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IRAQI JOURNALOF COMMUNITY MEDICINE

المجلة العراقية لطب المجتمع

ISSN: 16845382
Publisher: Al-Mustansyriah University
Faculty: Medicine
Language: English

This journal is Open Access

About

Peer reviewed Medical Journal, Issued every four Months, Published by the Iraqi Community Medicine Society and Community Medicine Department Al-Mustansyriah College of Medicine.
The Journal accept original works in the freldi of epidemiology & Communicable non communicable diseases, Primary health care , Social Medicine health administration, health economic, environmental Medicine in addition to basic and clinical sciences.

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jamalrawi58@yahoo.com/gmail.com/hotmail.com
monaalallow@yahoo.com

Table of content: 2014 volume:27 issue:1

Article
Uterine Artery Doppler Blood flow in Cases of Hydatidiform Mole and its Correlation with β-hCG
فحص الدوبلر الملون للشريان الرحمي وعلاقته بهرمون الحمل β-hCG للمريضات المصابات بالحمل العنقودي

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Abstract

Abstract Background: Gestational trophoblastic disease (GTD) is an uncommon complication of pregnancy, worldwide the incidence of GTD varies reportedly between 0.5 & 0.8 cases per 1000 live births. β-hCG has been used as standard tool for monitoring the biological activity of trophoblastic diseases and as a tumour marker. The abundant vascular supply of the tumour makes Colour Doppler Ultrasound a potentially useful tool to study the correlation of tumour’s blood flow and its clinical behaviour. Objective: To study the changes in the Doppler blood flow velocity of the uterine artery, the correlation between resistance indices & β-hCG level before and after evacuation of molar pregnancy as well as the value of Doppler flow in assessing the course of the disease. Patients and Methods: A-longitudinal study was conducted in AL-YARMOUK Teaching Hospital, Department of Obstetrics & Gynaecology, from Jan.2006 through Jan.2007. Twenty five cases of vesicular mole entered the study and were assessed before and after evacuation of the uterus by measuring serum β-hCG level and finding its relation with changes in the blood flow of the uterine artery using Doppler indices namely Systolic/ Diastolic (S/D), Resistance Index (RI), and Pusatility Index (PI). Results: Twenty two out of twenty five cases showed continuous decrease of their β-hCG serum level from pre-evacuation value of 1724.23 + 997.32 IU/L until it reached a value of 74.68 + 43.96 IU/L in the 6th week after evacuation.(P value = 0.0001), The Twenty two cases also showed continuous increase of all Doppler indices from pre-evacuation level to 6th week after evacuation as shown below: S/D pre-evacuation = 2.25 + 0.77 IU/L reached 10.12 + 0.79 IU/L in the 6th week post-evacuation. PI pre-evacuation =0.96 + 0.26 IU/L reached 4.1 + 1.08 IU/L in the 6th week post-evacuation. RI pre-evacuation =0.47 + 0.07 IU/L reached 0.95 + 0.08 IU/L in the 6th week post-evacuation. Two patients showed no consistent decrease of β-hCG serum level with plateuing of all Doppler indices for which Dilatation & Curettage (D&C) revealed Persistent Gestational Trophobastic Disease (PGTD). One patient showed significant increase of β-hCG serum level in the 6th week post-evacuation with drop of all Doppler indices. There was significant correlation (P value < 0.05) between β-hCG serum levels and Doppler indices throughout the course of follow-up: β-hCG & S/D(r) = - 0.778, β-hCG & RI(r) = - 0.581, β-hCG & PI(r) = - 0.483, Conclusion: Finding such a significant correlation between β-hCG serum level and Doppler indices suggest that colour Doppler may be used to predict the course of the disease and define its course. Keywords: Gestational Trophoblastic Disease (GTD), molar pregnancy, β-hCG level, Doppler indices. الخلفية : تعتبر أمراض المشيمة المصاحبة للحمل (GTD) من مظاعفات الحمل غير الشائعة، وتتراوح نسبة الاصابة بها عالميا بين 0.5 و 0.8 لكل1000 ولادة حية. يستخدم تحليل β-hCG كأداة قياسية لمراقبة الفعاليات الحيوية لأمراض المشيمة المصاحبة للحمل (GTD) وكعلامة ورم. يجعل التزود الغزير بالأوعية الدموية في الورم المشيمي فحص السونار الملون ( الدوبلر) أداة مفيدة جدا لدراسة العلاقة بين دفق الدم في الورم والسلوك السريري للورم. الهدف: دراسة التغيرات في سرعة دفق الدم في الشريان الرحمي عند فحص السونار الملون ( الدوبلر) ودراسة العلاقة بين معاملات المقاومة في فحص الدوبلر ومستوى هورمون β-hCG قبل وبعد تفريغ الرحم من الحمل العنقودي وكذلك دراسة قيمة فحص الدوبلر في تقييم مسار المرض. المرضى والطرق:اجريت هذه الدراسة الطولية في مستشفى اليرموك التعليمي/ قسم النسائية والتوليد خلال فترة اثنا عشر شهرا أبتدا من كانون الثاني 2006 وحتى كانون الثاني 2007 . شملت عينة الدراسة 25 حالة حمل عنقودي وتم تقييمها قبل وبعد تفريغ الرحم وذلك بقياس هورمون β-hCG في مصل المرأة المصابة وعلاقته بالتغيرات في دفق الدم في الشريان الرحمي بأستخدام معاملات الدوبلر (S/D، RI، PI) . النتائج:أظهرت الدراسة مايلي : أظهرت 22 حالة من أصل 25 حالة تناقص في مستوى هورمون β-hCG في مصل المرأة المصابة من قيمة ماقبل تفريغ الرحم 1724.23 + 997.32 وحدة دولية / لتر حتى وصولها الى 74.68 + 43.96 وحدة دولية / لتر عند الأسبوع السادس بعد تفريغ الرحم (قيمة P =0.0001 ). أظهرت هذه 22 حالة أيضا تزايد مستمر في كل معاملات الدوبلر قبل تفريغ الرحم ولغاية الأسبوع السادس بعد التفريغ وكما هو مبين أدناه: S/D قبل التفريغ = 2.25 + 0.77 وحدة دولية / لتر وصلت 10.12 + 0.79 وحدة دولية / لتر عند الأسبوع السادس بعد التفريغ. PI قبل التفريغ = 0.96 + 0.26 وحدة دولية / لتر وصلت 4.1 + 1.08 وحدة دولية / لتر عند الأسبوع السادس بعد التفريغ. RI قبل التفريغ = 0.47 + 0.07 وحدة دولية / لتر وصلت 0.95 + 0.08 وحدة دولية / لتر عند الأسبوع السادس بعد التفريغ. أظهرت مريضتان عدم تجانس في هبوط مستوى هورمون β-hCG مع استقرار في كل معاملات الدوبلر وقد اظهر التحليل النسيجي استمرار امراض المشيمة أثناء الحمل (Persistent Gestational Trophoblastic Diseaes) . أظهرت مريضة واحدة فقط أزدياد كبير في مستوى هورمون β-hCG عند الأسبوع السادس بعد التفريغ مع هبوط في كل معاملات الدوبلر. كان هناك علاقة متميزة ( قيمة P أقل من 0.05 ) بين مستوى هورمون β-hCG ومعاملات الدوبلر خلال فترة المتابعة. - 0.778= β-hCG & S/D(r) - 0.581= β-hCG & RI(r) - 0.483= β-hCG & PI(r) ألخاتمه: أيجاد هكذا علاقة متميزة بين مستوى هورمون β-hCG ومعاملات الدوبلر تقترح أن فحص السونار الملون ( الدوبلر) من الممكن أستخدامه للتنبأ بمسار المرض ( الحمل العنقودي ). مفتاح الكلمات: أمراض المشيمة في الحمل (GTD) ، الحمل العنقودي ، مستوى هورمون β-hCG ومعاملات الدوبلر.


Article
Lipid Profile of Controlled and Uncontrolled Diabetics in Erbil, Iraq

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Abstract

ABSTRACT: Background: Diabetes mellitus is a clinical syndrome characterized by hyperglycemia due to absolute or relative deficiency of insulin. This study was carried out to; compare lipid profile between uncontrolled and controlled diabetics, and find out; the prevalence, age and gender distribution of uncontrolled diabetics in a group of diabetic patients in Erbil, Iraq. Methods: A cross-sectional study was conducted between March 1st, 2012 and October 1st, 2012. A convenience sample of 351 diabetic patients attending Erbil Teaching Hospital was taken. The recommended goal for (controlled) HbA1C is ≤ 7%. Venous blood was collected after at least 8 hours fasting for HbA1c, total cholesterol, triglycerides, high-density and low-density lipoprotein cholesterol. Results: The sample included 351 patients (168 males and 183 females); their mean ± SD age was 61.71 ± 9.5 years (ranged from 40 to 79 years) with a male: female ratio of 0.92:1. The mean ± SD ages of controlled and uncontrolled diabetics were 59.91 ±9.95 and 62.90 ±9.02 years, respectively. ). Results revealed that the prevalence of uncontrolled diabetes is 60.1% and it is increased with age (P=0.015), and the prevalence of uncontrolled diabetes in males (65.5%) is significantly higher than (55.2%) that in females (P=0.049). The means ± SD of serum total cholesterol (198.49± 54.79 mg/dl), serum triglycerides, serum LDL-cholesterol of uncontrolled diabetes were significantly higher than that of controlled diabetes (P<0.001, P=0.042, and P=0.004, respectively). Conclusions: More than half of diabetic were uncontrolled and the prevalence of uncontrolled diabetes was higher in males than that in females and it was increased with age. There was significant difference of means of total cholesterol, triglycerides and LDL-cholesterol levels between controlled and uncontrolled diabetic patients. Key words: Uncontrolled Diabetes, HbA1c, Lipid

Keywords

Uncontrolled Diabetes --- HbA1c --- Lipid


Article
Drug Misuse in the Treatment of Diarrhea Among Children Under Five Years; a Sample from Baghdad

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Abstract

Abstract: Background: Diarrhea is a leading cause of childhood morbidity and mortality particularly in developing countries where an estimated five million deaths occur each year in children under five years of age. The unjustified use of medicines to treat simple episodes of diarrhea continues to divert attention, efforts and available resources away from appropriate treatment. Objective: The objective of this study is to figure out the extent of drug misuse in children under five years during an episode of diarrhea. Methods: A cross sectional study conducted in three major health facilities in Baghdad city (Child’s Central Teaching hospital, Children Welfare hospital and Al-Mansour training primary health care center). The data collection was done during the period from February through May 2012). A sample of 400 children (diagnosed by the pediatrician as having acute diarrheal diseases) was collected, with age ranging between (1-60 months) through a consecutive sampling technique. The mothers of children attending the outpatient departments of the health facilities were interviewed through a structured questionnaire that was developed based on relevant literatures. Results: Trimethoprim-sulfamethoxazole (TMP-SMX) was the most antimicrobial used in 39.75% followed by Metronidazole suspension 35.5% and gentamycin injection in 17.5% of the total. Duration of use of antimicrobials was 5 days or less in 73.5%, and more than 5 days in 26.5%. Anti –diarrheal drugs were used in 12.8% and anti emetics in 33.2% of the cases. The results also showed that oral rehydration solution (ORS) and Zinc tablets were not commonly used by the vast majority of mothers; where 15% of them use ORS and only 1.25% use zinc tablet. The prescription of medication was made by pharmacist in 34.5% of cases, nurses (23.75 %), relatives and friends (16%), private clinic doctors (15.5%) and PHCC (10.2%). Conclusion: Misuse of drugs in children with diarrhea is obvious. Illiterates and low educated mothers were more likely to use antimicrobials than highly educated mothers. Pharmacists were the major source of prescribing these drugs followed by nurses, relatives and friends. Key words: Drug misuse, children, diarrhea, Baghdad.

Keywords

Drug misuse --- children --- diarrhea --- Baghdad.


Article
Study the Effect of Sex Hormones in Diabetic Women

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Abstract

Abstract: Objectives: The purpose of our study was to investigate the association of C-peptide and steroid hormones (progesterone and testosterone) and type 2 diabetes in diabetic women under 42 years age. Materials and Methods: Thirty, type 2 diabetic women under 42 years old (35-42) years and 30 non diabetic women as control were investigated in this study, age and sex matched. Sex hormones (progesterone and testosterone) were measured by using minividas (Biomerieux). Also serum C-peptide was measured by using gamma counter (Wallac) and fasting blood sugar by using spectrophotometer. All measurements were done in the National Diabetes Center (NDC) / Al-Mustansiriya University, Baghdad - Iraq. Results: the progesterone, testosterone, FBS and C-peptide of diabetic women were 2.963±1.29 pmol/l, 0.150±300 pmol/l, 132.53±9.69 mg/l and 4.25±1.16 ng/l respectively; while the control healthy women were 2.865±0.988 pmol/l, 0.295±0.196 pmol/l, 87.45±7.53 mg/l and 3.76±0.49 ng/l respectively. Differences between diabetic and control women for the testosterone, FBS and C-peptide were statistically significant and for the progesterone were statistically insignificant. Conclusion: There is a strong association between the sex hormones and type 2 diabetes mellitus. Key words: sex hormones, diabetes

Keywords

sex hormones --- diabetes

Table of content: volume:27 issue:1