About

Karbala Journal of Medicine is a four monthly published journal issued by Karbala college of Medicine.The Journal accepts original articles, case reports, and letters to editors in all fields of medicine from all parts of the world. Review articles of high standards are also considered in this journal. All articles and manuscripts must be in english ,only the abstract must be in arabic and english.Papers are accepted, on understanding that the content has not been published in a whole or in part by other journals. The papers are subject to editorial revision, and the editor is responsible for the order of publication.Manuscripts are only accepted on the understanding that the author will permit editorial amendments, though proofs will always be submitted to the corresponding author before being sent finally to press. The Journal is peer- reviewed and each article is sent to two evaluators of the same specialty in addition to statistical and design review by expert statistician.
Date of first issue(2009)
No: of issue per year(4)
No. of pages per issue(120)
No. of issue published between 2009-2012) is(16)

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Contact info

Journal e-mail:karbalamedj@yahoo.com, karbalamedj@uokerbala.edu.iq
editor e-mail:dr.mohma.med.school@gmail.com
mobile: 07801363988

Table of content: 2013 volume:6 issue:2

Article
Prevalence of Schneirder’s First Rank Symptoms in Iraqi Schizophrenic Patients

Authors: Kareem Nasir Hussain
Pages: 1600-1607
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Abstract

background: Schizophrenia is a mental disorder defined in term of abnormal clinical feature of behavior, affect, thinking and perception. Kurt Schneider 1887-1967 divided schizophrenic symptoms into 1st or 2nd rank are entirely devoid of any therapy and are intended purely pragmatically diagnostically. Objectives (aims): To determine the prevalence of Schneider’s First Rank Symptoms in Iraqi schizophrenic patients and explain the finding on a cultural basis. Method: A cross sectional study that enrolled 76 schizophrenic patients treated as inpatient in Psychiatric Unit in Al-Diwaniya Teaching Hospital from1 May 2012 to 1 Jun. 2013, who met the diagnosis of schizophrenia according to ICD-10 and Schneider’s First Rank Symptoms according to C. S. Mellor . All patients were examined within a maximum of four days from admission to the hospital. Results: This study revealed that 55% of them have clear First Rank Symptoms. The commonest was somatic passivity, thought broadcast, commentary voices and thought insertion. Conclusion: First Rank Symptoms are of value in the routine clinic diagnosis of schizophrenia in Iraq. Phenomenology or descriptive psychopathology is of vital importance and it needs experience and training to help better clinical diagnosis of psychiatric disorder. NOTE: FRS: First Rank Symptoms.


Article
The Effect of Postural Changes on Spirometric Indices of Upper Airway Obstruction

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Abstract

the spirometric diagnosis of upper airway obstruction is an important non-invasive technique that was validated for the diagnosis of such lesions relying on several indices that were derived from the flow volume loops of patients. Objectives: Is to find out if postural changes have an effect on spirometric indices of airway obstruction in healthy subjects and if so, does this merit performing the test in supine posture? Subjects and methods: This study conducted in the department of physiology and medical physics/ Kerbala medical college, in which 17 males aged from 18-19 years (18.53 ± 0.51), had BMI of (22.95 ± 2.11 Kg/M2 ), heights of (1.75 ± 0.14 meters) and weights of (70.32 ± 6.34 Kgs) were enrolled. The following spirometric data were measured in two different body positions (erect versus supine): Forced vital capacity (FVC), Forced inspiratory flow at 50% of vital capacity (FIF50%), Forced expiratory flow at 50% of vital capacity (FEF50%), Forced expiratory volume in first second (FEV1), Forced expiratory volume in first 0.5 second (FEV 0.5), Peak inspiratory flow (PIF) and Peak expiratory flow (PEF). From these data, the following indices of upper airway obstruction were derived: (FEV1/ FEV0.5, FEV1/ PEF, FEF50%/ FIF50%, and PEF/PIF). These indices were compared with each other in respect to two body positions. Results: 1- All the measured inspiratory and expiratory flow rates were significantly lower in supine position (p < 0.05). 2- Of the four measured indices of upper airway obstruction, only the FEV1/PEF ratio increased significantly (p < 0.05) by about 27% upon reclining.

Keywords

PFT --- UAO --- FVL --- Body posture --- and OSAS.


Article
Modified Clinical Score of Acute Appendicitis

Authors: Ali Hussein Al - Taey
Pages: 1615-1620
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Abstract

background Suspected acute appendicitis is the most common non traumatic admissions to the surgical emergency units .Over past 100 years mortality and morbidity rates related to appendicitis have markedly decreased. The diagnosis of acute appendicitis is predominantly a clinical preoperatively but final diagnosis of acute appendicitis needs surgical reports per-operatively and the standard pathological examinations postoperatively .There are many clinical scores have been established to help in the diagnosis of the condition in surgical emergency room by junior surgeons in a short time in order to perform surgery in solid bases The main purposes of accurate diagnosis of acute appendicitis :- 1-Management of acute appendicitis in a short time and high accuracy to:- A-Avoid delayed diagnosis and prevent complications like perforation and finally peritonitis so mortality and morbidity of appendicitis markedly decrease B-Avoid missing of any cases . 2 -Avoid unnecessary surgery. Alvarado scoring system especially for junior residents who work as the primary receptors of surgical cases at surgical emergency units. Alvarado score system was identified as a useful clinical tool because it is readily available , extremely affordable ,and relatively accurate Aims This study: was conducted to modify Alvarado scoring system to more easy applicable, simple, cheap, quick and test( Reliability of suggested scoring system ) by which we avoided laboratory readings and technical errors that may cause diagnostic difficulties Patients and Methods a prospective study of 120 patients with suspected acute appendicitis admitted to surgical department -Al-Hussein teaching hospital—Karbala during the period from 1st January—to 31st December 2010 were included in this study. The patients were given specific scores according to this (Suggested score system) categorized into three categories Category 1 patients score 7 or more who underwent surgery Category 2 patients score 5—6 admitted for a surgical ward under observation Category 3 patients score 4 or less where acute appendicitis can be excluded. All appendices that removed surgically were sent for histopathological examination. Results By the (Suggested Score) Out of 120 patients 80 patients underwent surgery and acute appendicitis were confirmed in 60 patients thus negative appendectomy thus giving negative appendectomy frequency of 20%. Perforation rate was 6.25%.Positive Predictive Value was 80% (male 84% female 76%) Conclusion The (suggested scoring system) aids in the diagnosis of acute appendicitis. It helps junior residents in early diagnosis of acute appendicitis. It is quicker—simpler cheaper and easily applicable than Alvarado score in Iraq. The (Reliability of suggested scoring system) tested in this study and the result was that the new score had a good reliability compared to Alvarado scoring system


Article
Serological Study for TORCH Infections by ELISA Method in Women with Bad Obstetric History in Kerbala City

Authors: Ban Waheed Hussein --- Satar Jabbar Rahi --- Alaa Saad
Pages: 1621-1624
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Abstract

background: Bad obstetric history (BOH) implies previous unfavorable fetal outcome in terms of two or more consecutive spontaneous abortions, early neonatal deaths, stillbirths, intrauterine fetal deaths, intrauterine growth retardations and congenital anomalies. Maternal infections transmissible in utero at various stages of gestation lead to recurrent pregnancy wastage. Infections caused by TORCH –toxoplasma, rubella virus, cytomegalo virus (CMV) and herpes simplex virus (HSV) – is the major cause of BOH. Objective(S): The study aimed to evaluate the incidence of TORCH infections in women with bad obstetric history (BOH). Patients &methods : The study included 130 women with bad obstetric history and 65 clinically normal women with previous normal full term deliveries who were attended to the gynecological & obstetrical hospital from January to July 2012. Serological evaluation for TORCH infections was carried out by IgM ELISA method. Result: Seropositivity for toxoplasma was 39.23%, rubella 12.3%, cytomegalovirus 35.38% and herpes simplex virus1.53%. Maximum percent cases of abortion (41.37%) Early neonatal death (25%) congenital malformation (16.6%) was associated with toxoplasma infection. Maximum percent of cases of abortion (36.20%) Early neonatal death (25 %) congenital malformation (33.3%) was associated with cytomegalo infection. while (1.72%) and (13.79%) maximum percent of cases of abortion associated herpes and rubella respectively Conclusion(S): TORCH infections are associated with recurrent abortion, intrauterine growth retardation, intrauterine death, preterm labor, early neonatal death, and congenital malformation. Previous history of pregnancy wastages and positive serological reactions during the current pregnancy must be considered while managing BOH cases so as to reduce the adverse fetal outcome.


Article
Hypertension and Pregnancy in Karbala Maternity Hospital

Authors: Muna Kasim Mahmood
Pages: 1625-1629
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background: Hypertension complicates 5-7% of all pregnancies. Preeclampsia characterized by development of hypertension, proteinuria and multisystem involvement after 20 weeks of pregnancy in a previously normal female and disappear after peurperium and it is responsible for substantial maternal and fetal morbidity. Objective: the purpose of this study was to know the complications of hypertension in female during pregnancy and postpartum period, the method of termination of pregnancy, fetal and neonatal outcome of female with hypertension in pregnancy. Methods: this is a prospective study involve 75 pregnant women with hypertension admitted to Karbala maternity hospital, we monitored their pregnancies and recorded the development of complications. Results: eclampsia developed in 25.33% of them, HEELP syndrome developed in 9.33% and intrauterine fetal death occur in 6.66% and no maternal mortality occurring during this period, intrauterine fetal death occur in 6.66% of them and 32% of them delivered vaginally. Conclusion: lower incidence of eclampsia, maternal death, intrauterine fetal death and other complications due to preeclampsia due to good monitoring and the use of prophylactic magnesium sulphate in severe cases.

Keywords

--- hypertension --- proteinuria --- pregnancy


Article
Patterns of Sensitization to Inhalant Allergens among Asthmatic Children in Karbala Province

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background: The patterns of sensitization to inhalant allergens among asthmatic children varies greatly in different countries. The detection of sensitization to inhalant allergens in asthmatic patients is used primarily to establish the diagnosis of allergic asthma. Also it is helpful in reducing asthma exacerbations through allergen exposure avoidance. Objectives: This study aims to determine the most common inhalant allergens associated with childhood asthma in Karbala province using allergen-specific IgE immunoassay. Patients and Methods: The present study was conducted in Karbala Teaching Hospital for Children on 75 asthmatic children with elevated total serum IgE levels. All patients were screened for the presence of specific IgE against inhalant allergens most frequently involved in childhood asthma using EUROLINE Pediatric Inhalation IgE test kit that include 20 inhalant allergens. The position of the band was used to determine the specific allergen while the color intensity of the band was used as predictive for the specific IgE concentration in serum samples. Results: Among 75 patients screened for specific IgE, 60 patients (80%) were sensitized to at least one allergen and allergen-specific IgE was not detected in 15 (20%) patients. 30% of sensitized patients, were sensitized to single allergen and 70% were sensitized to multiple allergens. Cat allergen was found in 60% of sensitized patients followed by European house dust mite allergen (55%). However, dog and aspergillus fumigatus allergens accounted for 45% and 33.3% respectively. Most patients sensitized to cat and dog allergens (55.5% and 52% respectively) showed clear bands signal intensity (moderate allergen-specific IgE concentration). However the majority of patients sensitized to other inhalant allergens showed weak bands signal intensity (low allergen-specific IgE concentration). Conclusions: Animal allergens (mostly cat) are the predominant inhalant allergens associated with childhood asthma in Karbala province with relatively higher allergen-specific IgE concentrations than house dust mite and fungal allergens.


Article
Evaluation of Period from Onset till Operation in Acute Appendicitis

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background: The vermiform appendix, is a small blind tubular structure ,and in no way a vestigial organ but a specialized structure without any definitely known function, probably concerned with the establishment and maintenance of the body defense , immunity of the body and other benefits in the surgery. Its importance in surgery results from propensity for inflammation, which results in the clinical syndrome called acute appendicitis which is the most common cause of acute abdomen in surgery, and results in the most frequently performed abdominal operations. Objectives: Even the most experienced physicians and surgeons are not able to diagnose appendicitis 100% of the times, thus many patients wait a period of time ranging from one to several hours until they receive a treatment, so we evaluate the period of time from onset of symptoms till the definitive treatment in acute appendicitis. Methodology: An observational cross sectional study based on a standardized preformed questionnaire contains 20 questions answered directly by the patient who underwent a surgical removal of the appendix in the surgical department of Al -Hussain medical city for the period 1010 -10122012, and Fisher Exact test used for data analysis Results: A total 100 cases where interviewed, 42% of cases their waiting time more than 24 hours before receiving the definitive treatment and perforation occurred in 6% of cases, and perforation rate was higher among patients who wait more than 24 hrs before operation, but with no statistical significance. Conclusion: The overall period from onset of symptom till operation in acute appendicitis was acceptable as compared to many scientific and clinical based studies and didn't seem to associated with significant incensement of complication.


Article
Prevalence of Anti-Rh (D) Antibody in Karbala

Authors: Mohammed Shnain Ali
Pages: 1644-1647
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background: Neither Rh(D) positive individuals nor Rh (D) negative individuals normally have anti-Rh(D) antibody in their blood; however, Rh (D) negative individuals have the ability to form such antibody when they are transfused with Rh(D) positive blood. Objective: To determine the prevalence of anti-Rh (D) antibody in Karbala. Patients and methods: From January 2012 to March 2013, 226 patients (127 males and 99 females with age range of 20-49 years) were studied after their consent. For each patient, 4 ml of venous blood sample was obtained and investigated as follows: Two ml of blood were transferred to EDTA tube for ABO and Rh(D) grouping using the commercially available kit (monoclonal anti-A, anti-B and anti-D) by doing the ordinary tile method (equal volumes of blood and reagent were mixed on tile looking visually for the agglutination for positive reaction and positive result. Absence of agglutination means negative reaction and negative result). The other 2 ml of blood were transferred to plain tube, centrifuged and serum is investigated for anti-Rh(D) antibody in Rh(D) negative individuals by double dilutions of each serum and antibody titration method. Results: Out of 226 individuals, 186 (82.3%) were Rh(D) positive, 40 (17.7%) were Rh(D) negative, and 2 were found to be positive for anti-Rh(D) antibody. The prevalence of anti- Rh(D) antibody is 0.88%. Conclusion: The study showed that the prevalence of anti-Rh(D) antibody in Karbala is 0.88%.


Article
Assessment of Secondary Shielding of the Mammography Room of Al-Hussaini Hospital in Karbala City, Iraq

Authors: Header S. Jaafer, --- Abdullah A. Rasheed
Pages: 1648-1654
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X-ray equipment must be installed in adequately shielded rooms to ensure that public in the vicinity of the x-ray installations are not unduly exposed to x-ray radiation. The adequacy of shielding depends on the material and thickness used for this purpose. This work therefore studies the secondary shielding of the mammography room. By considering the mammography room design and the radiographic devices profiles used , the clinical total workload per week and total workload per patient have been computed and its distribution according to the most widely used voltages has been determined by recording the actual clinical technical values of maximum ,average and minimum mAs and the corresponding values of kilovolt peak for 2119 women over six months. As a diagnostic xray radiation shielding reference, the National Council on Radiation Protection and Measurements report No.147 (NCRP report No.147) and XRAYBARR computer program have been used to compute the secondary barrier thicknesses of Gypsum and Wood of the mammography room.. It is found that the total workload per week and the total workload per patient of the room were about three times that of stated by the NCRP report No.147 for a half value of the patients.The required thicknesses of Gypsum and Wood were about 4 mm and 20 mm respectively, whereas the actual thicknesses are higher than these values ,furthermore ,another conventional materials were used as secondary barriers ,such as bricks and concrete, hence the secondary barriers thicknesses exist in the room are more than adequate.

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Article
Assessment of the Morphology of Diabetic Macular Edema Using Optical Coherence Tomography

Authors: Hussain Ali Tufaili;
Pages: 1655-1659
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background: Diabetic macular edema(DME) is a major cause of visual loss in patients with diabetes. It usually results from the breakdown of the inner blood–retinal barrier. Early detection of retinal abnormalities is vital in preventing diabetic macular edema and subsequent loss of vision. Until recently, the methods available for detecting and evaluating diabetic macular edema were slit-lamp bio microscopy and stereoscopic photography, both of which are limited in detecting earlier retinal changes. Optical coherence tomography (OCT) is a new diagnostic imaging modality that provides high-resolution, cross-sectional images of the eye. It is proving to be an accurate tool for the early diagnosis, analysis and monitoring of retinopathy. It allows not only the qualitative diagnosis of diabetic macular edema, but also the quantitative assessment of edema. Objective: To verify different morphological types of diabetic macular edema that needs different treatment strategies. Patients and methods: A descriptive observational study was done in the OCT unit of Immam Hussain eye center in Kerbala city from December 2010 to May 2013. OCT done for 420 eyes of 237 patient. Cases with low image quality and cases with other eye disease were excluded. Results: Of 420 eyes,211 eyes (50.4%) have OCT morphological appearance of diffuse spongiform DME,115 eyes (27.5%) mixed spongiform and cystoid edema, 56 eyes (13.3%) have cystoid changes, and 38 eyes ( 9% ) showed edema with traction at vitreoretinal interface. Conclusion: Optical Coherence Tomography based classification of diabetic macular edema is more accurate in identifying the morphological types that need specific regimes of treatment and in the follow up the response to treatment.


Article
Snapshot of Genetic Diversity of Mycobacterium Tuberculosis in Al-Sadr City, by Using Mycobacterial Interspersed Repetitive Units-Variable Number Tandem Repeats (MIRU-VNTR) Genotyping Method. A Preliminary study

Authors: Mohanad Mohsen Ahmed --- Suhad Hadi Mohammed*,
Pages: 1660-1667
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background: Genotyping methods of M. tuberculosis (MTB) isolates such as MIRU- VNTR provides informations that may help in TB control program because it help in detecting the infection, confirming lab errors, determining treatment failure, reactivation and exogenous reinfection, and to detect any epidemiological link between patients by monitoring the transmission chain and identifying successful clones of MTB isolates and especially those with multidrug resistance. Al-Sadr city is the most populated city in Iraq with majority of people are living under the poverty line. Crowdedness and poverty are two essential requirements for successful tuberculosis (TB) transmission. Aims: To Shed light on the genetic diversity, clustering rate and transmission dynamics of TB cases while assessing the utility of 15-loci MIRU-VNTR in typing of MTB clinical isolates in Al-Sadr city. Subjects and Methods: Twenty nine MTB culture isolates were genotyped by using MIRU- VNTR-15 typing. Results: Twenty five distinct type were yielded, 8 isolates (27.6%) were grouped into 4 clusters (2 isolates/cluster), and 21 (72.4%) were unique. The clustering rate was (13.7%). Fourteen out of 15 loci were moderate or highly discriminative (h> 0.6, and h> 0.3, respectively) according to their allelic diversity. The mean of the allelic diversity of the 15 loci was high (0.64), indicating the high power of discrimination of MIRU-VNTR typing (HGDI was 0.99). Conclusions: MIRU-VNTR typing has a high discriminatory power and is useful in identification of the origin and transmission of M. tuberculosis isolates Al-Sadr city and possibly other densely populated cities in Iraq.

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Article
The Value of Serum Ferritin in the Prediction of Iron Deficiency in Patients with Lymphoid Neoplasms

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background:- anemia is a well-known complication of patients with lymphoid neoplasm and many factors are involved in its pathogenesis including defective iron utilization and diagnosing iron deficiency in the context of malignancy or chronic illness can be very challenging as many of the parameters used are acute phase markers and can be misinterpreted in the presence of chronic illness .bone marrow iron is the gold standard mean for assessing marrow iron but it is an invasive and a laborious procedure ,on the other hand serum ferritin has been used as the most relevant indicator of iron deficiency in the general population but it has the drawback of being increased in the presence of an acute response. Objectives:- evaluate the ability of serum ferritin at different cutoff levels and in combination with other parameters to identify iron deficiency in patients with lymphoid neoplasms. Patients and methods:- 39 anemic patients with different types of lymphoid neoplasm attending the hematology unit in Baghdad hospital were enrolled in the study ,exclusion criteria included history of blood transfusion and iron therapy in the past 2 months .for all patients bone marrow iron study was carried out and accordingly patients were classified into 2 groups the iron depleted group (with absent marrow iron) and the iron replete group (with present iron stores).from all patients peripheral blood was taken for the evaluation of complete blood picture and ESR and serum ferritin by enzyme Linked immunosorbant assay method (ELISA). Results:- the mean serum ferritin for the iron depleted group was 78.31ng/dl while for the iron replete group it was 202.77ng/dl there was a highly significant difference for serum ferittin between the 2 groups (p value .005),a less significant difference was found also for the mean cell volume(p value .05) while the other parameters showed no difference, the lowest cutoff level for serum ferittin that could accurately identify iron deficiency with a high sensitivity 96% and a high specifity 80% was 66.7ng/dl . Logistic regression analysis was done for serum ferritin and ESR to test for the effect of these parameters on the predictive power of bone marrow iron stores. The logistic equation was: Log (p)=0.163 + .0621*ESR -0.026*ferritin Using this equation with ferritin and ESR gave a prediction power of about 74% to identify the iron bone marrow store however using ferittin alone gave a 69% prediction power. Conclusion: - serum ferritin at a cutoff value of 66.7ng/dl can be used with high accuracy for the identification of iron deficiency in patients with lymphoid neoplasm and can be used as a suitable alternative for bone marrow iron, correction of serum ferritin for the acute phase response did not enhance much its predictive power in identifying iron deficiency in those patients.


Article
The Effect of Two Types of Separating Medium and Investment Materials on Some Physical Properties of Acrylic and Nylon Denture Base Materials

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background: The relatively rough surface of gypsum mould may be penetrated by acrylic denture base resin and adhere to it, to prevent this, a separating medium must be employed. Objectives: The aim of this study is to evaluate the effect of separating medium substitute and investment materials on Surface roughness, Water sorption and solubility of acrylic and nylon denture base materials. Material and method: Two types of separating medium were chosen (Cold mold seal and glycerin). 160 specimens were prepared from heat cure and Valplast resins. Each main group was subdivided into four subdivisions according to the type of investment material and separating medium used; each group of them contains 10 specimens for each test. After processing of both resins, some physical properties such as water sorption, solubility and surface roughness have been evaluated according to investment material and compared with those processed using cold mold seal and glycerin. Result: In this study, the surface roughness and water solubility of both base materials are significantly higher when using cold mold seal than glycerin. Mean value of heat-cure acrylic resin shows high water sorption than that of Valplast. When compared by ANOVA test, there is no significant difference between groups in both investment materials. Conclusion: The use of glycerin as a separating medium leads to smoother surfaces of both denture base materials, while for water sorption, neither the separating medium nor the investment material has an effect on it. Cold mold seal leads to higher water solubility of both base materials regardless of the type of investment material.


Article
Maximal Voluntary Ventilation in Patients with Type I Diabetes Mellitus

Authors: Ali Hussein al- Bayaty --- Safaa Jawad Kadhem
Pages: 1684-1688
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background and study Objectives: Several studies in adults report abnormalities of lung function in patients with diabetes. The objectives of this study are to assess the Maximum Voluntary Ventilation (which is a measure of the mechanical factors of breathing) in patients with type I diabetes mellitus and its relation to the duration of diabetes. Patients and methods: 36 patients with a known history of type I DM (26 male, 10 female) with an average age between 16-42 years were enrolled in this study with 38 sex and age matched healthy individuals as a control group. The MVV test was performed in both groups for at least 3 times to ensure reproducibility. The study group was subdivided according to the duration of diabetes into group1 for those < 5 years duration (13 patients), group2 for those between 5-10 years (11 patients) and group 3 for those > 10 years duration (12 patients). Results: mean values of direct Maximal Voluntary Ventilation test was reduced in diabetic patients compared to their matched controls in all study groups but it was most obvious in group 2 and 3 as duration of diabetes increase Conclusion: in patients with type I DM there is impaired mechanical factors of breathing manifested by increase in airway resistance, reduced compliances or respiratory muscle force as indicated by reduction in the mean values of direct Maximal Voluntary Ventilation test relative to their matched controls.

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Article
Langerhans’ cell Histiocytosis of Temporal Bone -Case Report-

Authors: Nadhim Omran Khadhim*,
Pages: 1689-1693
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A 3 year old child presented with a history of progressive abdominal distention associated with low grade fever and discharging left ear for the last 6 months. He was diagnosed as a case of chronic suppurative otitis media. He was not responding to the medical treatment. He then developed left post-auricular soft not tender swelling with aural granulation tissue and hepatosplenomegaly. Clinical and histological examination confirmed the diagnosis of Langerhans’ cell histiocytosis. His condition responded very well to steroids and chemotherapy. This case report to highlight this condition as a possible cause of chronic suppurative otitis media and requires imaging and histological examinations for definitive diagnosis and appropriate treatment. Key words: Langerhans cell histiocytosis (LCH), temporal bone, chronic suppurative otitis media, hepatosplenomegaly. Complete Blood Picture (CBP)


Article
Thyroid Function Tests in Patient with Ischemic Stroke

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bjectives: To analyze thyroid functions tests in patients with ischemic stroke at acute stage and to study the association between ischemic stroke and different types of thyroid dysfunctions. Methods: A hospital based, cross-sectional, case-control study with trial to cancel the role of age, gender, hypertension and diabetes mellitus as confounding factors was adopted to achieve the aim of this study. A total number of 210 cases (105 as patients group presented with ischemic stroke and another 105 case as control group not suffering from ischemic stroke) were examined for TSH, T4 and T3. The period of data collection was from Jan. 2011 to the end of Jan. 2012. The patients were collected from the wards of neurology while the control group were collected from the out patients clinic, of Baghdad Teaching Hospital, Baghdad, Iraq. Ischemic stroke was confirmed by their clinical picture and native brain CT scan. Exclusion and inclusion criteria, definition of variables and the consents from all patients were fulfilled. Results: 8.6% of ischemic stroke patients showed hypothyroid pattern, 8.6% hyperthyroid pattern and 3.8% sick euthyroid pattern and these results were statistically significant as compared with control cases. 7.6% of patients had atrial fibrillation (AF) statistically of significant difference. Most cases of AF registered among patients with hyperthyroidism 60%. 12.7% of patients with hypothyroid pattern had statistically significant obesity and 8% of patients with sick euthyroid pattern had diabetes which was also significant. Conclusions: Both hyperthyroidism and hypothyroidism might be considered as risk factors for developing ischemic stroke. Atrial Fibrillation may be a predictor for developing ischemic stroke especially in patients with hyperthyroidism. In hypothyroidism, there may be an association of several atherosclerotic risk factors with ischemic stroke. Sick euthyroid is not uncommon in patients with ischemic stroke which reflect the increase in physical stress associated with the insult.


Article
Immunofluorescence and the Spectrum of Glomerular Diseases in Iraq (Single Center Study)

Authors: Heider S Abood --- Lina W. Assad --- Riyadh M.Al-Saegh
Pages: 1703-1719
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objective: Immunofluorescent microscopy is an important tool for the diagnosis of glomerular diseases. In this study, we focused on using IF technique together with light microscopy and clinical features in the diagnosis of different types of glomerulonephritis. Spectrum of glomerular disease in Iraq is to be studied and compared with other studies in Iraq and other countries. Methods: A total of 58 kidney biopsies were taken for routine LM, while IF technique was done in 56 of them. The study started from 1st of June 2010 to the 1st of June 2012. Results: Focal segmental glomerulosclerosis (17/58=29.3%) topped the list followed by minimal change disease(12/58=20.7%).Immune deposition was observed in (21/56=37.5%) cases and the predominant deposit was immunoglobulin G(20/56=35.7%).The pattern of deposition was granular in most of the cases either in the glomerular basement membrane and/or in the mesangium except one case where immunoflourecent microscopy showed dominant positive staining (3+) for complement factor 1q in the glomerular mesangium and slightly positive staining for complement factor 3 in the same mesangeal areas.(Tow/58=3.4%) cases fulfilled the clinical, serological and histopathological criteria of lupus nephritis . Conclusion: To obtain a correct diagnosis of glomerulonephritis, we require immunofourescent in parallel with light microscopic examination of renal biopsies and correlation with clinical features, biochemical and serological markers. Clinically, the majority of patients presented as nephrotic syndrome (44/58=75.9%). Key words: Immunofluorescence,glomerular disease.


Article
The Effect of Hyperthyroidism on Refractive Errors and Visual Acuity

Authors: Ali Noaman Al-Ibadi --- Saba D. Ahmed --- Muna F. Abbas
Pages: 1720-1725
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Hyperthyroidism is a condition in which there is over production of thyroid hormones, abnormal antibodies that attack the thyroid gland causes it to become over active. Abnormal antibodies may cause swelling and inflammation of the soft tissue around the eyes and the muscles that move the eyes and the eyelids. Aim of the study: The aim of the study was to find the effect of hyperthyroidism on the vision and development of refractive errors in patient with hyperthyroidism Results: It was found that the usual age of onset of hyperthyroidism was between 30 and 50 years with the females’ preponderance. Myopia showed in high percentage within the age 40-50 and >50 years (61.1%), (68.0%) respectively. While hypermetropia was seen more in age <40 (28.9%) and hyperthyroidism has a bad effect on the visual acuity. Conclusion: Myopia was seen more in older age group while hypermetropia seen in younger age group. Hyperthyroidism has a bad effect on the visual acuity.

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Table of content: volume:6 issue:2