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:4

Article
Bone Transport of Tibia by Performing Z-Osteotomy Using Convenvtional External Fixator

Authors: Omer Ali Rafiq Barawi
Pages: 446-453
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ABSTRACT: BACKGROUND: This is a descriptive study to evaluate the outcome of forty patients with bone loss in tibia using conventional (mostly monoaxial) external fixation device, based on principles of distractive osteogenesis. OBJECTIVE: To prove the effectiveness of conventional external fixation device in distraction osteogenesis in tibia successfully and simply. PATIENTS AND METHODS: Forty patients with bone loss of 4 to 10.5 centimeters in tibia between March 2003 and March 2011 were treated, ages (15-65years), 6:34 female to male ratio .In 30 patients site of bone loss was in the lower third of tibia while in 4 patients was in the middle third of tibia and in the remaining 6 patients it was the upper third of tibia. The cause of defects in tibia was fracture due to road traffic accident (20cases), bullet injury to leg (8cases), gap nonunion (8) and infected non unions (4 cases) respectively. Conventional external fixation device were used in all cases using the principles of z-osteotomy and results were evaluated according to Association for Study and Application of Ilizarov Method (A.S.A.M.I.) scoring system. RESULTS: According to ASAMI scoring system, functional results were achieved as excellent in 20 patients (50%), good in 10 (25%), fair in 8 (20%) and poor as 2 (5%) without failure. while bone results achieved excellent 18 (45%), good 14(35%), fair 6 (15%), poor 2(5%) without failure and bone loss in upper tibia has more chance and excellent result than in lower part. CONCLUSION: Conventional external fixation devices can be used to achieve distraction ontogenesis in tibia bone defects successfully, as it is cheap, safe and simple assembly.


Article
Managements of Type 2 Tibial Hemimelia; Short Review on Treatment of Tibial Defects and The Results of Four Patient Treated Using a Modified Brown Procedure

Authors: Mohammed H. Salal --- Isam H.Ali
Pages: 454-465
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ABSTRUCT: BACKGROUND: Tibial hemimelia is a very rare deformity and problematic syndrome usually associated with variable visceral and skeletal deformities. The treatment is always difficult and challenging. Amputation was the preferred treatment option specially in complete tibial absence, however, a conservative management sometimes used in other types of the deformity or in cases of amputation refusal. OBJECTIVE: To review the methods of management of chronic tibial defects and to study the results of operative treatment of 4 patients with type ii congenital tibial hemimelia. PATIENT AND METHOD: All along thirty-two months period and after a proper clinical and radiological assessment we treated four male children with a mean age of 8.5 years who were all right sided type 2 tibial hemimelia according to Jones and Kalamchi with absence of the distal tibia. Treatment consisted of proximal fibula transfer to the lower end of the tibial stump (brown's operation) followed by Syme's amputation and prosthetic fitting. RESULTS: In all cases the transferred fibular shaft to the distal end of the tibial remnant was united within two to three months. The fibulae grew in length and the size to be tibialized and the leg increased in length as we preserved the distal fibular epiphysis. CONCLUSION: The results were acceptable as we saved and reconstructed the limb, we gained an acceptable knee function and stable prosthetic fitting that aided proper rehabilitation.


Article
Treatment of Mallet Finger; Conservative or Operative

Authors: Alaa A. Dawood
Pages: 466-474
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ABSTRACT: BACKGROUND: Mallet finger injuries, still represent a controversy as the best way of treatment, when to treat conservatively and when to go for surgical management . OBJECTIVE: This prospective study was undertaken to evaluate functional outcome of conservative versus surgical treatment of acute and chronic mallet finger injuries. PATIENTS AND METHODS: A prospective study was conducted between November 2011 and December 2013 . Forty six patients with mallet finger deformity were treated,21 by non-operative technique and 20 were treated surgically, the time between injury and commencement of treatment ranges from 3 days to 3 years mean ( 17 weeks).Follow up ranges from 12 months to 18 months mean( 15 months). RESULTS: Successful outcome was found in 57.15% of mallet fingers treated conservatively by splintage .patient satisfaction with conservative treatment was 66.7%. Successful outcome of surgical treatment was 65% while patient satisfaction was found in75% of cases treated surgically. Patients started conservative treatment within 4 weeks of injury had better outcome (success rate 81.8%) than those started treatment after 4 weeks (success rate 30%). Mallet finger injuries treated after 4 weeks from injury, show a better functional outcome in surgically treated group(success rate 61.5%), than injuries treated by splint (success rate 30%). CONCLUSION: Conservative treatment is safe, effective well tolerated, method of treatment for early closed and uncomplicated cases, with better outcome in patient started treatment within 4 weeks of injury than those started treatment after 4 weeks .Surgical treatment is required for open ,chronic cases and those complicated by swan neck deformity. Mallet injuries presented after 4 weeks show a better outcome if surgical treatment is undertaken.


Article
Unipolar Versus Bipolar Hip Hemiarthroplasty in the Treatment of Femoral Neck Fractures in the Elderly

Authors: Ali A. Ali --- Saad M. Rashed --- Mushtaq T. Hussien
Pages: 475-485
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ABSTRACT: BACKGROUND: Hip fractures are associated with high morbidity and mortality, which require a treatment plan that ensures a good outcome with minimal complications. Different treatment modalities and arthroplasty prosthesis are available and widely used. OBJECTIVE: The aim of this study was to compare the short outcome of surgical treatment of femoral neck fractures in elderly using unipolar and bipolar hip hemiarthroplasty. PATIENTS AND METHODS: Thirty four patients with intracapsular femoral neck fractures ranging from Garden’s class II to class IV were enrolled in the study for surgical intervention using either unipolar hemiarthroplasty (Group A: 14females, 6 males) or bipolar hemiarthroplasty (Group B: 10 females, 4 males). Patients were followed up for up to 2 years by Harris Hip Score to assess the outcome of the surgery. RESULTS: The average hip score for patients per group over the whole follow-up period showed better results in group B than in group A. Average score results were higher in all grades among group B patients. However, the difference from scores of group A patients was statistically insignificant (p>0.05). Patients of both groups had a negative correlation of age to score outcome regardless of sex and grade of fracture. In group A patients, score points for pain, stiffness, range of motion and support/locomotion were all higher during the first six months of follow up. The scores started to decline gradually after 18 months towards the end of the follow up period. In group B patients, the score points for the same parameters were all significantly lower than Group A patients during the first 3-6 months of follow up but started to increase to significantly higher levels towards the end of the follow up period. CONCLUSION: The short-term advantages of unipolar hemiarthroplasty may outweigh its long-term complications in elderly patients with limited daily activities and/or associated serious medical illnesses. In younger age patients with more ambulatory activities and greater life expectancy, bipolar hemiarthroplasty offers a better solution.


Article
A Comparative Study Between Ventriculoperitoneal Shunt and Endoscopic Third Ventriculostomy in the Manegment of Obstructive Hydrocephalus

Authors: Abdulameer Alkhafaji --- Samir Faissal Hassan
Pages: 486-492
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ABSTRACT: BACKGROUND: Uncertainty persists on the best treatment for patients with obstructive hydrocephalus: endoscopic third ventriculostomy (ETV) or V-P shunt. Most patients with obstructive hydrocephalus are treated with ventriculo-peritoneal (VP) shunt placement. OBJECTIVE: Of this study is to compare between V-P shunt and ETV in the manegment of obstructive hydrocephalus in relation to the degree of complication. METHODS: This is a prospective study of 90 patients with obstructive hydrocephalus of various etiologies operated by V-P shunt or Endoscopic 3rdventriculostomy in the Department of Neurosurgery in Al-Khdhemia Teaching Hospital, Neurosciences Teaching Hospital and Neurosurgical Teaching Hospital from October 2011 to December 2012. Presenting symptoms and signs, clinical shunt function, operative findings and outcome were recorded. RESULTS: Common presenting features were headache, vomiting, irritability and general toxic look of patients. Male to female ratio was 1.14:1. Patients with obstructive hydrocephalus were treated with V-P shunt or with endoscopic third ventriculostomy and followed for 6 months as an average. In patients with V-P shunts, upper end block was a common problem followed by wound dehiscence and valve exposure and other complications such as lower end obstruction, slipped catheter, subdural hematoma, and subcutaneous CSF collection. While in patients with ETV spontaneous closure of the stoma was more frequent than other complications. The complication rate in ETV is lower than that of V-P shunt (30% in V-P shunt and 17% in ETV). However ETV is less successful in patients below 2 years old and in those with normal pressure hydrocephalus. CONCLUSION: Endoscopic third ventriculostomy is becoming more popular as an alternative to shunting in the management of obstructive-type hydrocephalus. Obstructive hydrocephalus is the main indication for endoscopic third ventriculostomy. However, in cases where this procedure is indicated, good knowledge of third ventricle anatomy, surgeon preference and experience with endoscopic surgery can yield success rates of up to 80%.


Article
Surgical Difficulties of Cochlear Implantation in Children

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ABSTRACT: BACKGROUND: Cochlear implantation is a recent surgical treatment of deaf children, surgical difficulties may arise and has impact on outcome of implant. OBJECTIVE: To define the difficulties encountered during surgery and how the surgeon deals with them. METHODS: 120 patients of bilateral severe to profound hearing loss who all had implantation in the department of otorhinolaryngology, medical city, during the period from July 2010 to September 2011. All of them received the Nucleus Freedom cochlear implant with Contour Advance Electrode, model CI24RE. They are classified into two groups according to difficulty arises during surgery :(group a ) those identified during access to cochlea.(group b) those associated with difficult electrode insertion. RESULTS: Difficulties encountered during access occurred in 8 patients (6, 66%); Difficulties encountered during insertion of electrode occurred in 16 patients (13.33%). CONCLUSION: We concluded that although cochlear implant (C.I.) surgery is now well practiced , and difficulties during surgery are infrequent, the Surgical management of certain obstacles encountered during surgery demands expert knowledge of surgical technique for successful implantation .


Article
How to Reduce Time Delays in Presentation and Treatment of Testicular Torsion; the Role of Public and Practitioners Education

Authors: Saad Dakhil Farhan Daraji
Pages: 499-503
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ABSTRACT: BACKGROUND: Testicular torsion (TT) requires prompt diagnosis and treatment to avoid testicular Loss. Most studies have focused on the ideal work up to rule TT out in cases of acute scrotum. A long response time to the scrotal pain was related to high orchidectomy rate during surgery for acute torsion. OBJECTIVE: We attempted here to highlight the causes behind high orchidectomy rate during the surgery for testicular torsion and the advices to decrease this problem. PATIENTS AND METHODS: Surgical exploration which was done for suspected testicular torsion in 50 consecutive males with their age (range 1-20 years. All patients were evaluated with detailed history, physical examination and Basic Laparotory investigations, some patients underwent scrotal ultrasound scan with color-Doppler preoperatively when possible. Patient age, site of pain, duration of symptoms, ultrasound finding, approximate time from admission to surgery, operative findings, and type of the operation and causes of delay for orchidectomy group were recorded. RESULTS: Intra operative Testicular torsion was documented in 36 patients, orchidectomy and orchidopexy was performed equally, Delays to reach the hospital for more than 4 hours after the onset of pain significantly associated with increase the risk of orchidectomy .The risk of orchidectomy significantly increased with increased patient age. Parents neglect appear the most important cause for small age group while self ignorance, social fear and false medical advices for older ages. CONCLUSION: A long response time to the scrotal pain and a high orchidectomy rate were exposed by this study. This was thought to be due to ignorance, which could be eliminated through public education.


Article
Inhalational Anaesthesia Versus Total Intravenous Anaesthesia During a Rigid Bronchoscopy in Paediatrics

Authors: Osama Haider Al-Hassani
Pages: 504-508
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ABSTRACT: BACKGROUND : General anaesthesia is routinely used for rigid bronchoscopy in paediatrics for different causes. Both methods of anaesthesia were used inhalational and total intravenous anaesthesia (TIVA). OBJECTIVE: Is to compare inhalational anaesthesia with total intravenous anaesthesia (TIVA) for rigid bronchoscopy in paediatric age group in regard to the heart rate, oxygen saturation, coughing, bucking, laryngeal spasm and bronchospasm. PATIENT AND METHOD: Thirty patients aged 2-6 years were chosen, divided randomly in two groups. In group I ( inhalational anaesthesia) consisted of 15 patients and the anaesthesia was maintained with halothane while in group II use (total intravenous anaesthesia) TIVA was consist of 15 patients and anaesthesia was inducd and maintained with remifentanyl and propofol. The heart rate, oxygen saturation, coughing, laryngeal spasm and bronchospasm were evaluated during and after the procedure. RESULT: Blood oxygenation and Heart rate were more stable in group II (P=0.045 and P=0.024 respectively). There were slightly less cough and bucking in group II as compare with group I. CONCLUSION: TIVA is a good choice of anaesthesia during rigid bronchoscopy because of a good and stable level of blood oxygenation and heart rate. Coughing, bucking, laryngeal spasm and bronchospasm were less in TIVA group compare with inhalational group.


Article
eamodynamic Changes During Airway Managment in Hypertensive Patients Undergoing Abdominoplasty Surgery

Authors: Ali Abdulhamed Mohamed --- Abbas Mohamed Suhan
Pages: 509-514
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ABSTRACT: BACKGROUND: Avoidance of heamodynamic changes in hypertensive patients receiving general anesthesia is a goal including patients undergoing abdominoplasty surgery. OBJECTIVE: To compare haemodynamic responses to use of a classic laryngeal mask airway (LMA) versus endotracheal tube (ETT) in hypertensive females undergoing abdominoplasty surgery. PATIENT AND METHODS: Place and Duration of study: Al-Amaal private hospital from march. 2012 to march 2014. Fifty hypertensive female patient undergoing abdominoplasty surgery were randomly distrusted into two equal groups using alternate patient technique endotracheal tube( ETT ) and laryngeal mask airway (LMA) ( n=25 each). Patients in both groups were received general anaesthesia using standard anesthetic technique. Patients in ETT group underwent laryngoscopy and ETT intubation, whereas patients in LMA group received LMA without laryngoscopy for their airway maintenance. Haemodynamic variables, (pulse, systolic, diastolic and mean arterial pressures) were measured using non-invasive monitoring technique at various intervals before and after intubation or LMA placement , before and after extubation or LMA removal. CONCLUSION: Laryngeal mask airway provide more stable heamodynaics parameter than endotracheal tube during incertion and removal in hypertensive patients receving general anesthesia for abdominoplasty surgery.


Article
The Clinical Presentation of Hypertensive Crisis in the Emergency Department of Baghdad Teaching Hospital

Authors: Manal Khudder Abdul Razak
Pages: 515-523
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ABSTRACT: BACKGROUND: Uncontrolled hypertension can progress to a hypertensive crisis defined as a systolic blood pressure ≥180 mm Hg or a diastolic blood pressure ≥120 mm Hg which is potentially fatal. It can manifest as either hypertensive emergency or urgency, depending on end-organ damage including cardiac, renal, retinal and neurologic injury. OBJECTIVE: To analyze the clinical presentation, and characteristics of patients presented with hypertensive crisis and to assess the frequency of the target organs involved. METHODS: An 8 months cross sectional study in which 306 patients older than 18 years who attended the medical emergency department of Baghdad Teaching Hospital with a hypertensive crisis were selected; excluding cases of preeclampsia and eclampsia. The criteria that were used were based on the 7th Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure which was the latest report at the time of the study. Patients were differentiated into hypertensive emergency or urgency, and were divided according to age into five groups: ≤30y, 30-39y, 40-49y, 50-59y, ≥60y. From each patient, a clinical history, physical examination including fundoscopy, blood analysis, electrocardiogram, and a chest X-ray were obtained. Computarised tomography was done when indicated. RESULTS: Hypertensive emergency was found in 60.8% and hypertensive urgency in 39.2% of cases. Of total; 56.2% were males. Mean age of total sample was 48.7 ± 16.2y, but patients with a hypertensive emergency were older with statistically significant difference. Hypertension was unknown to 48% of patients.Twenty-four percent of patients were diabetics. Smoking and dyslipidemia were significant risk factors. Hypertensive emergency presented with dyspnea in (30%), and papilledema was found in (18.63%) with statistically significant difference. Patients with hypertensive urgency presented with epistaxis in (11.90%), and papilledema was found in (9.80%). Most cases of hypertensive emergency corresponded to acute myocardial infarction (25.3%) followed by encephalopathy (21.0%), renal failure (20.4%), heart failure (17.2%), and cerebrovascular accident (11.3%). CONCLUSION: Hypertensive emergency was more frequent, males were more frequently affected and were significantly older than those with a hypertensive urgency. Smoking & dyslipidemia were significant risk factors. Hypertension was unknown to about half of patients. The most frequent clinical manifestations were papilledema and dyspnea. Acute myocardial infarction, encephalopathy, and renal failure were the most frequent target organ lesions in hypertensive emergency.


Article
Types ,Frequency,Clinical Presentation of Congenital Central Nervous System Anomalies in Al- Kadmayhia Teaching Hospital

Authors: Lamyaa Abdul Kareem Hamoodi
Pages: 524-531
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ABSTRACT: BACKGROUND: The central nervous system (CNS)anomalies are the most severe, difficult to detect its etiology, and predict its clinical presentation and course. OBJECTIVE: To find out the common types of congenital malformations in central nervous system.,determine the frequency and the clinical features of these malformations. And to study the risk factors associated with congenital central nervous system malformations. PATIENTS AND METHODS: This cross-sectional study was performed at Al-Kadhimiyia Teaching Hospital (Neonatal care unit) from the 1st of January to the 1st of July, 2011. One hundred newborn infants were proved to have congenital abnormalities by physical examination alone. Fifty five neonates were diagnosed as having CNS congenital anomalies. neonatal evaluation include: gestational age, sex, body weight, type of CNS congenital anomaly. Maternal age, parity, antenatal care, any history of abortion, previous baby with CNS congenital abnormality, still births, or drug intake during pregnancy. the residency of the family and consanguinity . RESULTS: The number of neonates delivered alive was 2700 neonates, one hundred of them (3.7% of total deliveries) were delivered with congenital anomalies, and 55 cases from those (2% from total deliveries / 55% from congenitally abnormal deliveries) have had CNS congenital anomalies,the most frequent anomalies aremeningocele 25( 45.5%),the second and third in frequency were hydrocephaly 12 (21.8%), and myelomeningocele 10 (18.2%) respectively. There were 34(61.8%) male and 21 (38.2%) female. There were 30(54.5%) full term and 25(45.5%) preterm. Thirty cases out of the total 55 cases (54.5%) with body weight 3-3.5 kg. Most of the affected neonates to mothers with an age range of 20-40 years where 34 mothers (61.8%) aged between 20-30 years . Most of the mothers were multipara (45 cases / 81.8%) .The majority of the neonates were the product of a consanguineous marriage 39 (70.9%). Maternal peri-conceptional folic acid supplementation was not taken in the vast majority of cases (43 cases / 78.2%). Positive family history of CNS congenital anomalies was reported in 4 cases only (7.3%) . Familial residence was documented as urban in 30 cases (54.5%), and rural in 25 cases (45.5%). CONCLUSION: The most common type of CNS anomalies is meningocele with relatively higher male to female ratio.These anomalies occur in full term multipara mothers. Occur more frequent in infants with larger body weight and to younger multipara mothers. Consanguinity is a major risk. There was a low utilization of maternal peri-conceptional folic acid supplementation


Article
Vascular Cognitive Impairment in Ischemic Stroke Patients

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ABSTRACT: BACKGROUND: Stroke is associated with considerable physical and psychological impairment. Cognitive impairment is common sequel of stroke and small vessel ischemic disease. Potentially modifiable risk factors for vascular cognitive impairment (VCI) include hypertension, DM, hyperlipidemia and others. Because of the close association of these factors with stroke, prevention of VCI is largely tied to control of stroke risk factors. OBJECTIVE: The main aims of the study were to ascertain the significant determinants of cognitive impairment in stroke patients and the associated risk factors. PATIENTS AND METHODS: This is a case series descriptive study that enrolled 100 patients whose ages were 50 years and above with stroke attending at Al-Yarmouk Teaching Hospital in Baghdad-Iraq during the period between the 1st of January 2007 to the 31st of January 2008. All of the patients were asked about demographic and atherogenic risk factors and subjected to cognitive assessment by MMSE and executive function also the patients subjected to thorough clinical assessment, laboratory investigations and radiological studies. RESULTS: This study revealed that distribution of VCI in stroke patients was 27%, the patients with vascular CIND represent 19% and those with VaD represent 8%. The mean age of the patients was 65. The most common risk factors were hypertension 25%, hypercholesterolemia 20%, smoking 17%, acute myocardial infarction 10%, diabetes 10% and atrial fibrillation 5%. We observed that increasing age, low level of education and acute myocardial infarction were significant determinants of cognitive impairment in stroke patients. CONCLUSION: Considerable proportion of stroke patients presented with cognitive impairment which is determined by modifiable risk factors like atherogenic and demographic risk factors.


Article
Evaluation of Patients with Lymphadenopathy in Hematology Unit in Baghdad Teaching Hospital

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ABSTRACT: BACKGROUND: Lymphadenopathy is defined as abnormality in the size or character of lymph nodes, is caused by the invasion or propagation of either inflammatory cells or neoplastic cells into the nodes. OBJECTIVE: To determine the etiological and clinical characteristics of Lymphadenopathy in adults. PATIENTS AND METHODS: Sixty patients with Lymphadenopathy attended Hematology department/Baghdad Teaching Hospital for the period between December 2011 and April 2012. Diagnostic procedures included clinical history and examination, complete blood count, lymph node, bone marrow studies and immunohistochemistry studies. RESULTS: Thirty six male and 24 female patients were included, with mean age of 36.2 ±16.3 years. Malignant causes were found in 55(92%), mainly lymphomas 40(66.7%), while benign causes constituted only 8 %( 5 patients). Size, consistency and systemic symptoms were important parameters in differentiation between both, and immunohistochemistry was important in reaching a diagnosis in one patient and in solving the discrepancy between lymph node and bone marrow results in other patient. CONCLUSION: Lymph node and bone marrow examination, in addition to immunohistochemistry were important investigation to reach a diagnosis in patients with Lymphadenopathy. High malignant etiology is attributed to being the study done in tertiary hospital.


Article
Safety Profile of Rituximab In 100 Adults Patients With B-Lymphoproliferative Disorders

Authors: Salih Khdier Abdullah --- Ali Mohammed Jawad
Pages: 543-549
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ABSTRACT : BACKGROUND: Non-Hodgkin lymphoma (NHL) is the most common hematologic cancer in adults. Rituximab is a chimeric anti-CD20 monoclonal antibody that transformed the outcome of the B- lymphoproliferative disorders . Treatment with rituximab is relatively safe but occasionally serious. OBJECTIVE: To evaluate the safety of Rituximab in the treatment of Iraqi adult patients with B- lymphoproliferative disorders. PATIENTS AND METHODS: A total of 100 patients with low grade, high grade B-cell non-Hodgkin lymphoma and chronic lymphocytic leukemia (CLL) who were admitted to the Haematology unit of Baghdad Teaching Hospital to receive their scheduled Rituximab containing protocol were included in this cohort prospective study between April 2011 to march 2012 .The patients were divided into two groups according to the presence or absence of infusional side effects of rituximab. Infusional side effects of rituximab were recorded with each dose and correlate them with certain patients’ parameters including age, gender and serum LDH . RESULTS: Fever (36%), Rigor (28%) and nausea and vomiting (23%) were the most prevalent infusional side effects of rituximab in both NHL and CLL, with most of these infusional side effects occur in the first infusion. One treatment related mortality occurred. Infusional side effects of rituximab were more prevalent in CLL than other patients with NHL (P=0.0005) and in those with normal serum LDH(P=0.046) CONCLUSION: Rituximb-induced infusional side effects in this study are more common in the first infusion, and patients with CLL . Most of infusional side effects are mild of grade one or two although one fatal side effect had occurred.


Article
Glucose Tolerance Test in Beta-Thalassemia Major in Al-Sader City

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ABSTRACT: BACKGROUND: β-thalassemia are inherited defects in the synthesis of B-globin portion of hemoglobin. The combination of transfusion and chelating therapy has dramatically extended the life expectancy of thalassemic patients. OBJECTIVE: This study is to determine the prevalence of diabetes mellitus and association of some factors with impaired glucose tolerance test in transfusion dependent β- thalassemia major. PATIENTS AND METHODS: A case-control study done on patients attending blood disease center in Ibn-Al-Balady hospital from 1st of July to 31st of October 2011. Data collected from 287 thalassemic patients (being attended the hospital for regular follow up and blood transfusion) and their relatives which included age, sex, height, weight, history of splenectomy, family history of DM, hepatitis B or C infection, serum ferritin level and an oral glucose tolerance test. RESULTS: It was found that 9.7% of β- thalassemic patients had impaired glucose tolerance test and 1.1% were diagnosed with diabetes, 32.7% were splenectomized, 38.3% had viral hepatitis infection, mean serum ferritin in those older than 20 years was 5923±1033µg/l and 16.8% had family history of diabetes. CONCLUSION: Increased serum ferritin concentration, splenectomy and viral hepatitis infection are associated with abnormal glucose tolerance in patients with blood transfused b-thalassemia. Aggressive iron-chelating therapy and prevention and treatment of viral hepatitis infection were warranted.


Article
The Clinical Significance of Interleukin-15 and Interleukin -17 in Patients with Rheumatoid Arthritis

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ABSTRACT: BACKGROUND: Rheumatoid arthritis (RA) is a chronic, deforming arthritis that can lead to disabilities and poor quality of life. Cytokines produced by inflammatory cells play a pivotal role in synovial inflammation and joint destruction in rheumatoid arthritis; they are the final mediators and/or regulators of inflammatory process. OBJECTIVE: This study was designed to assess serum IL-15 and IL-17 levels in a sample of patients with RA and to evaluate the correlation between their levels and various clinical, laboratory parameters of RA disease activity and severity. SUBJECTS AND METHODS: A case – control study was carried out from January 2013 till October 2013. It was conducted on 80 RA patients who attended Basra General Hospital outpatient rheumatology clinic. Eighty apparently healthy adults, age and sex matched, were also included as control group. Peripheral blood samples were collected from both patients and controls and used for estimation of serum IL-15, IL-17 and anti-CCP antibodies by ELISA, RF and CRP by slide agglutination test and ESR by Westergren method. RA activity was measured using disease activity score28 (DAS-28). RESULTS: RA patients showed significantly higher serum IL-15 and IL-17 levels than controls (P<0.01). In addition, IL-15 and IL-17 were found to be significantly higher in RA patients with active disease compared to those at remission. No significant correlations were noted between IL-15 serum level and RF, CRP, ESR, anti-CCP but it was significantly correlated with DAS-28, TJC and SJC. Significant positive correlations of serum IL-17 level and ESR, CRP, anti-CCP, DAS28, TJC and SJC were found. Also there was a significant direct correlation between IL-15 and IL-17concentration. CONCLUSION: The current study demonstrated that serum IL-15 and IL-17 levels were significantly higher in RA patients than the controls confirming their important role in the pathogenesis of RA and possible target for future therapy .Ele¬vated IL-17 levels could be considered as a possible indicator of more severe clinical course, This is underscored by relatively strong correlations between almost validated disease activity and severity markers including CRP, ESR, anti-CCP, DAS28, TJC and SJC.


Article
Frequency of Anti Lactoferrin Antibodies in Patients With Systemic Lupus Erythematosus and Rheumatoid Arthriti

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ABSTRACT: BACKGROUND: Lactoferrin is a multifunctional iron-binding protein present in several mucosal secretions as well as in secondary granules of polymorphonuclear leukocytes.Anti-Lactoferrin antibodies, which belong to antineutrophil cytoplasmic antibodies have been described in several immunomediated diseases, including Systemic Lupus Erythematosus and in patients with Rheumatoid Arthritis and others, with conflicting results regarding either their prevalence or clinical associations. OBJECTIVE: Detection of anti-Lactoferrin antibodies in Systemic Lupus Erythematosis and Rheumatoid Arthritis patients and studying its association to disease activity in comparison to healthy controls. PATIENT& METHODS : The study involved 74 Systemic Lupus Erythematosis patients, 40 Rheumatoid Arthritis patients who were referred to Immunological Department in Teaching laboratory Medical City during period of (1st of January – 31st of June) 2011 and 30 apparently healthy individual. Antinuclear antibody, complement C1q, rheumatoid factor and lactoferrin antibody were detected by enzyme-linked immunosorbent assay technique While double stranded DNA was detected by indirect immunofluorescent technique and complements (C3, C4) by single radial immune diffusion. RESULTS: Anti-lactoferrin Ab was detected in 14(18.9%) SLE patients, 4 (8.9%) Rheumatoid arthritis patients. Both C3&C4 levels were decreased significantly in Systemic lupus with positive anti lactoferrin Ab level in comparison to healthy controls( p value 0.024). In this regard Circulating immune complex was positive in 38(51.3%) systemic lupus patients only 12(31.5%) had positive lactoferrin antibody level, (p value 0.004).double stranded DNA was detected in 41(55.4%) Systemic lupus patients only 7(17.0%) of them had positive lactoferrin Ab level. Anti -Lactoferrin Abs showed neither a significant correlation with Rheumatoid factor IgG& IgM ( P value 0.159 ) nor with rheumatoid factor IgA ( P value 0. 857). CONCLUSION: Anti-lactoferrin antibodies could be detected in patients with Rheumatoid Arthritis and more often in patients with Systemic Lupus with significant correlation to decrease complements levels in comparison to healthy control.


Article
The Role of Parity on Some Macroscopical and Microscopical Variables in Placentas of Normal and Preeclamptic Women

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ABSTRACT: BACKGROUND: The placenta is a dynamic organ, throughout gestation, it continuously undergoes different changes in structure and function to support the prenatal life. The anomalies of the placenta are usually associated with pregnancy complicated diseases which could lead to fetal complications. Hence, a careful examination of placenta in-utero as well as post-partum provides much insight into the prenatal health of the baby and the mother and can give information which could be useful in the management of complications in mother and the newborn, especially in a community like ours, where antenatal mothers still come unbooked to the labour room. OBJECTIVE: The aim of the present study was designed to elicit some morphometrical variables of delivered placentas ( both gross and microscopic) in normal and preeclamptic pregnancies with regard to the role of parity (birth order) as a physiological change in women's life that may affect placental morphometrical variables. PATIENTS AND METHODS: A total of twenty- four placentas were freshly collected. They were grouped into two major groups (normal and preeclamptic) and each group was further subdivided according to parity into primi and multi subgroups (6 placentas for each subgroup). The placentas were grossly examined for (shape, insertion of umbilical cord,diameter and central thickness). Then tissue samples were fixed, processed , sectioned and stained by heamatoxylin and eosin stain to study the following microscopical variables as number of (villi, syncytial knots and fetal capillaries) . RESULT: Studying placentas had circular to oval shape. The percentage of central insertion of umbilical cord was increased in control group, mainly in multi one. While marginal insertion was increased mainly in primi preeclamptic. There was a significant reduction in diameter of placentas of preeclamptic group, mainly at primi. The placental thickness was significantly increased in preeclampsia. Statistical analysis for histomorphometrical variables had got an increased in number of villi, syncytial knots and fetal capillaries with preeclampsia and parity. The number of fetal capillaries was significantly increased with preeclampsia (mainly in primi subgroup). CONCLUSION: In our study, the definite changes in macroscopical and microscopical variables in placentas of normal and preeclamptic women could be attributed to placental insufficiency especially in preeclamptic group and this may be a compensatory repair mechanisms to factors like hypoxia in order to provide better fetal growth.


Article
Survey of Human Papilloma Virus 18 in Breast Epithelium of Iraqi women Using In situ Hybridization Technique

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ABSTRACT: BACKGROUND: There is an increasing evidence suggesting that high-risk human papilloma virus (HPV) was involved in cancers other than cervical cancer. A number of reports have identified HPV DNA in breast tissue and breast cancer specimens, suggesting that the virus could play a role in the pathogenesis of this tumor. Therefore, OBJECTIVE: was directed towards the use of In situ molecular methods to localize the virus in mammary gland tissue. In addition, this study investigated the prevalence of high-risk HPV18 infections in Iraqi women with and without ductal carcinoma of the breast. PATIENTS AND METHODS: Twenty night cases of ductal carcinoma patients and 44 controls obtained from adjacent area to benign breast lesions. Formalin fixed, paraffin embedded specimens were used by In situ hybridization technique for detection of HPV18 subtype. Data analysis was performed by SPSS 20 software using descriptive statistics and Chi-square tests. RESULTS: The HPV18 were identified in 65.5% and 20.5% of the ductal carcinoma and control breast tissue specimens respectively. Statistically, the difference between the normal and ductal carcinoma cases were highly significant (P=0.001 CONCLUSION: Statistically, In situ hybridization revealed a significant increase of HPV18 in cases of ductal carcinoma (DC) (65.5%) when compared to their controls (20.5%) . Most HPV were localized in the nuclei of integrative form. HPV18 were detected in skin and mammary tissue of both ductal carcinoma and control cases. This may indicates that HPV18 has a role in ductal carcinoma pathogenisis.


Article
Corneal Specular Microscopy Changes in Type II Diabetes Mellitus

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ABSTRACT: BACKGROUND: Corneal endothelial cells count and shape are vital in keeping corneal transparency with normal vision. Diabetes mellitus is associated with significant changes in the corneal endothelium. OBJECTIVE: To compare corneal endothelial structure and central corneal thickness (CCT) between type II diabetics and non-diabetic control patients. METHODS: Specular microscopy was used to measure central corneal thickness (CCT), average size of endothelial cells, standard deviation of cell size and coefficient of variation in cell area (CV), endothelial cell density, as well as hexagonality of 260 eyes from 260 patients ( 130 eyes from type II diabetic patients and 130 eyes from non diabetic controls). RESULTS: The diabetic corneas have a significant increase in average size of endothelial cells (410.4 ± 89.6 µm² vs. 382.3 ± 83.4 µm²)(p <0.05 ), standard deviation of cell size (152.2 ± 38.0 µm² vs. 128.7 ± 19.5 µm²)(p <0.05) and coefficient of variation (CV) (38.3 % ± 5.4 % vs. 33.4 % ± 4.4%)(p<0.05). and a significant decrease of endothelial cell density (2570.7 ± 563.1 cells / mm² vs. 2704.1 ± 572.5 cells / mm²)(p <0.05) and hexagonality (48.3 ± 17.1% vs. 56.5% ±15.6%)(p<0.05). There was no significant difference in central corneal thickness(CCT) (516.3 ± 63.4 µm vs. 512.8 ± 61.7µm )(p >0.05). CONCLUSION: Type II diabetes associated with a significant changes in the corneal endothelium including, reduction of endothelial cell density, increased variation of cells shape (pleomorphism) and increased variation of cells area (polymegathism). There was no significant changes of central corneal thickness (CCT).


Article
A Review of 277 Cases of Patients with Chest Trauma in the Medical city Teaching Complex

Authors: Abdulameer Mohsin Hussein
Pages: 599-605
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ABSTRACT: BACKGROUND: Thoracic trauma is one of the leading causes of morbidity and mortality in developing countries. It represents 50% of all traumas. They are the cause of 25% of trauma deaths. OBJECTIVE: Describing the incidence, association with other injuries, understand the mechanism of common fatal injuries in chest trauma, diagnosis and operative morbidity and mortality. PATIENTS AND METHODS: A retrospective study of 277 patients, victims of chest trauma between August 2009 and August 2011 in Ghazi Al-hariri teaching surgical specialties hospital – Department of thoracic and vascular surgery/ medical city teaching complex. The records of all patients were reviewed and data were collected retrospectively. Management and follow up of the patients during hospitalization were evaluated. According to management patients were divided into two groups (conservative and surgical). RESULTS: Of 277 patients involved in this study 244(88.08%) of them were male and 33(11.91%) were female, with female /male ratio: (1/7.33). The majority of patients were in their third decade of life 100(36.10%) from 21-30 years. Penetrating chest trauma was seen in262 (94.58%) of the total number, 11(3.97%) had blunt chest trauma and 4(1.44%) had blunt and penetrating chest trauma. Bullets or shells in 205(74%), were the commonest penetrating injury, and commonest blunt trauma cause was blunt object in 8(2.88%) patients whereas 3(1.08%) patients due to RTA. The associated traumas were seen in 40.4% and the commonest one was limbs trauma in 57(20.57%) patients. The majority of the patients 219(79.06%) arrived to the hospital within hours of the injury mainly the first 4 hours. 190(68.59%) patients were treated as emergency cases and 87(31.40%) as cold cases. Chest x-ray performed to the all patients and the main radiological findings were haemothorax in 172 (62.1%). Conservative treatment in 37 (13.35%) patients and surgical treatment in 240 (86.64%) patients. The main Indication for thoracotomy was an initial drain more than 1500ml in 17(6.13%) patients, lung injuries were the commonest operative finding 29(10.46%). Hospital stay ranges from 1 day to 1 month and most of the patients 187(67.5%) discharged within the first 5 days of admission. Morbidity was seen in 19(6.85%) patients, wound infection was the commonest seen in 6(2.16%) patients, wound infection in 6(2.16%) patients, atelectasis in 5(1.8%) patients, respiratory distress syndrome in 4(1.44%) patients, CVA in 1(0.36%) patients, stress ulcer in 1(0.36%) patients, postoperative bleeding in 1(0.36%) patients and post intubation tracheal stenosis in 1(0.36%) patient. The overall mortality were 10(3.61%) patients, 2(0.72%) of them died perioperative were both of them they had associated injuries namely cardiac and central vessel injury respectively. All the 10 patients were male and the type of injury was penetrating in all. 8 out of 10 died had associated injuries. CONCLUSION: Penetrating chest injuries resulting from violence are the major public health problem in Iraq and bullets or shells are the commonest cause. Chest X-ray is diagnostic in most of cases. Associated injury should be carefully considered in the medical response strategies. The majority of patients with simple chest injuries can be managed by tube thoracostomy. Mortality is common with penetrating chest injuries.


Article
Metastatic Solid Pseudopapillary Tumor of the Pancreas: A Case Report

Pages: 606-611
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ABSTRACT: OBJECTIVE: To report a case of Metastatic Solid Pseudopapillary Tumor of the pancreas (SPTP), in young age female patient after one year of distal Pancreatectomy, discovered during regular follow up, with review of literature

Table of content: volume:13 issue:4