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:2

Article
Comparison between the Clinical Assessment, Peripheral Nerve Stimulation (PNS), and Acceleromyography (AMG) to Reverse Neuromuscular Blockade

Authors: Iyad Abbas Salman --- Mortada A. Jubara
Pages: 146-152
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ABSTRACT: BACKGROUND: Traditionally, most of anesthesiologists in Iraq evaluate the degree of neuromuscular blockade during and after anesthesia using clinical criteria alone, which are inaccurate to assess adequate recovery from neuromuscular block (NMB) which is essential for the patient to have full control of pharyngeal and respiratory muscles. Fade cannot be detected reliably with a peripheral nerve stimulator (PNS) at a TOF ratio > 0.4. The time gap between losses of visual fade by using a PNS until objective TOF ratio has returned to > 0.90 can be considered “the potentially unsafe period of recovery.” OBJECTIVE: To compare between assessment of subjective clinical, subjective TOF by peripheral nerve stimulation (PNS), and objective TOF by acceleromyography (AMG) before reversal of neuromuscular blockade PATIENT AND METHOD: A prospective clinical trial of one hundred females who underwent caesarian section under general anesthesia. Standard anesthesia was conducted for all patients. Giving of neuromuscular reversal was decided by the anesthesia care providers depending on clinical criteria, at that time, TOF measured by 2 ways, 1st: counting the twitches visually (principal of PNS), and 2nd: the device showing the TOF reading objectively (principal of AMG). RESULT: Comparisons between subjective criteria and objective AMG T4T1 ratios revealed no statistical significance (P > 0.05) in all comparisons (except that with the moving limb and lift the head). The association and consistency of subjective criteria and visual PNS was insignificant differences in all comparisons. There was wide discrepancy between objective reading and the visual PNS. CONCLUSION: The moving limbs and sustained lift head 5 seconds clinical criteria were correlated to TOF. Other criteria (protruding tongue, respiratory effort, and swallowing reflex) were not correlated to TOF. Objective AMG more sensitive to detect the fourth twitch than the subjective PNS. KEY WORDS: train of four (TOF), peripheral nerve stimulator (PNS).


Article
Serum Interleukin-8 and Hs-C Reactive Protein Determination in Iraqi Multiple Sclerosis Patients: Case Control Study

Authors: Khawla A. A. AL-Sammariey
Pages: 153-155
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ABSTRACT: BACKGROUND: Multiple sclerosis (MS) is an autoimmune disease caused by a complex disorder that cluster many common diseases in children and adults, leading to chronic inflammatory disease of the central nervous system with morphological hallmarks of inflammation, demylination, axonal loss and gliosis .Factors responsible for MS and its progression are still not fully understood, but it has been suggested that both environmental determinants and genetic susceptibility are involved. OBJECTIVE : The aim of this study is to evaluate the role of inflammatory markers ;hs-CRP and IL-8 in pathogenesis of MS and to see the correlation between them. PATIENTS AND METHODS: Twenty one MS Patients (7male,14 female) attending the MS Clinic at Baghdad teaching hospital, their ages range between( 20-32) years (15) age- and sex- matched healthy control participated in the study. Investigations included serum measurements of high sensitive C-reactive protein (hs- CRP) and interleukin-8 in patients and control groups. RESULTS: The result of the present study showed significant increase in both CRP(p<0.001 ) and IL-8 (p< 0.001 ) in the serum of MS patients compared to control. CONCLUSION: There is evidence that neuroinflammatory process due to elevation of CRP and IL-8 has an important role in MS .


Article
EEG Changes in Patients with Migraine

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ABSTRACT: BACKGROUND : migraine is a recurring syndrome of headache, nausea, vomiting, and/or other symptoms of neurological dysfunction in varying admixtures. Migraine, is one of the most common causes of headache, afflicts approximately 15% of women and 6% of men. OBJECTIVE: This study was designed to determine the EEG changes in a sample of migraineurs with their relation to its types. PATIENTS AND METHODS: This cross-sectional study was conducted in the department of neurology of Baghdad teaching hospital from December 2007 to February 2008. A total of 60 migraineurs were taken, aging (10-40) years, diagnosed according to International headache society (IHS) criteria. Patients with history of epilepsy, head injury, brain lesion and recurrent headaches not Compatible with IHS criteria were excluded from the study . EEG was performed, whenever possible, during headache and between attacks of headache. RESULTS: Sixty Iraqi patients with migraine were evaluated. Twenty patients (33.3%) were having migraine with aura (MWA) while 40 patients (66.7%) had migraine without aura (MWOA). Of the sixty studied patients 15 were having electroencephalographic finding. Among patients with MWA, 8 of them have abnormal EEG (40%), while in patients with MWOA, 7 of them have abnormal EEG (17.5%). Slow waves were found in 10 patients (52.64%), sharp waves in 8 (42.10%), and spikes in one patient (5.26%). It has been found that 9 patients (50%) have abnormality in occipital region, 6 of them (33.34%) in frontal region, and 3 of them (16.66%) in temporal region. CONCLUSION: EEG is not useful as a diagnostic tool for migraine, as the EEG changes found in migraine are not specific, they are infrequently associated, and there is no EEG difference between MWA and MWOA. So, clinical criteria are the only way for diagnosis of migraine. KEYWORDS: migraine, headache, EEG

Keywords

KEYWORDS: migraine --- headache --- EEG


Article
Trace Elements Levels and Oral Manifestations in Type 2 Diabetic Patients

Authors: Huda Shakir Ahmed
Pages: 161-164
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ABSTRACT: BACKGROUND: Diabetes mellitus (DM) has been shown to be associated with oral manifestations and abnormalities in the metabolism of micronutrients, especially copper, zinc, and magnesium. OBJECTIVE: To study the oral manifestations in type 2 diabetic patients and to estimate trace elements levels such as copper (Cu), zinc (Zn), and magnesium (Mg) in those patients comparing to control group. PATIENTS AND METHODS: A total of 30 diabetic patients were studied for their oral manifestations and trace elements levels including serum copper, zinc, and magnesium; their age range was (40-55) years and compared with 30 healthy controls. RESULTS: There was a significant decrease in serum Cu, Zn, and Mg in DM patients as compared with their controls, (P < 0.05). Also, several oral complications are seen among diabetics. CONCLUSION: It can be concluded that several oral complications are seen in diabetic patients. The deficiency of some essential trace metals such as Cu, Zn, and Mg may play a role in the development of diabetes.


Article
The Role of anti –DNA Abs. in Chronic Renal Failure in Diabetes Mellitus Type I and Type II

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ABSTRACT: BACKGROUND: Diabetic nephropathy (DN) is the leading cause of CKD and end-stage renal disease (ESRD). CKD is characterized by a progressive loss of renal function, chronic inflammation OBJECTIVE: To compare the relationship between the anti –DNA Abs in diabetic patients type 1 and type 2 and their relation with chronic renal failure. METHODE: The ELISA methods was used to detect the presence of anti-DNA –Abs in sera of diabetic patients with type 1 and type 2 D.M. with CRF. RESULT: The concentration of anti-DNA Abs. were more in type II D.M. patients with CRF than those with type I D.M. without CRF and control group. CONCLUSION: The anti-DNA Abs. play an important role in the CRF in patients with long duration of D.M. type II ,while in patients with short duration of D.M. type I , anti-DNA Abs. do not play a role.


Article
Food Poisoning Outbreak in Tikrit City, Iraq, 2013: Staphylococcus aureus and Salmonella Typhimurium were the Incriminated Pathogens

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ABSTRACT: BACKGROUND: On June, 22nd, 2013, Communicable Disease Control Center (CDCC) in Baghdad notified on an outbreak of Food Poisoning (FP) involving more than 100 persons attending a restaurant in Tikrit City, Salah Al Din province on21st, June. OBJECTIVE: to identify source, and causative agents of the outbreak. PATIENTS AND METHODS: A case seeries study conducted on accessed cases in Tikrit and Sala Al Din hospitals. Information on basic, clinical and food item consumed were collected using a questionnaire. Environmental assessment of the restaurant using a standardized checklist and bacteriology testing of food samples, patients’ stool specimens and different specimens from food handlers were conducted. RESULTS: A total of 214 persons who attended the restaurant sought medical care for acute gastroenteritis; 82 (38.3%) were admitted. Only 175 patients (including 11 affected food handlers) were accessed. Main symptoms were diarrhea (92.5%), nausea (87.5%), and vomiting (84.5%). Apart of one death, all other patients recovered completely. 32% of patients’ stool samples were positive for Salmonella typhimurium, and 30% of food specimens were positive for Staphylococcus aureus, and 10% for coliform bacteria; 13 food handlers were examined and specimens of blood, urine; and stool, and under the finger nail swabs, were negative. Health inspection of the restaurant revealed unhygienic food processing and poor personal hygiene of food handlers. CONCLUSION: Staphylococcus aureus and Salmonella typhimurium were the responsible pathogens. Contaminated food stuff and unhygenic foodhandlers practices were the source. Strengthening the role of health inspection, and upgrading local laboratory capacity were recommended.


Article
Evaluation of Certain Acute Phase Reactants in Patients with Acute Myocardial Infarction

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ABSTRACT: BACKGROUND : Acute myocardial infarction ( AMI ) is an important clinical condition which is associated with a significant inflammatory changes that result in acute-phase responses. Significantly elevated concentrations of cytokines and other acute phase reactants are the major events that accompanied such condition. Our aim was to evaluate certain acute phase reactants : Interleukin-6 ( IL-6 ) , C-Reactive Protein ( CRP ) and plasma fibrinogen in patients with AMI. OBJECTIVE: This study was focused on the evaluation of certain acute phase reactants : Interleukin-6 ( IL-6 ) , C-Reactive Protein ( CRP ) and plasma fibrinogen in patients with AMI. PATIENTS AND METHODS: Thirty patients from Baghdad city with AMI were included between July 2011 and January 2012 : 21 males and 9 females, their ages range between 40 – 73 years. Thirty healthy subjects ( 16 males, 14 females ), age matched with patients as a comparative group were included. Both groups were investigated for IL-6 , CRP , and plasma fibrinogen levels. RESULTS : IL-6 concentrations were found to be significantly higher with ( P value : 0.0001 ) –table 1- in patients with AMI) than in control subjects. CRP concentrations were also found to be significantly higher with ( P value : 0.0001 ) in patients with AMI than in control subjects. plasma fibrinogen level was significantly higher with ( P value : 0.0001 ) in patients with AMI than in control subjects. CONCLUSION : The study revealed a significant elevation in IL-6 , CRP concentrations and plasma fibrinogen level in patients with AMI.


Article
The Pattern of Drug Resistance in Iraqi Pulmonary Tuberculosis Patients Referred to the Specialized Center for Chest and Respiratory Disease

Authors: Arwa Tahrir Ramadhan --- Ahmed Asmer Mankhi
Pages: 181-186
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ABSTRACT: BACKGROUND: Tuberculosis control in the world today must face the challenge posed by the global spread of Mycobacterium tuberculosis strains that are resistant to standard anti-TB drugs. OBJECTIVE: This study was done to identify the drug resistance to the first line antituberculosis drugs in Iraqi Patients. METHODS: This prospective study conducted in National Center for Tuberculosis and Chest Diseases in Baghdad from January 2012 to August 2012.For study the demographic characters and drug sensitivity test (DST) in a total number of 155 case of sputum smear positive pulmonary tuberculosis (97 old and58 New) For each patient 3 consecutive sputum samples were taken for direct smear microscopy and cultured to test drug resistance for First Line anti-TB drugs (INH, Rifampicin ,Ethambutol and pyrazinamide). RESULTS: In this study we found ethambutol resistant in 20(34.5%)of samples in the new group and in 49(50.5%) of samples in old group. On the other hand,our study showed that resistance to rifampicin in the new group was 58.6% while in the old group was 75.3%. In regard to the INH drug resistance it seen in 72.4% of samples in new group and in 83.5% of samples in old group.This study showed that reistance to streptomycin present in 44.8% of new group samples and in 55.7% of old group samples .The pattern of drug resistance according to patient group show high frequency of polyresistance 82 cases in both patient group(new and old) and low frequency in other group of resistance 14 cases,and MDR type of resistance in total of 17 cases . CONCLUSION: The study showed 11%(17/155) of patients with pulmonary tuberculosis in this sample of patients had multidrug resistance MDR tuberculosis . .


Article
Expression of Serum Cytokines (IL-6 & IL-8) and Oxidative Stress Marker (MDA) in Patients with Knee Osteoarthritis

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ABSTRACT: BACKGROUND: Osteoarthritis is a degenerative joint disease, occurring primarily in older persons. Although many factors initiate this disease, progress to overt OA needs many biological substances like IL-6 and IL-8 that reduce cartilage repair ability or like reactive species that induce cartilage destruction through direct degradation of matrix components. OBJECTIVE: To shed the light on the expression of serum IL-6 and IL-8 levels, and production of serum malondialdehyde level (marker of oxidative stress), then estimation of the correlation among serum IL-6, IL-8 and MDA levels in patients with knee osteoarthritis. PATIENTS AND METHODS: This study was conducted in AL-Kadhemiya Teaching Hospital during the period from April 2011 to December 2011. The study included two groups: knee osteoarthritis( KOA) group of patients and the control group. Each group was further sub-divided into: obese & non-obese according to their BMIs. Sixty osteoarthritic patients aged 40-70 years were chosen depending on medical history, clinical examination, and radiographic observations. 10 ml of blood needed for assessment of the above makers. Thirty healthy control (age and sex-matched) were enrolled in this study. RESULTS: Mean serum IL-6 and IL-8 levels were significantly higher in KOA patients compared to control group for both (P<0.001), with the highest levels seen in the obese KOA group. Mean serum MDA level was significantly higher in patients with KOA compared with that in control (P<0.001). Significant negative correlation was observed between serum IL-6 and IL-8 levels. CONCLUSION: IL-6, IL-8 & MDA have important role in the pathogenesis of KOA. Receptors of IL-6 and IL-8 on chondrocytes could be considered as target for future therapy of any arthritic inflammation and also to consider MDA reduction in patients with knee osteoarthritis, as part of treatment of osteoarthritis.

Keywords

KEYWORDS: IL-6 --- IL-8 --- MDA


Article
Comparism Between Transvaginal Cervical Length Measurement and Digital Examination in Prediction of Imminent preterm Delivery

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ABSTRACT: BACKGROUND: Preterm labour is a major cause of perinatal morbidity and mortality, so it is important to predict preterm delivery using the clinical examination of the cervix and uterine contraction frequency. New markers for the prediction of preterm birth have been developed such as transvaginal ultrasound measurement of cervical length as this method is widely available. OBJECTIVE: To determine, whether transvaginal cervical length measurement predicts imminent preterm delivery better than digital cervical length measurement in women presented with preterm labour and intact membranes. PATIENTS AND METHODS: Two hundred women presented with preterm labour between 24 and 36+6 weeks of gestation were included in this study. All women subjected for digital and transvaginal ultrasound cervical length measurement and the outcome measures were occurrence of preterm delivery within 48 hours and within 7 days. RESULTS: Assessment of cervical length measurement using transvaginal ultrasound for the 200 women presented with preterm labour with intact membrane revealed that 8 (4%) delivered within 48 hours and 16 (8%) delivered within 7 days. According to the Bishop score, the test was positive if the Bishop score was ≥8, or 4-7 with cervical length ≤30 mm. The cut-off value for transvaginal ultrasound cervical length considered as 30 mm in the study group. CONCLUSION: Transvaginal sonographic measurement of cervical length can predict imminent preterm delivery in women presented with preterm uterine contractions and Bishop score between 4 - 7 compared with digital cervical length measurement.


Article
Evaluation of Amniotic Fluid volume with Ultrasound at Term Pregnancy and its Correlation to Perinatal outcome

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ABSTRACT: BACKGROUND: recognition of abnormal amniotic fluid volume before delivery may alert the clinician to situations of potentially high prenatal risk. pregnancies complicated by extremes of amniotic fluid volume also experiences increase maternal & neonatal morbidity. OBJECTIVE: To identify the incidence of fetal morbidity & mortality associated with abnormal liquor volume compared with those having normal liquor volume at term pregnancy. Study design: A prospective cohort study. Setting: The study was conducted at Al-Elwiya Maternity Teaching Hospital, during the period from Mar. 2011 to Apr. 2012. PATIENTS AND METHODS: Three hundred fifty one pregnant women at their term were collected for the study. The participants were classified according to the amniotic fluid volume into 3 groups: Group 1: (244) those with normal liquor volume (maximum vertical pocket 3-8 cm), Group 2: (63) those with oligohydramnios ( maximum vertical pocket <3cm), Group 3: (44) pregnants having polyhydramnios ( maximum vertical pocket > 8 cm). Multiple pregnancy, preterm, postterm pregnancy or those with ruptured fetal membranes had been excluded. The fetal outcome of the groups were analysed & data arranged in tables & subjected to statistical study. RESULTS: In oligohydramnios group, hypertensive disorders & IUGR were 17.4% & 9.52% respectively, while in polyhydramnios women with diabetes diseases were 22.7% versus1.64% in the control group. In oligohydramnios group, low birth weight , intrapartum complications & admission to NICU were more significant with incidence of 9.59%, 39.6%, 46% respectively versus 0.04%, 5.33%, 11.07% for control respectively. Fetal congenital anomalies, early neonatal complications , macrosomia, low Apgar score& early neonatal death were more in polyhydramnios group as follow: 18.18%, 29.25%, 15.9% , 18.18% & 9.09% respectively compared with the control which were 0.41%, 8.6%, 5.74% respectively & there were no recorded cases of low Apgar score or early neonatal complications in the control group. CONCLUSION: Largest vertical pocket less than 3cm at term is associated significantly with higher incidence of hypertensive disorders & IUGR. It was highly significant in predicting neonatal admission (NICU ) & intrapartum complications. While when the largest vertical pocket is more than 8cm, diabetes disease, fetal macrosomia, congenital anomalies, low Apgar score, early neonatal complications & neonatal death are more frequently seen.


Article
Human Papilloma Virus in a Sample of Iraqi Women with Normal and Abnormal Pap Smear

Authors: Nada Salih Ameen --- Dalia Thamer Ahmmad
Pages: 211-218
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ABSTRACT: BACKGROUND: World wide, cervical cancer is one of the most common cause of death from cancer in women, HPV testing have a key role in primary cervical screening and the currently accepted view is that HPV is an essential factor in the causation of the disease. OBJECTIVE: The objective of the study is to outline the presence of HPV infection in our community through sample of Iraqi's women who attended Central Health Laboratories with normal and abnormal Pap smear during the period from August 2006 to December 2008. METHODS: The data were collected from records of the laboratory which includes the information about patients who were referred to the central health laboratories to do HPV test , these data includes: age of the patients , marital state, years after marriage which represents the age of first sexual acts , also the records includes the smoking state, Pap smear results and lastly the HPV test results. HPV testing was done by PCR method , which initially required DNA extraction by MICROGENO DNA from AB Analitica , then DNA Amplificaion by PCR , and finally Electrophoresis for reading the UV light and translating it into certain molecular weight by Molecular Weight Markers. RESULTS: The percentage of HPV infection was 15.65 % , the percentage of positive test was 20% among those aged between 20-30 years old , no viruses had been detected above 50 years old . All the cases that have been examined were married and had 15% infection rate among them . The maximum infection rate 20% was among those who had sexual activity for 5-9 years. 91.6% of the infected women were smokers. 5.5% of the women with negative cytological results was infected, 26.3 % of those with ASCUS, 43.3% of those women with CIN I, 45.5% of those with CIN II , and 57% of those with CIN III ; the highest infection rates were 100% among patients with micro-invasive cancer. CONCLUSION: -High rate of HPV infection is associated with age , smoking and multiple sexual partners(married more than once). - High frequency of detection of oncogenic HPV infection are associated with increasing grade of cervical lesion.


Article
Bacteriological, Serological and Histopathological Study on Tonsillectomy Specimens

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ABSTRACT: BACKGROUND: Tonsillitis is one of the commonest infectious disease occurring in the young age group. Tonsillectomy is generally indicated when there are frequent attacks of acute tonsillitis, usually six attacks or more per year for two successive years. Other indications of tonsillectomy include obstructive sleep apnea, quinsy ( usually after the second attack of quinsy) and suspicion of malignancy OBJECTIVE: The aim of the present study is to: i) identify the types of bacteria in the tonsil core and to study the sensitivity of bacterial isolates to some antibiotics. ii) estimate serum concentration of Antistreptolysin O (ASO), C-Reactive Protein (CRP) and Epstein Barr Virus (EBV) serology in patients subjected to tonsillectomy compared to control group. iii) study the histopathological changes of routine tonsillectomy specimens. METHODS: This case series included hundred patients who underwent tonsillectomy at Al-jamhori Teaching Hospital from January 2010 to July 2012. The main indication for surgery was recurrent attacks of tonsillitis for two or more successive years. Core of the tonsil was studied regarding bacteriology and sensitivity of the cultured bacteria to some antibiotics. At the same time blood sample was obtained and analyzed for ASO, EBV and CRP. Finally the removed tonsils were sent for histological examination. RESULTS: The mean age of our patients was 10.32 years with a range of 3-35 years. The study included 60 males (60%) and 40 females (40%) with a ratio of 1.5 :1. Group A beta hemolytic Streptococcus pyogenes was the commonest isolate from tonsil core (21.4%) and was most sensitive to azithromycin. Serological tests for ASO, CRP and EBV were positive in 24%, 22% and 20% compared to 22%, 8% and 10% in control group respectively. CRP was significantly higher among patients than control group. Histological examination revealed chronic non-specific tonsillitis with reactive lymphoid hyperplasia. CONCLUSION: The resistance of many bacteria to penicillin and amoxicillin, and the high percentage of beta-lactamase secreting microbes in recurrent tonsillitis mandate the need to consider a combination of amoxicillin and clavulanic acid or second generation cephalosporin. ASO titer is not an accepted indication for tonsillectomy.


Article
The Role of Ultrasound in the Diagnosis of Acute Appendicitis: A Prospective Study

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ABSTRACT: BACKGROUND: Misdiagnosis of acute appendicitis is a common and crucial problem in general surgery, as the mortality and morbidity increase from 3 – 15 folds if appendix is perforated. Graded compression ultrasonography is one of the new diagnostic techniques that were introduced to improve the diagnostic accuracy and consequently the clinical outcome. OBJECTIVE: The aim of the current study is to assess the diagnostic accuracy of ultrasound in the diagnosis of suspected acute appendicitis. METHODS: One hundred-eighty patients admitted to the general surgical ward at Al Kindy Teaching Hospital from 1 June 2009 to 28 Feb. 2010. All patients were complaining of right iliac fossa pain and tenderness with a suspicion of acute appendicitis, a clinical assessment done for them by using modified Alvarado score (only patients with Alvarado score 5 and below were included). All patients were investigated by WBC count and general urine analysis. When the diagnosis of acute appendicitis was clinically equivocal, an abdominal ultrasound performed within 4 hours of admission. A dilated, Non- compressible appendix greater than 6 mm diameter, and edema and asymmetry of the appendicular wall were considered positive for the diagnosis of acute appendicitis. A normal appendix on histopathological examination with positive ultrasonographic findings was considered false positive result. RESULTS: The findings according to histopathological examination shows that 160 cases were true positive cases,14 cases were found to be true negative , 1 cases was false positive and 5 cases were false negative cases.: Ultrasonography yielded a sensitivity rate of 96% and specificity rate of 93%. CONCLUSION: Ultrasound by graded compression technique provides highly accurate, sensitive and specific test for clinically equivocal acute appendicitis. .


Article
Epistaxis Etiology and Management

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ABSTRACT : BACKGROUND: Epistaxis is one of the commonest medical emergencies. It affects all age groups and both sexes. The causes may be local or systemic. Trauma is considered to be a major etiological factor. Various treatment protocols are utilized to control epistaxis depending upon the type, severity and cause of bleeding. OBJECTIVE: To show most etiological factures that causes epistaxis and who we manage each case by different method. MATERIALS AND METHODS : This descriptive study was designed to evaluate the etiology and efficacy of management of epistaxis.210 patient underwent prospective evaluation in the otolaryngology department of Al Diwaniyah Teaching Hospital . Standard principles where followed in the management. RESULTS: This study demonstrated a bimodal distribution with incidence peaks below25 years and above50 years of age. Males affected more than females (1:1.16) . Anterior nasal bleeding was noted in the majority of patients. Anterior nasal packing was the most effective method of controlling anterior epistaxis followed by chemical cautery. While posterior bleeding was controlled by posterior nasal packing and anterior nasal packing. The most common cause was found to be trauma followed by hypertension. CONCLUSION: Epistaxis affects all age groups and it has a bimodal age presentation, it affects both sexes equally. Anterior nasal bleeding is more common than posterior bleeding .Epistaxis may be controlled with chemical or electrical cautery if the bleeding point is visible. In case of failure to localize or access a bleeding point or profuse bleeding, anterior nasal packing can effectively control majority of epistaxis cases. Foley s catheter is a good option that can be used for posterior nasal packing. Gelfoam may be used for controlling epistaxis in cases of bleeding disorders, when there is mucosal ooze.


Article
Management Approaches of Splenic Surgery

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ABSTRACT: BACKGROUND: Splenic surgery is common surgical procedure with different indications and approaches that carries some potential complications which can be avoided. OBJECTIVE: To analyze the indications, management and complications of splenic surgery. PATIENTS AND METHOD: Prospective study conducted in the 3rd unit of general surgery department of Baghdad teaching hospital & private hospital over a period of 3 years, from the first of January 2008 till the end of December 2011. Ninety six patients with traumatic and non traumatic splenic pathologies were evaluated and followed up. RESULTS: This study includes ninety six patients with different splenic pathologies were included in this study with mean age of 23.69 ± 14.853 years. Sixty five patients with non traumatic pathology were treated by elective surgery with mean age of 20.25 ± 12.857 years, fifty eight of them by open splenectomy, four by laparoscopic splenectomy, two cystectomy of hydatid disease of the spleen and one by drainage of splenic abscess. Idiopathic thrombocytopenic purpura (I.T.P.) was the most common indication of non-traumatic splenectomy followed by thalassemia. Thirty one patients with trauma with mean age of 30.90 ± 16.325 years (16 of them had penetrating injury and 15 had blunt trauma) were treated by emergency splenectomy in 24 patients, splenorrhaphy in 5 and conservative treatment in 2 of them. Post-operative complications occurred in 25(26%) patients, pulmonary complication was the most common one, and the overall mortality was 5.2%. CONCLUSION: Splenectomy still the most common option in traumatic cases but the availability of new diagnostic imaging might improve the future results to conserve some injured spleen and there is a place for laparoscopic approach in selected cases of elective splenectomy and splenic preservation in some splenic hydatid cyst.


Article
Prevelance of Helicobacter Pylori in Patients with Hepatic Hydatid Cyst

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ABSTRACT: BACKGROUND: Echinococcosis (hydatid disease or hydatidosis) is endemic in some parts of the world. It is a zoonotic disease and human is an accidental intermediate host.Helicobacter pylori (H. pylori) is a spiral-shaped bacterium that is found in the gastric mucous layer or adherent to the epithelial lining of the stomach. H. pylori causes more than 90% of duodenal ulcers and up to 80% of gastric ulcers. OBJECTIVE: To detect the prevalence of H. pylori in patients with liver hydatid disease. PATIENT AND METHOD: The study was carried out from the 1st of July / 2009 to the 1st of October / 2010 & included two groups: Group A, which included sixty patients who presented to the surgical units of Baghdad teaching hospital & Al – Fairoos general hospital in Al – kut governorate with liver hydatid cyst for elective surgery, they were investigated for H pylori(by ELISA test for anti H-pylori IgG Ab). Group B, which included 72 of the patients first degree relatives who live in the same house also investigated for H pylori. RESULTS : The study found that in group A : patients with hydatid cyst and positive H pylori represents 48 cases ( 80% ) , while in group B: first degree relatives with positive H pylori 43( 59.7%). CONCLUSION: The prevalence of H-pylori is increase in the patients with hepatic Hydatid cysts, as There is a significant positive relationship between the presence of H pylori and liver Hydatid disease.


Article
Delayed Anastomotic Posterior Urethroplasty : Longterm Results

Authors: Hayder M. AL-Aridy
Pages: 248-256
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ABSTRACT: BACKGROUND: There is still controversy regarding the treatment of post-traumatic posterior urethral distraction injuries. Initial suprapubic cystostomy and delayed perineal urethral reconstruction has been considered the reference standard. OBJECTIVE: We review our experience with delayed perineal urethral reconstruction,with a focus on the long-term outcome and complications. PATIENTS AND METHODS: Between March 2007 and April 2012, 56 patients with posterior urethral distraction injury due to pelvic trauma underwent reconstruction with delayed perineal approach. Motor car accident were the main mode of trauma ocuring in 34 patients(60.71%)followed by blunt pelvic trauma in 15 patients(26.78%)and fall from height in 5 patients(8.92%).Bullet injury in 2 patients(3.57%).The definitive repair was delayed after a time interval ranging from 2 to 9 months (mean 2.83±1.14) after initial management . Mean patient age was 30.16±15.31 (range 6 to 65) years. In all cases, the area of fibrosis was aggressively excised, the corpus spongiosum was mobilized, and a tension-free, spatulated end-to-end anastomosis was achieved by splitting the corporeal bodies. The preoperative evaluation consisted of combined antegrade and retrograde cystourethrograms . A detailed sexual history was obtained in all patients . RESULTS: After a mean follow-up of 29.78±15.79 months (range 9 to 60 months ), 50 patients(89.28%) had a successful outcome (with or without additional urethrotomy).6 patients (10.71%)was considered a surgical failure ,endoscopy was unsuccessful .The patients is scheduled for another trial of surgical repair. CONCLUSION: Our results support the belief that delayed perineal reconstruction with extensive excision of fibrosis and a tension-free, spatulated end-to-end anastomosis is a successful treatment for posterior urethral distraction defects, with acceptable morbidity. KEY WORDS:urethral stricture,posterior urethral injuries,urethroplasty.


Article
Acute Renal Failure in Neonates, Single Center Experience: Child's Central Teaching Hospital

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ABSTRACT: BACKGROUND: Acute renal failure is an acute deterioration in the ability of the kidneys to maintain homeostasis of body fluids, electrolytes and is associated with acute decrease in the glomerular filtration rate that leads to retention of toxic metabolic end products. It’s incidence in hospitalized neonates is 8-24%. The main causes of acute renal failure in neonates are pre-renal in nature, intrinsic and post-renal mechanisms of failure are much rarer conditions. OBJECTIVE: To evaluate; types, associated predisposing factors, and short term outcomes of renal failure in neonates of neonatal unit in Child’s Central Teaching Hospital, and to compare the results with those reported in the literature. PATIENTS AND METHODS: A cross sectional study was carried out on 30 neonates with acute renal failure admitted to neonatal unit in Child’s Central Teaching Hospital during the period from 1st of June 2012 to 30th of November 2012. RESULTS: There were 43 cases diagnosed as renal failure out of 927 hospitalized neonates (4.63%).Thirteen cases were excluded according to the inclusion criteria, so only 30 cases were enrolled in this study. Male to female ratio was 1.7:1. Most of patients were term (86.7%). The prevalence of pre-renal, renal and post renal causes of acute renal failure were 76.6%, 16.7% and 6.7% respectively. The most common predisposing factors for acute renal failure in this study were sepsis (80%), perinatal asphyxia (10%), heart failure (3, 4%). Most patients had more than one predisposing factor. Among admitted neonates with renal failure, mortality rate was 16.7% and it was significantly higher in patients with sepsis (P<0.05). CONCLUSION: Early recognition of risk factors such as sepsis, perinatal asphyxia or, heart failure, and rapid effective treatment of contributing conditions will decrease acute renal failure in the neonatal period.


Article
Seroprevalance of Hepatitis B&C In Pediatric Malignancies

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ABSTRACT: BACKGROUND: Children with cancer who are on intensive chemotherapy require multiple blood and its products transfusion which increases the risk of blood transmissible infection OBJECTIVE: To know the prevalence of HBV and HCV infection in pediatric malignancy after starting anti cancer therapy and To identify the risk factor, that increased the possibility of infection Design a Prospective interventional study Participants The present study was conducted on 85 children with malignancies who were attending the department of pediatric oncology in Mosul,(Ibn-Alather hospital) the age of the patients were between 1-15 years with male: female ratio of 1.5: 1 Main outcome measure. All our patients were tested for HBsAg and HCV antibodies at diagnosis of malignancy and before starting chemotherapy then after six and twelve months RESULTS: Two patients (2.3%) had HBV infection, and no patient had HCV infection initially, while after 6 month of receiving chemotherapy we have 8/70 (11.4) had HBV and also no patient with HCV, and after 12 months of receiving chemotherapy the percentage of patients with HBV and HCV were increase to 13/63 (20.6%) and 2/63 (3.2%) respectively . CONCLUSION: Its important to ensure on accurate screening of blood and its products before transfusion to these patients, and also ensure on the receiving HB vaccine before starting chemotherapy. Before this study, the prevalence of HBV and HCV infection in pediatric malignancy in Mosul city were unknown, the present study was designed to fill this gap. .


Article
Her 2/Neu Overexpression in Gastric Cancer

Authors: Nadwa Subhi Al-Azow
Pages: 268-272
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Abstract

ABSTRACT: BACKGROUND : Overexpression of Human epidermal growth factor receptor 2(Her2/neu) Protein has been observed in many human cancers including gastric cancer . Gastric cancer remains the most common cause of cancer –related death worldwide. Her2/neu overexpression in gastric cancer associated with poor prognosis and shorter survival rate , the assessment of this protein for selection of eligible patients for treatment with trastzumab in addition to conventional chemo therapy. OBJECTIVE: To evaluate the Her2/neu over expression in gastric cancer by immunohistochemical Technique and to find the correlation between the protein exopression and clinicopathological Parameters as age ,sex, histological types and grade of the tumor. MATERIALS AND METHODS : This is a pro-& retrospective study conducted at the pathology department of Al-Jamhuri Teaching hospital and some private laboratories . A total of 30 cases of gastric cancer were collected and diagnosed in the period spanning from April 2010 to April 2012, .An immunohistochemical technique was used for the assessment of Her2 against age,sex, histological types and grade of tumor RESULTS : The mean age of the patients was 54.5 years ranging from 30 to 87 years, Her2/neu overexpression was shown in 30% of the cases , in this study there is no relation between Her2 positivity and age or sex, , it was associated with histological types p-value = 0.04,where as 42.6 % of the intestinal type show immunoreactivity and 11.1% of diffuse type,while two cases of mixed types were shown no reactivity(0.0% ). Her2 positivity was associated with moderate differentiated tumor (50%) more than poorly differentiated (20%) but not reaching the statistical significance. CONCLUSION: Her2/neu positivity was found in 30% of gastric cancer , there is no relation between the age or sex of the patient & Her2 positivity while intestinal type and moderately differentiated tumor were associated with high percentage of Her2 positivity.


Article
Epidermal Skin Cancers: Anatomical and Pathological Distribution

Authors: Rana Aasim Abdul-Kareem Azooz
Pages: 273-278
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ABSTRACT: BACKGROUND : There are three major types of skin cancer; basal cell carcinoma (BCC), squamous cell carcinoma (SCC) and malignant melanoma.The distribution of these tumors on the face follows particular anatomical regions which may be related to histological subtypes of the tumor. OBJECTIVE: To describe and compare the clinicopathological characteristics of epidermal skin cancers regarding facial distribution of these tumors and their histological correlations. METHODS: Data sources for this retrospective case-series study included all pathological reports of patients with epidermal skin cancers diagnosed at histopathology laboratory of Al-Jamhuri Teaching Hospital in Mosul city between the years 2008 and 2010. RESULTS: There were 117 patients with different facial epidermal skin cancers. BCC represented the highest frequency (68.3%) among all facial epidermal skin cancers (and the most frequent eyelid malignancy), followed by SCC (28.5%) while malignant melanoma was the least frequent skin cancer (3.2%). There was no difference in the frequency of distribution of both BCC and SCC between nose and cheek (p=1, p=1, respectively) but the nose was the most frequent region of involvement of the nodular variant of BCC. Preexisting mole, xeroderma pigmentosa, actinic keratoses and scar of previous burns were found to be associated with different epidermal skin cancer. CONCLUSION: BCC was the most frequent epidermal skin cancer of the face followed by SCC. Histological variant of BCCs followed variable facial distribution , while no difference in facial involvement was found regarding BCCs and SCCs.


Article
Accuracy and Safety of the Free Hand Technique for Thoracic Pedicle Screw Placement in Spinal Deformity

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ABSTRACT: BACKGROUND: Pedicle screw construct has become widely accepted method for correction of spinal deformities. Better correction, higher rates of fusion as well as low complication rates have been reported. Free hand technique for placement of pedicle screw has been shown to be associated with low complication rate when performed by experienced surgeon. Low dose CT scan was used for postoperative assessment of screw placement and shown to be safe and effective method. OBJECTIVE: To determine the accuracy and safety of malpositioned screws in the thoracic spinal deformities using the free hand technique and to determine the effectiveness of the low dose CT scan regarding this issue METHODS: 502 pedicle screws were used in 21 patients with adult idiopathic and congenital scoliosis using the free hand technique, screws positions were estimated one week postoperatively using low dose CT scan. RESULTS: Of the 502 screws inserted 262 (52.19%) were well placed inside the pedicle while 110 (21.91%) were medially misplaced and 108 screws (21.51%) were misplaced laterally, 16(3.19%) anterior perforation, 5 (1%) perforated the underlying neural foramen and 1(0.2%) perforated the upper end plate; without any significant neurological or visceral complication. CONCLUSION: Placement of the thoracic pedicle screws in the surgical correction of the deformed spine using the free hand technique is a safe, cost effective and non-time consuming and that the low dose CT scan used postoperatively is effective and safe method in detecting malpositioned screws.


Article
Idiopathic Benign Retroperitoneal Cyst : Uncommon Retroperitoneal Mass

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Abstract

ABSTRACT: Retroperitoneal cysts are uncommon, with an estimated incidence of 1/5750 to 1/250,000 . A 54 year old female patient presented to Al-Karama Teaching Hospital with sensation of mild left lower abdominal pain colicky in nature with mild backache , ten days duration. No dysuria, normal bowel motion . On physical examination we palpated a fixed mass in the left lateral side of abdomen. Ultrasound revealed thin walled large cystic mass ,CT-scan showed large regular cystic mass in left side of abdominal retroperitoneum . During the operation we found a retroperitoneal cyst at the lateral side of sigmoid colon and extend posterior to the descending colon . The cyst arising within the retroperitoneum outside the major organs. CT scan, and MRI help in confirming the diagnosis, but surgery is the keystone in confirming the diagnosis, and surgery remains the best treatment option.

Table of content: volume:13 issue:2