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: 2014 volume:13 issue:1

Article
Colonoscopy at the National Center for Early Detection of Cancer: Evaluating Indications and Diagnostic Yield

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ABSTRACT: BACKGROUND: Colonoscopic procedure is an accepted modality for the evaluation of colonic disease and an accurate procedure in the workup and screening of patients with lower gastrointestinal symptoms. The clinical spectrum and diagnostic yield depend upon the indications for the procedure. OBJECTIVE: To identify the yield of the major indications for the procedure, and the pattern of colon pathology in study population. Study design and Setting: A retrospective study was conducted over a period of 6 months extending From 18th November 2011 to 18th May 2012 at the National Center for Early Detection of Cancer by reviewing the records of 224 colonoscopy examinations which were done in the center between January 2010 and December 2012. RESULTS: The patients comprised 66 females (29.4%) and 158 males (70.6%) and their mean ages was (46.6) years. There were 114 patients (50.9%) who were aged less than 50 years. Complete examination to the caecum was possible in 114 cases (50.9%). Pathological findings were identified in 127patients (56.7%). The diagnostic yield of patients referred for lower abdominal pain and alternation in bowel habit was low, of (29.72%) and (46.66%), respectively. The yield was high for those with lower gastrointestinal bleeding (71.15%), diarrhea (61.9%), category 'others' (65%). The diagnostic pattern showed that non-specific colitis and double colonic lesions were identified in (29.13%), and (16.53%) respectively. Colonic cancer was diagnosed in 19patients (14.96%), ulcerative colitis in 9patients (7.08%), polyps were detected in13patients (10.23%), and internal hemorrhoids in17patients (13.38%). CONCLUSION: The highest diagnostic yield of colonoscopy procedure was for lower gastrointestinal bleeding and diarrhea and the main pattern of colonic pathology was nonspecific colitis and double colonic lesions.


Article
Evaluation of Direct Trocar Insertion Technique at Laparoscopic Surgery

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ABSTRACT: BACKGROUND: Commonly we utilize veress needle in laparoscopic surgery as usual to start with introduction of pneumoperitoneum in the abdomen (classic pneumoperitoneum], but there are alternatives to it for better and fast work even in obese patients. OBJECTIVE: The purpose of this study is to compare direct trocar (DT) to Veress needle (VN) entry for tie creation of pneumoperitoneum during laparoscopy with regard to the duration of the procedure (trocar and Veress placement time), volume of gas used, ease of performance, and frequency of complications through a randomized clinical study in Al-Karama hospital and some other private Baghdad hospitals. PATIENTS AND METHODS: 60 patients scheduled to undergo diagnostic and therapeutic laparoscopy (general surgery and gynecology cases), 45 cases divided into DT (group A = 25) and VN (group B = 20), the other 15 cases were obese patients BMI>30, subdivided into two subgroups (1, 2) submitted for the study, they were randomly allocated to either DT or VN entry for pneumoperitoneum. The laparoscopic procedures performed by the same surgeon. RESULTS: The trocar and Veress placement time, volume of gas consumption, ease of performance and frequency of complications were analyzed. The mean trocar and Veress placement time was significantly shorter in group A and subgroup 1 than in group B and subgroup 2. The mean gas consumption was significantly less in group A (2-3Iiters) and subgroup 1 than in group B and subgroup 2 (4-6 liters). No major complications (bowel, vessels injury) in both groups were encountered. Minor complications (failure pneumoperitoneum) were significantly less in group A and subgroup 1 than in group B and subgroup 2. CONCLUSION: DT entry is a safe alternative to the VN entry technique for the creation of pneumoperitoneum. This approach has further advantages with less cost and instrumentation along with rapid creation of pneumoperitoneum even in obese patients. .


Article
CT-guided Drainage of Pelvic Collection Following Acute Appendicitis: Technical Success and Possible Complications

Authors: Mohammed Abd Kadhim
Pages: 12-17
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ABSTRACT: BACKGROUND: Acute appendicitis is a common clinical problem with an incidence of approximately 1 case per 1,000 persons per year. Perforation is a common complication of appendiceal inflammation, with an overall incidence of approximately 30% in pediatric populations and as high as 66% in children younger than 5 years and up to 100% in 1-year-olds. Computed tomography (CT)-guided abscess drainage has also been shown to provide definitive treatment for 70–90% of abdominal abscesses OBJECTIVE: The aims were to report the role of CT-guided drainage of pelvic collection following acute appendicitis, technical success and possible complications. PATIENTS AND METHODS: A prospective study was done in Al-Kadhimyia teaching hospital,between March 2009 and November 2012. The study included 48 consecutive patients with pelvic abscess following appendicectomy for acute appendicitis. Age range was 10–58 years; 26 male, 12 female. All patients underwent sonography and contrast-enhanced abdominal CT was performed to confirm the diagnosis. CT guided drainage with a pigtail multi-sidehole catheter of 12 – 14 French was done. Post-drainage scans were obtained to assess the position of the catheter and to exclude early complications (e.g., hematoma). Catheters were flushed with 10-15 ml of 0.9% sterile saline every 8 hr. to maintain patency. The decision for catheter removal was based on the following criteria: clinical improvement (normal body temperature and white blood cell (WBC) count, no clinical symptoms), drainage output of 10 mL/d or less, and ultrasound findings of complete resolution of the target fluid collection. RESULTS: The study included 48 patients. The depth of the collections was ranged from 4-8cm (mean of 6cm). Of the 48 patients, 40 had single drainage procedure, and 8 returned for a second procedure. The (8/48) necessitated a second drainage procedure (5cases of catheter displacement and 3 cases of catheter obstruction). Treatment failure was seen in 3/48 (6.25%) patients and were treated with surgical drainage. Clinical success of the procedures was (93.75%). The volume of fluid drained ranged from 200 ml to 4,500 ml (mean 440 ml). Fluid culture reveals Escherichia coli in 27%, and Enterococcus spp in 15% and polymicrobial in 58% of cases. hospital stay was 13±6.4 days (8–28 days), while those who underwent two procedures had an average stay of 20.2±6.5 days. No catheter-related wound sepsis was noted at the time of discharge or follow-up, and no catheter tract failed to close spontaneously. CONCLUSION: CT _guided drainage of pelvic abscess following acute appendicitis is an effective method of treatment with no catheter-related wound sepsis and no major periprocedural complications.


Article
Direct Primary Trocar Insertion without Prior Pneumoperitoneum is a Safe, Feasible and Quick Laparoscopic Entry Technique

Authors: Jawad Kadhim S. Al-Dhahiry
Pages: 18-24
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ABSTRACT: BACKGROUND : In laparoscopic surgery, the primary (first) trocar entry is of a great importance because of it’s association with serious complications such as visceral and vascular injuries. There are several techniques for laparoscopic entry, the commonly used ones are Veress Needle (closed) and Hasson’s ( open ) techniqes. Recently, the Direct Primary Trocar Insertion (DPTI ) without prior pneumoperitoneum was reported as safe alternative laparoscopic entry technique . OBJECTIVE: This study assesses the safety ,feasibility ,complications and time of DPTI without a prior pneumoperitoneum in laparoscopic surgery. PATIENTS METHODS: This is a prospective study included 219 patients ,196 females ( 89.5 %) and 23 males (10.5 %), prepared for different laparoscopic procedures using only DPTI .Open laparoscopic entry ( Hasson’s technique ) was reserved for patients with associated small umbilical hernias or previous mid-line lapararotomy.Veress Needle ( VN ) and other methods of laparoscopic entry were not used.This study was performed in AL-Karama Teaching Hospital/ College of Medicine / Wasit University,IRAQ from April 2011 till July 2013 .Recorded data were : age,sex, indications for laparoscopic surgery,time of DPTI , laparoscopic entry related complications, conversion to laparotomy , length of hospital stay and the mortality. RESULTS AND DISCUSSION: DPTI technique was feasible in 208 patients (95%) while open laparoscopy was reserved for the remaining 11(5 %) patients . Conversion to laparotomy was done for 12 patients (5.47 %) . This study has no major complications nor deaths . Immediate minor complications occurred in 7 patients (3.2%).Late minor complications occurred in 6 patients(2.7 %).Time of DPTI was 1.80 ± 0.64 SD minutes, P-value= 0.01 . The follow-up period ranged from 2- 27 months . CONCLUSION: DPTI entry is a safe alternative to the Veress Needle and other techniques of laparoscopic entry and creation of pneumoperitoneum. It has shorter laparoscopic entry time than the other laparoscopic entry techniques.


Article
Comparison Between Endoscopic Band Ligation and Sclerotherapy in Management of Upper Gastro-Intestinal Hemorrhage Due to Esophageal Varices

Authors: Ahmed Hamid Jasim --- Akram Ajeel Najeeb
Pages: 25-28
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ABSTRACT: BACKGROUND: Upper gastrointestinal bleeding is serious complication of portal hypertension which can be treated by different medical and surgical methods with possibility of failure, re-bleeding and death. OBJECTIVE: To evaluate the efficacy of band ligation and Sclerotherapy in controlling initial bleeding, failure of control (during first 24 hours) and re-bleeding within 5 days. PATIENTS AND METHODS: this prospective study was conducted at Gastroenterology and Hepatology Teaching Hospital in Medical city complex in Baghdad from the 1st of January 2010 to the 1st of March 2012. The study engaged 100 consecutive patients who were divided equally into two groups (50 patients each), first group were treated with banding procedure while patients in second group were treated with sclerotherapy and both groups were followed up for 5 days. RESULTS: Neither failure to control bleeding (during first 24 hours) nor death occurred in both groups. Successfulness (no re-bleeding within 5 days) was more common in Band ligation group (94%) rather than sclerotherapy group (90%). On the other hand, 8 patients in both groups all were child-pugh C developed re-bleeding, 3 patients (6%) in Band group and 5 patients (10%) in sclerotherapy group and need second session which was successful in all patients in both procedures , comparison statistically was significant and Band procedure was better than Sclerotherapy procedure, (P. value=0.029) . CONCLUSION: Endoscopic Band ligation is more effective than Sclerotherapy in controlling initial attacks of esophageal varices bleeding and decreasing recurrent attacks of bleeding. KEYWORDS: upper gastro-intestinal bleeding, esophageal varices, liver cirrhosis, portal hypertension.


Article
Performance of Ultrasound as a Second Line Test to Serum Ca125 in Ovarian Cancer Screening in Postmenopausal Women

Authors: Nada Salih Amin --- Asmaa Mohammed Abid
Pages: 29-36
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ABSTRACT: BACKGROUND: Epithelial ovarian cancer is uncommon before 40 years of age but the incidence then rises steeply until the mid sixth and seventh decades for which performance of transvaginal ultrasonography as a screening test for ovarian cancer in asymptomatic postmenopausal women with an elevated serum CA 125 had been performed. OBJECTIVE: Prospective ovarian cancer screening trial had been performed to estimate sensitivity, specifity and positive predictive value of different ultrasound criteria for detection of index cancer (e.g. primary invasive epithelial carcinoma of ovary) in postmenopausal women. PATIENTS AND METHODS: This study was carried out at the department of obstetrics and gynecology in AL-Yarmouk Teaching Hospital from October 2002 through October2003.The study included 110 Postmenopausal women ≥ 45 years, they underwent measurement of serum CA125.Women with CA 125 of 30 IU/ml (or more) were recalled for an ultrasound examination. RESULTS: Of the 110 women included in this study, 9 women underwent 30 scans during a follow up of one year. The sensitivity for detection of ovarian cancer of different ultrasound criteria was 100% for abnormal ovarian morphology, 100% for abnormal ovarian volume and 50% for complex abnormal ovarian morphology. The highest specificity (100%) and positive predictive value (100 %) was achieved by using complex abnormal ovarian morphology. CONCLUSION: A variety of ultrasound criteria had achieved high sensitivity, specificity and positive predictive value for ovarian cancer screening in postmenopausal women with an elevated CA 125. Ovarian morphology and ovarian volume used to interpret ultrasound had achieved increased sensitivity for ovarian cancer screening. While complex abnormal ovarian morphology had achieved increased in the specificity and the positive predictive value for ovarian cancer screening. KEYWORDS: ovarian cancer, CA125, transvaginal ultrasound.


Article
Severe Early– Onset Preeclampsia: Prognostic Role of Uterine Artery Doppler Examination

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ABSTRACT: BACKGROUND: Preeclampsia is essentially an endothelial disease. Early- onset preeclampsia appears to be linked mainly to a failed placental vascular remodeling. Uterine artery Doppler is a validated noninvasive surrogate of trophoblastic invasion and placental perfusion. OBJECTIVE: To evaluate the predictive capacity of uterine artery Doppler investigation for maternal and neonatal complications in women with severe early- onset preeclampsia. METHODS: This prospective comparative study was carried out on sixty-five Iraqi pregnant women with severe early-onset preeclampsia. Their gestational age ranged from 28-34 weeks of gestation. A uterine artery Doppler examination was performed on admission to the participants. According to the result of Doppler ultrasound, they were arranged into two main groups: group one comprising twenty-nine patients with normal uterine artery Doppler results, and group two comprising thirty-six patients with abnormal uterine artery Doppler results. The maternal and neonatal outcome of women with abnormal uterine Doppler results was compared to those with normal Doppler results, and then results were analyzed accordingly. RESULTS: Sixty-five patients were enrolled in this study. In 53% of them, uterine artery Doppler results were abnormal. This group showed statistically significant lower birth weight (p = 0.003), higher caesarean section rate (p= 0.014), abnormal umbilical artery Doppler examinations (p=0.0001) and higher neonatal complications rate (P= 0.006). Regarding the maternal complications (HELLP syndrome, neurological manifestations, acute renal failure and pulmonary oedema), occurred at higher rate in the group with abnormal uterine artery Doppler compared with those having normal Doppler results (58.3% versus 37.9%), but only acute renal failure reached the statistical level of significance (P=0.017). CONCLUSION: Women with severe early-onset preeclampsia are at higher risk of maternal and neonatal complications if abnormal uterine blood flow is present. .


Article
National Biochemical Reference Ranges for Adult's Age Group

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ABSTRACT: BACKGROUND: Reference range basically originates in what is most prevalent in a reference group taken from the healthy population. It is a basis for a physician or other health professional to interpret a set of results for a particular patient. In our country it's preferable to redistribute a normal list of values instead of the old one, taking into consideration a specific reference ranges for population with any factor that may affects their measurement as, climate, type of food, and race. It should comprise both sexes; all age groups and between which 95% of values of a reference group fall into after enrollment of the inclusion/exclusion criteria. OBJECTIVE: To establish a reference ranges of some biochemical parameters for healthy adults' population. METHODS: one thousand healthy individual (aged 20-40 year), with 450 male and 550 female, selected from Baghdad city, from AL-Mammon University College and Ministry of Health, were recruited for the study between march.2011-april.2012 after they were subjected to an inclusion/exclusion criteria, reference ranges of some biochemical parameters was constructed by using the parametric methods to estimate 2.5 and 97.5 percentiles of distribution. RESULTS: Specific ranges for some biochemical parameters shows somewhat a little bit difference in comparison to their counterparts from other countries. Moreover it was clearly noticed that the present dependent-format missed many important parameters as (HDL-Cholesterol), (LDL-Cholesterol) in addition to missing sex and age difference. Results also shows statistically significant higher values in female than male for (HDL-Cholesterol) (p=0.000), (Total Protein) (p=0.000), and lower values in females than male for (Uric Acid) (p=0.000), (CREAT) (p=0.000), (Blood Urea) (p=0.000). CONCLUSION: There is a need for the national clinical chemistry laboratory to establish its own ranges for both sexes to all age groups, and to redistributes them in a new format. .


Article
Comprative Study between LAT and Elisa in Detection of Toxoplasmosis in Groups of Women

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ABSTRACT: BACKGROUND: Toxoplasmosis is a zoonotic disease caused by the parasitic protozoan Toxoplasma gondii . This parasite is an obligate intracellular organism and is found in two forms in humans. widespread throughout the world, approximately half a billion humans have antibody to T. gondii. OBJECTIVE: This study aimed to compare the efficiency of two methods in diagnosis of toxoplasmposis in pregnant and non-pregnant women. METHODS: Blood samples were collected from 350 (15-46 year-old, 100 pregnant and 250 non-pregnant) females. Two serological methods were used: Latex agglutination test (LAT) and Enzyme linked immune-sorbent assay for IgM detection (ELISA). RESULTS: The study showed that 38.86% of women had given positive results for LAT, of which 31 were pregnant and 105 were non-pregnant, while only 14.28% of the total subjects had given positive results for ELISA. CONCLUSION: These results indicate that positive sera for LAT should be further investigate by more reliable method in order to confirm the infection with toxoplasmosis.


Article
Study of Some Miswak (Salvadora persica L) Components and Effect of Their Aqueous Extract on Antioxidant

Authors: Mustafa Taha Mohammed
Pages: 55-60
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ABSTRACT: BACKGROUND: Oxidative stress defines that, the level of Reactive Oxygen Species (ROS) exists in excess of antioxidant defenses. This imbalance in the redox milieu results in a switch from ROS-stimulated ambient signaling processes to ROS-mediated pathophysiological consequences. Oxidative stress has been implicated in the installation and progression of several degenerative diseases via DNA mutation, protein oxidation and/or lipid peroxidation. Therefore, possible use aqueous extracts of Miswak to protect brain against the Lipid peroxidation. OBJECTIVE: The present study was undertaken to evaluate the potential of Salvadora persica L. (miswak) against the DPPH Free Radical Scavenging System and Lipid peroxidation. METHODS: The chemical components of the prepared aqueous extracts of Miswak were detected as: glycosides, alkaloids, saponins, phenolic compounds, tannins, flavonoids , proteins ,steroids and Vitamine C. and then estimate DPPH Free Radical Scavenging System and Lipid peroxidation RESULTS: The study showed that the Miswak ( Salvadora persica L.) in the aqueous extracts contain : glycosides , proteins, saponins ,tannins ,phenolic compounds, flavonoids , alkaloids , steroids and vitamine C . Aqueas extracts were found effective in scavenging DPPH(62.45℅) in concentration (250µl/ml), as well as inhibiting the lipid peroxidation (42.04℅). CONCLUSION: Our results suggest that Miswak ( Salvadora persica L.) treatment protects the rat brain against lipid peroxidation and DPPH free radical scavenging. .


Article
Effect of Hypertension on Aortic Root Size and Prevalence of Aortic Regurgitation

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ABSTRACT: BACKGROUND: Although early reports suggested that hypertension predisposed to aortic root enlargement and consequent aortic regurgitation, more recent pathological and M-mode echocardiographic studies have not found an association between hypertension and aortic root enlargement when age is considered. OBJECTIVE: The aim of this study is to asses the effect of hypertension on aortic root size and to estimate the prevalence of aortic regurgitation. METHODS: measurement of two-dimensional echocardiographic diameters of the aortic root at four locations and compared findings with resting blood pressures and measures of body BMI in 110 normotensive and 110 hypertensive men and women matched for age and sex.Colour and continuous wave Doppler study are used to diagnose and assess severity of aortic regurgitation. RESULTS: Aortic diameters at the anulus (2.40±0.29 versus 2.33±0.24 cm, P=.06) and sinuses (3.45±0.43 versus 3.35±0.35cm, P=.08) were marginally higher, whereas diameters at the supra-aortic ridge (2.93±0.39versus 2.73±0.33cm, P<.01) and ascending aorta (3.27±0.44versus 3.12±0.31 cm, P<.01) were significantly increased in hypertensive subjects. Aortic diameters increased with increasing quartiles of diastolic and systolic pressures, particularly at the supra-aortic ridge and ascending aorta. In multivariate analyses, blood pressure remained an independent determinant of distal aortic diameters after body size and age were considered. Aortic regurgitation was seen in 6 normotensive and 8 hypertensive subjects and did not differ in severity. CONCLUSION: Hypertension is associated with a slight increase in aortic root size, most notably of the supra-aortic ridge and proximal ascending aorta. Although dilatation at the commissural attachment might be expected to predispose to an increase in aortic regurgitation, we did not detect such a difference in this population of, asymptomatic hypertensive individuals.


Article
Relationship Between Tei index and Left Ventricular Geometric Patterns in Hypertensive Patients

Authors: Talib Hashim Salim --- Basil Najeeb Saeed
Pages: 70-74
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ABSTRACT: BACKGROUND : Various left ventricular geometric patterns occur in hypertension and may affect the cardiovascular risk profile of hypertensive subjects. Tei index is a combined index of systolic and diastolic functions and has been shown to be a predictor of cardiovascular outcome in heart diseases. OBJECTIVE: The aim of this study was to investigate the relationship between Tei index and left ventricular (LV) geometry in hypertensive patients. METHODS : Two dimensional-guided M-mode echocardiography and Doppler study were performed in 122 hypertensive patients and 67 control subjects. This study was conducted at Baghdad Medical City / Teaching Hospital and Alshahed Mohammed B. Alhakem Hospital in Alshulla city . According to the value of relative wall thickness (RWT) and left ventricular mass index (LVMI), hypertensive patients were subdivided into four geometric patterns. The Tei index was obtained from the summation of isovolumic relaxation time (IVRT) and isovolumic contraction time (IVCT), divided by the ejection time. Statistical analysis was done using SPSS 17.0. RESULTS: This study showed that the Tei index was significantly higher among the hypertensive patients with concentric hypertrophy(CH), eccentric hypertrophy(EH), concentric remodeling and normal geometry compared with the control group(0.81±1.1, 0.78±0.3, 0.69±0.3, 0.59±0.5 respectively). Tei index was correlated to the left ventricular ejection fraction (LVEF), left ventricular fractional shortening(LVFS), mitral E/A ratio, heart rate(HR), LVMI and RWT. CONCLUSION: The Tei index are impaired in all subgroups of hypertensive patients according to their LV geometry compared to control group. This impairment is more advanced in patients with concentric and eccentric hypertrophy. .


Article
The Predictive Value of Intima-Media Thickness of the Common Carotid Artery in the Prevention of Stroke

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ABSTRACT: BACKGROUND: Non invasive measurement of intime-media thickness(IMT) of the common carotid artery by high resolution ultrasonography and its importance in stroke patient. OBJECTIVE: The study was designed to study this relation in our locality. PATIENTS AND METHODS: Thirty patients with ischemic stroke that were admitted in the medical department of Al Yarmook teaching hospital were tested by the aid of echocardiography department to measure intima-media thickness of the common carotid artery and they were compared with 20 persons(matching age and sex) without history of stroke or transient ischemic attack. RESULTS: The mean of IMT of common carotid artery in stroke pateints was 1.24mm while in control group the mean was 0.765 mm. CONCLUSION: There is a significant relation between the increased IMT of common carotid artery and stroke.


Article
Uric Acid and Endothelial Dysfunction in Essential Hypertension

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ABSTRACT: BACKGROUND: Uric acid can stimulate the synthesis of c-reactive protein, and that might be one of the mechanisms underlying the endothelial dysfunction. Several studies showed an independent link between UA and CRP suggest that chronic exposure to mild hyperuricemia may be a factor that contributes to micro inflammation and raised CRP in individual the essential hypertension. OBJECTIVE: To investigate the relationship between the serum uric acid, C-RP , total cholesterol and endothelial dysfunction in patient with essential hypertension. PATIENTS AND METHODS: Twenty patients with essential hypertension and fifteen apparently healthy subjects matched for age and weight have been included in this study,uric acid and total cholestrol were determined by enzymatic methods, high sensitivity C-reactive protein (HsCRP) enzyme immunoassyfor the quantitative determination in human serum was used. RESULTS: The data obtained showed that the serum levels of uric acid, C-Reactive protein and total cholesterol were significantly higher in patients with Hypertension than in healthy controls. CONCLUSION: The conclusion was that hyperuricemia in individuals with essential hypertension is associated with endothelial dysfunction.the hypothesis that uric acid plays a significant role in this alteration in humans.


Article
Plague Epidemic in Sumerian Empire, Mesopotamia, 4000 years ago

Authors: Amjad Daoud Niazi
Pages: 85-90
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ABSTRACT: This research work concerns the realization and verification that an epidemic of plague had in reality occurred 4000 years ago in Sumer , present day Iraq, that affected the population in a catastrophic way and had lead to the decline and fall of the Sumerian Empire . This important conclusion came after verifying the translations and transliterations of thousands of clay tablets which was made available by scholars and international academic agencies . Of course there was no mention clearly of the disease as we know now but there was a clear description of various aspects of the disease including signs and symptoms, epidemic occurrence and effects on the people and propagation through place over time which may have reached a pandemic proportions . It was concluded that such an epidemic could be the main factor in the declining of the Sumerian Empire. The epidemic itself could be a ring in the chain of plague epidemics propagated through place in history and known nowadays as the black death,


Article
Hemodynamic Effects of Muscle Relaxants a Comparative Study between Pancuronium and Vecuronium

Authors: Hassan Sarhan Haider --- Rafal Rajab Hasan
Pages: 91-98
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ABSTRACT: BACKGROUND: The cardiac effects of equipotent doses of pancuronium and vecuronium were compared in 50 patients, anaesthetized with thiopentone and maintenance with halothane. Heart rate and arterial pressure were recorded from simultaneous tracings of ECG and pulse oximeter and automatic noninvasive monitor respectively. Pancuronium (0.08 mg/kg) caused a significant increase in heart rate and significant changes in arterial pressure.The equipotent dose of vecuronium (0.05 mg/kg) caused no significant changes in heart rate and arterial pressure. OBJECTIVE: The study was designed to determine the comparison between Pancuronium Bromide &Vecuronium Bromide according to cardiovascular effects in young adult patients undergo different variety of surgical operation under general anaesthesia. METHODS : Fifty adult patients (ASA class I and II ) were allocated to 2 subgroups: Group A (n=25) received pancuronium bromide 0.08mg/Kg Group B (n=25)received vecuronium bromide 0.05mg/Kg Anaesthesia was induced with Fentanyl (1μg/Kg), Sodium thiopentone (4-6mg/Kg) and maintained with Halothane 1% in Oxygen.The neuromuscular blocking agents were given and after 2-3 minutes tracheal intubation was performed with ease in all patients. Heart rate and mean arterial pressure were recorded every10minutes in all patients for40 minutes. RESULT: There was significant differences in mean heart rate and mean arterial blood pressure in group A (p<0.05). There was no significant differences in mean heart rate and mean blood pressure in group B (p<0.05). CONCLUSION: From this study, it can be concluded that: 1- The use of pancuronium as a muscle relaxant cause significant increase in heart rate and mean blood pressure in anaesthetized patients. 2- The use of vecuronium as a muscle relaxant cause insignificant changes in heart rate and mean blood pressure in anaesthetized patients that lead us to prefer vecuronium on pancuronium for hemodynamic stability.


Article
Remifentanyl Infusion Intraoperatively Decreased the Total Dose of Atracurium Required for Recipient in Renal Transplant Surgery

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ABSTRACT: BACKGROUND: Renal failure is a disease characterized by loss of renal function and it affects all body systems. Anasthesia for renal transplant recipient needs skill and care to manage the abnormal systemic presentation of patient. Anesthetic plan is affected by renal failure and effects appear by anesthetic drugs choices, doses, and combination. This Anasthetic plan also affected by the cause of renal failure, drugs therapy, dialysis, and duration of disease. OBJECTIVE: To assess the effect of remifentanyl infusion on total dose of atracurium required during renal transplant surgery. METHOD: Between 1stJanuary-2011 to 1st February-2013, in renal transplant center, medical city-Baghdad-Iraq, and hundred patients had renal transplant. All patients had received midazolam (0.05Mcg/kg), fentanyl (1Mcg/kg), propofol sleeping dose (1-1.5mg/kg) and atracurium (0.6mg/kg) then intubated. Fifty patients were maintained with isoflurane (0.5-1 MAC), boluses of atracurium. Other fifty had same maintenance with addition of remifentanyl infusion using infusion pump in dose of (0.05-0.1Mcg). RESULT: Group with remifentanyl needed less dose of atracurium than group without remifentanyl. Mean dose for group with remifentanyl was (1.255mg/kg) while for group without remifentanyl was (1.623mg/kg). Mean time for surgery in both groups was approximately equal, in group with remifentanyl time was (172.16min), and other group was (174.16min). CONCLUSION: Remifentanyl infusion decrease the dose of neuromuscular blocking agents required and may abolish it but blood pressure and pulse rate should monitored carefully.


Article
A Comparison of Using Ketamine Versus Combination of Ketamine and Thiopentone in Short Painful Procedures in Pediatrics

Authors: Iyad Abbas Salman --- Saba J. AL-Wardi
Pages: 103-109
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ABSTRACT: BACKGROUND: Short painful procedures in pediatric age group like bone marrow aspiration (BMA) and biopsy taking are day case operations which demand rapid recovery and minimal incidence of postoperative complications. OBJECTIVE: To compare between intra & postoperative complications & the time of stay in the recovery room for pediatrics undergoing short painful procedures under general anesthesia with either "ketamine and thiopental" or "ketamine alone". PATIENTS AND METHOD: THIS IS A PROSPECTIVE RANDOMIZED clinical trial done in Children Welfare Hospital in Medical City, Baghdad, Iraq, from August - November 2010 on 89 children patients who were scheduled for short painful procedures. All patients were allocated randomly into 2 groups: the 1st group (KT) received I.V ketamine 1% (1mg/kg) plus I.V thiopental 1% 3-5 mg/kg (anesthetizing dose) on induction and maintained on intermittent I.V doses of thiopental 1% in case of need. While the 2nd group(K) received I.V ketamine 1% (1.5mg/kg) alone on induction and maintained on intermittent I.V doses of ketamine 1%(0.5mg/kg) in case of need. Any intra or postoperative complications & the duration of recovery for all patients were recorded. RESULTS: It was found that the intraoperative complications (temporary & mild decrease in arterial O2 saturation and its associated breath holding, & cough) occurred more in the KT group, while the occurrence of (mild involuntary movements and verbal responses) occurred more frequently in the K group. The postoperative complications (nausea, vomiting, verbal hallucinations and dizziness) occurred only in the K group. The duration of recovery is more prolonged in the (KT) group. CONCLUSION: The use of combination of thiopentone and ketamine is associated with more mild and temporary intraoperative decreased arterial oxygen saturation, breath holding, and postoperative cough than using ketamine alone, while the use of ketamine alone is associated with more mild involuntary movements and verbal responses, postoperative nausea &/or vomiting, hallucinations, and dizziness. The duration of recovery is prolonged by the use of thiopental. KEY WORDS: ketamine, thiopental, TIVA, pediatrics, day case.


Article
Prevalence of Erosions in Metacarpophalangeal Joints and Proximal Interphalangeal Joints in Rheumatoid Arthritis Patients

Authors: Khudir Z. Mayouf --- Faiq. I. Gorial --- Warda S. Lasso
Pages: 110-114
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ABSTRACT: BACKGROUND: Bone erosion is a central pathophysiological process and an important outcome parameter in rheumatoid arthritis (RA). OBJECTIVE: To assess prevalence of erosions in metacarpophalangeal joints (MCPJs) & proximal interphalangeal joints (PIPJs) in RA using ultrasonography and to evaluate the associates if present. PATIENTS AND METHODS: Ninety two patients with RA diagnosed according to The 1987 American College of Rheumatology (ACR) classification criteria for RA were compared with 158 healthy individuals matched for age and sex. Disease activity score 28 joints (DAS28), erythrocyte sedimentation rate (ESR), C-reactive protein (CRP), and rheumatoid factor (RF) were measured. Ultrasonography was performed using Seimens Elegra with 7.5 MHz linear array transducer by radiologist for MCPJs and PIPJs. RESULTS: Erosions in RA were significantly more than those of controls (44 (47.8%) versus 0(0%) (p = 0.000). Erosions in MCPJs were more than PIPJs and both MCPJs & PIPJs (33(75% ) versus 4(9.1% ) versus 7(15.9%) respectively) (p=0.005). High ESR, positive CRP, and positive RF were significant associates with the erosions (p= 0.008, p= 0.000, p= 0.002 respectively). CONCLUSION: Prevalence of erosions in MCPJs and PIPJs of RA patients was high (47.8%).High ESR, positive CRP, and positive RF were significant associates with erosions.


Article
Reduction Versus Non-Reduction Technique in Low Grade Spondylolisthesis; Functional Outcome

Authors: Mohanned A. Al-Falahi --- Mohammad Saeed --- Sinan Adnan
Pages: 115-121
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ABSTRACT: BACKGROUND: Spondylolisthesis is a condition in which a vertebra slips anteriorly in relation to the vertebra below as a result of pars defect or degenerative disease. The slipped segment produces abnormal positioning of the vertebrae in relation to each other along the spinal column that causing back pain and neurologic deficit. OBJECTIVE: There are debates about surgical maneuvers regarding low grade spondylolisthesis (grades I and II according to Meyerding classification) whether to reduce the slipped segment or not, the aim of this study is to determine the short and long term difference in the functional outcome between these methods. PATIENTS AND METHODS: This randomized prospective study consist of 32 patients aged between 42-63 years old (11 males and 21 females) treated for symptomatic low grade spondylolisthesis between October 2009 to November 2011 and followed up for 24 months. All patients were randomly divided into two groups: Group I (15 patients) underwent surgical reduction of the slipped segment, and Group II (17 patients) who underwent in-situ fusion without reduction. Both groups had the same pre and postoperative management. RESULTS: Early postoperative minor complications including one case in each group had superficial wound infection (6.6% and 5.8% in Group I and II respectively) which was controlled in the hospital, and one case in each group (6.6% and 5.8% in Group I and II respectively) had dural tear intraoperatively that was repaired during the operation; none of patients had CSF leak postoperatively. There were two cases in Group I (13.3%) and one case in Group II (5.8%) had postoperative transient sciatic pain due to nerve irritation. Depending on the Oswestry Disability Index (ODI), there was a significant statistical difference between both groups in the short term (p-value = 0.04), but there was no significant statistical difference in the long term follow up between them (p-value =0.33) regarding the functional outcome. CONCLUSION: Surgical treatment of low grade symptomatic spondylolisthesis usually include neural decompression, fixation and fusion; however reduction of the slipped segment is not necessary for these patients as the ultimate outcome is similar to those who underwent in-situ fusion only.


Article
Identification of Nasal Bone Fracture by Ultrasonography Versus Plain Lateral X-Ray View

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Abstract

ABSTRACT: BACKGROUND: Although a physical examination is regarded as the gold standard for diagnosis of nasal bone fracture, adequate imaging of a nasal fracture is often required because of the legal consequences that can result from the injury's cause. OBJECTIVE: The aim of the present study is to compare the validity of ultrasonography versus plain lateral X-ray view of nasal bone in diagnosing different classes of nasal bone fracture. METHODS: This randomized clinical trial study included 117 patients presented with trauma to nose who consulted Otolaryngology Department at Aljamhory Teaching Hospital, Mosul, Iraq for the period from August 2008 to May 2009. The results of plain lateral X-ray view and ultrasonography of the nasal bone were compared with the clinical findings after oedema has subsided completely which is the gold standard for evaluating the results.Moreover, accuracy rate, sensitivity, specificity, positive predictive and negative predictive values of both plain lateral X-ray view and ultrasonography were calculated. RESULTS: The accuracy rate, sensitivity, specificity, positive predictive and negative predictive values of plain lateral X-ray view in diagnosing nasal bone fracture were 76.6%, 81.8%, 62.5% ,85.7% and 55.5% respectively. Moreover, the accuracy rate, sensitivity, specificity, positive predictive and negative predictive values of utrasonography in diagnosing nasal bone fracture were 96.6%, 97.9%, 90.9% ,97.9% and 90.9% respectively. CONCLUSION: The use of ultrasounography in the diagnosis of different classes of nasal bone fracture was found to be superior to plain lateral X-ray view in accuracy rate, sensitivity, specificity, positive predictive and negative predictive values.


Article

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Abstract

ABSTRACT: BACKGROUND: Tonsillectomy is one of the most commonly performed surgical procedures in otolaryngology. There are several operative methods currently in use, but the superiority of one over another has not been clearly demonstrated. OBJECTIVE: To compare intraoperative efficiency and postoperative recovery between dissection and coblation tonsillectomy. PATIENTS AND METHODS: This prospective clinical study was conducted at Rizgary teaching hospital/ Erbil,and Baghdad private hospitals from 29th November 2011 to 17th July 2012. The study included 100 patients who underwent tonsillectomy, half of them by coblation and the other half by cold dissection technique. Both techniques performed under general anesthesia. Each tonsillectomy technique was assessed intraoperatively for amount of blood loss, and duration of operation. Postoperatively they were assessed for pain, hemorrhage, and day of return to normal activity and normal diet. RESULTS: Duration of operations was significantly shorter for the coblation group versus the dissection group (17.7min vs. 22.3 min, P= 0.000). Intraoperative blood loss was statistically lower for the coblation versus the dissection group (45.3 ml vs. 74.7 ml, P = 0.003) There was statistically significant difference in daily pain scores and return to normal diet and activity between the two groups (mean 5.7 day for coblation vs. 7.32 day for the dissection, P= 0.001). And only two patients (4%) in coblation group developed secondary bleeding. CONCLUSION: Coblation tonsillectomy offers better operative speed, intraoperative hemostasis, less postoperative pain scores and faster recoveries than dissection tonsillectomy especially in pediatric age group.


Article
Prevalence of Color Vision Deficiency among Adult Males from Baghdad Province

Authors: Bassam Musa Sadik Al-Musawi
Pages: 134-139
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Abstract

ABSTRACT: BACKGROUND: Color Vision Deficiency (CVD) is mostly an inherited trait and is not an uncommon problem. Prevalence of CVD differs among different ethnic and geographic properties of the population that affect their genetic constitution. Ishihara plates remain an internationally accepted tool for screening red-green CVD. OBJECTIVE: To determine the prevalence of red-green CVD among adult males from Baghdad province. PATIENTS AND METHODS: One thousand and five (1005) adult males were enrolled in this study, using a systematic sampling technique, and were screened for CVD utilizing 24-plate Ishihara plates and re-tested by EnChroma 39-Color plates. All males were residing in Baghdad and the center of Iraq. RESULTS: Among all tested males, 948 reside in Baghdad province; of them, 64 showed red-green CVD; thus making prevalence rate of 6.75% in Baghdad province. The deutan/protan ratio was 2.79:1. CONCLUSION: Prevalence of CVD among the people of Baghdad lies within the published range for Caucasian males worldwide. Screening children/adult males for CVD from other provinces is recommended.


Article
Intra-Thoracic Stomach Injury

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Abstract

ABSTRACT: This case- report presents a successful operation of a ruptured stomach , herniated through a defect in the diaphragm , due to bullet injury which remained in this position for three years , covered by thick adherent pleura which sealed the stomach

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Table of content: volume:13 issue:1