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: 2015 volume:14 issue:2

Article
Do All Anterior Cruciate Ligament Tears Need Reconstruction?

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ABSTRACT: BACKGROUND: Anterior cruciate ligament (ACL) injury is common among active individuals, and mostly associated with other complex injuries in the knee. ACL reconstruction is vital for normal knee function. The treatment of ACL injuries of knee depend on many factors including Age of the patients, degree of laxity, level of activities and associated injuries . OBJECTIVE: To assess outcome after conservative management of ACL tear. Moreover, determine the patients who need reconstruction, and the best time to perform surgery. PATIENTS AND METHODS: Prospective study of 72 patients who had unilateral ACL tear, 61 males and 11females (age 18-40Y). 56 patients started management with rehabilitation program without reconstructive surgery, 12of them have underwent surgery after that because of unsatisfied outcome. ACLR performed for 28 patients 7 of them were female, complete ACL tear was observed in 21patients. Hamstring graft by one-incision technique were used: same protocol of rehabilitation was followed postoperatively. This study has been achieved in Al Shaheed Ghazi Al Hariri Hospital. RESULT: Average follow up period of 18 months, 78.5% of patient with rehabilitation (no ACLR) had good functional result. While all patients with ACLR have been satisfied where 85% of them return to their activity at level of I and II sport and 97% of quadriceps girth gaining compared to the sound side also observed at the end of follow up period. CONCLUSION: Not all ACL tear need surgical reconstruction. It is indicated for high-risk life style and repeated attacks of giving way. There is no differences between early and late reconstruction.


Article
Comparison of Plate VS. Nail Fixation for the Treatment of Distal Tibial Shaft Fractures in a Sample of Trauma Patients

Authors: Ali A. Ali
Pages: 172-178
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ABSTRACT: BACKGROUND: Fractures of the distal third of the tibia are the major cause of morbidity in patients with lower extremity injuries. Most fractures are sustained in young adults during high velocity injuries. PATIENTS AND METHODS: Forty patients with closed fractures of distal third of the tibia were treated in Al-Yarmouk Teaching hospital between May 2012 and April 2014. 20 patients had been treated with open reduction and internal fixation by heavy-duty plate and screws and were matched to 20 patients treated with closed reduction and intramedullary nailing fixation, with regard to gender, age, and the AO classification of the fracture. RESULTS: There were no significant differences in regard to: time of surgical procedures, non-union, hardware failure or deep infections between plate fixation and intramedullary nailing. Open reduction and plate fixation was associated with higher risk of: delayed union, osteopenia, ankle joint stiffness and algodystrophy. Closed reduction with intramedullary nailing was associated with higher rates of rotational malalignment and knee joint pain/stiffness. The limb length difference was of no clinical significance in all patients. CONCLUSION: Intramedullary nailing is the preferred method for treating closed distal tibial fractures but open reduction and plate fixation may provide superior results in terms of optimal alignment.


Article
Can the Automated Pump be an Alternative to Tourniquet in Knee Arthroscopy?

Authors: Firas Abdalhadi Naser Alobidi
Pages: 179-184
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ABSTRACT: BACKGROUND: Arthroscopic knee surgeries are performed in very large numbers worldwide, and in spite of relatively low complication rate, but the total number is significant. Some of these complications are due to tourniquet use and can be serious. OBJECTIVE: Is to asses if automated pump (with or without) dilute epinephrine saline irrigation can replace the tourniquet use in soft tissue arthroscopic knee surgeries. PATIENTS AND METHODS: 36 patients (9 females 25 % and 27 males 75 %) were included in this prospective experimental nonrandomized study, and were necessitated soft tissue arthroscopic knee surgeries. Patients were divided into two groups, in group A (patients) tourniquet and automated pump were used. In group B (18 patients) automated pump with or without epinephrine irrigation fluid were used. For both groups, visibility, time of surgery, amount of irrigation fluid used, pressure of pump, postoperative pain and hemoglobin level before and after surgery were assessed and compared. RESULTS: There was no significant statistical difference( p value more than 0.05) in regard to visibility, time of surgery, amount of irrigation fluid used, pressure of pump and postoperative pain between the two groups. There was no significant statistical difference between hemoglobin levels before and after surgery in both groups. CONCLUSION: Automated pump (with or without) dilute epinephrine saline irrigation can replace the tourniquet in soft tissue arthroscopic knee surgeries.


Article
The Role of Autospreader Flap in Primary Rhinoplasty

Authors: Sabir Osman Mustafa
Pages: 185-191
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ABSTRACT: BACKGROUND: A spreader flap, or autospreader flap, is a flap used for dorsal reconstruction in primary rhinoplasty after cartilage dorsum excision. In a primary rhinoplasty that requires a humpectomy, the dorsal aspect of the upper lateral cartilages is commonly discarded. Many of these patients need spreader grafts to reconstruct the middle third of the nose. However, it is possible to reconstruct the upper lateral cartilages into “spreader flaps” that act much like spreader grafts. OBJECTIVE: To evaluate the efficacy of autospreader flap for midvault reconstruction after humpectomy in primary rhinoplasty. PATIENTS AND METHOD: This prospective study was done on 124 patients in Erbil, from February 2010 to Jan. 2014. All patients who underwent primary rhinoplasty and requiring humpectomy are included in this study. A tunnel is created on the underside of the upper lateral cartilage, which is released from the cartilaginous septum and also from its attachment to the nasal bone. It is then rolled on itself to make a spreader flap, which is secured with sutures. Scoring along the dorsal edge of the upper lateral cartilage may be necessary in thick cartilage. The flap is then secured to the dorsal edge of the reduced dorsal septum. Data were entered and analyzed using the statistical package for social sciences SPSS version (18). RESULTS: In 124 patients who underwent an open approach rhinoplasty (44 patients were male and 80 patients were female), the autospreader flap almost always reconstructed the middle third of the nose. It was easy to execute in the open approach. At surgery, seven patients needed spreader grafts because the flaps were too narrow. Postoperatively, twelve patients exhibited inadequate nasal width. CONCLUSION: Autospreader flap is a suitable technique for restoration of midvault after humpectomy in primary rhinoplasty. The application of autospreader flap allows the surgeon to reconstruct the internal valve and design an aesthetically pleasing dorsal nasal line.


Article
Accuracy of Fiberoptic Nasopharyngoscopy in the Diagnosis of Pharyngolaryngeal Diseases

Authors: Ragheed Turky Miteab
Pages: 192-196
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ABSTRACT: BACKGROUND: In recent years, flexible laryngoscope is a major contribution to endoscopic technique and is a standard method in diagnosis of many laryngeal and pharyngeal diseases. OBJECTIVE: To show the accuracy of flexible fiberoptic endoscope in the diagnosis of laryngeal and pharyngeal disorders in comparison with direct laryngoscopy PATIENT AND METHOD: A prospective study conducted at otolaryngology department, Surgical Specialties Hospital, Medical City, Baghdad between Feb.2008 and Feb. 2009 with fifty patients were included in the study. All patients with laryngeal or pharyngeal symptoms were examined by flexible fiberoptic endoscope and direct laryngoscope under general anesthesia. RESULTS: Male to female ratio was 1.8:1; dysphonia was the main chief complains in 66% followed by dysphagia in 16%. The commonest finding of flexible fiberoptic endoscope was laryngeal mass in 58% patients followed by impaired or immobile vocal cords in 18%. The accuracy of flexible fiberoptic endoscope in diagnosis of pharyngolaryngeal disease was 76% while of the direct laryngoscope accuracy was 92%. CONCLUSION: Flexible fiberoptic endoscope is vital instrument in outpatient clinic especially when indirect laryngoscope is unsatisfactory, but don’t supplant direct laryngoscopy specially when biopsy is indicated.


Article
Effect of Shock Wave Frequency on Treatment Outcomes in Patients with Renal Stone Treated by Extracorporeal Shock Wave Lithotripsy

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ABSTRACT: BACKGROUND: since the introduction of ESWL in treatment of renal stones, it remained the first option for most renal and ureteric stones, with a success rate ranging from 60% to 90%. Multiple variables can affect treatment outcome, including those related to the machine, dose administered, and factors related to the patient; the exact role of most of these factors is still under study. OBJECTIVE: We investigated the effect of shock wave frequency on treatment outcomes in terms of success and complication rates. PATIENTS AND METHOD: 139 patients with radio-opaque renal stones, presented to the Urology consultancy clinic during the period June 2010 through January 2012 and decided to undergo ESWL treatment were randomized into three groups, the first group (46 patients) received shock waves at a frequency of 120 waves per minute, the second (47 patients) at 90 w/m, and the third group (46 patients) at 60 w/m. Patients were followed for treatment outcome and appearance of complications at 1 week, 3 weeks, and 6 weeks. Stone free status or insignificant asymptomatic residual gravels of 5mm or less are considered as success. Durations of hematuria and analgesic requirement were the main complications looked for during follow up, while subcapsular and retroperitoneal hematomas were looked. RESULTS: All patients received 3500-4000 shock waves per session at 17-18 KV energy. Success rate was significantly higher in the second and third groups, while the durations of hematuria and analgesic requirement were significantly shorter in groups 2 and 3. There was no significant difference between groups 2 and 3 in all outcome and complication parameters; however, the duration of treatment was significantly longer in groups 2 and 3. CONCLUSION: ESWL efficacy in fragmenting renal stones is significantly improved by decreasing frequency from the standard 120 sw/min to slower rates (90 and 60 sw/min), with significantly decreased analgesic requirement and hematuria durations. There were no significant differences between the 60 and 90 sw/min frequencies. Taking in account the longer treatment duration for the 60 sw/min frequency; the 90 sw/min frequency would be optimal in terms of stone disintegration, complications, and duration of treatment.


Article
The Outcome of Two Modes of Treatments in Patients with Posterior Urethral Valve

Authors: Saad Dakhil Farhan Daraji
Pages: 203-208
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ABSTRACT: BACKGROUND: The obstructive effect of the posterior urethral valve (PUV) can manifest along a spectrum of severity, ranging from disease incompatible with postnatal life to conditions that have such minimal impact that they may not manifest until later in life. OBJECTIVE:: To compare the outcome of patients with PUV underwent both techniques of PUV incision and primary urinary diversion (with a delayed PUV incision). PATIENTS AND METHODS: A prospective and retrospective study of twenty-eight children with posterior urethral valve was conducted. Details of age, presenting symptoms, serum creatinine, ultrasound and Voiding cystographic (VCUG) findings, the presence or absence of vesicoureteric reflux and the type of surgical interventions done were recorded. On the follow-up between 1- 2 year period, the patients were assessed by progression of the clinical state, biochemical analysis and ultrasound of the abdomen. Outcomes of surgery and further surgical intervention also assessed in addition to the assessment of the bladder function for older children. RESULT: The primary treatment of the PUV was with incision of the PUV in 13 cases (46.4%) while the primary treatment with urinary diversion and delayed incision of the PUV was performed in 15 cases (53.3%). A posterior urethral valve incision was cured in 46% of patients, while the primary diversion and the delayed incision operation was cured in 26.6%; Most of the patients (60.7%) still needed further urological intervention. There was no statistical significance between the results of both surgical procedures. Renal impairment and poor bladder function were more common with diversion operation. CONCLUSION: There is no convincing evidence to support any procedure as a way of improving long-term renal function or long-term bladder function. Therefore, urinary diversion is to be considered in selected cases with clear goals and endpoints in mind as it has an important place in the management of boys with PUV.


Article
Laparoscopic Cholecystectomy : Retrieval of the Gallbladder Specimen and Spilled Gallstones, Inside a Sterile Male Condom as an Endobag, Reduces the Septic Complications

Authors: Jawad Kadhim S. AL-Dhahiry
Pages: 209-215
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ABSTRACT: BACKGROUND: During the course of laparoscopic cholecystectomy .the gallbladder specimen and the spilled stones are retieved by the formal endobag , which is not available in Iraq , or directly through the umbilical or the epigastric port .Direct retrieval of the gallbladder specimen and the spilled stones may cause contamination of the port site . OBJECTIVE : To evaluate the safety,cost effectiveness and incidence rates of intraperitoneal and port site infections when using a sterile male condom as an endobag for retrieval of gallbladder specimen and spilled gallstones . METHODS : This is a prospective study performed in AL-Karama Teaching Hospital, Medical College / Wasit University, Iraq .A total of 306 patients, with symptomatic cholelithiasis underwent Laparoscopic Cholecystectomy (LC), were included in this study performed during the period from April 2011 to June 2014. A sterile male condom was inserted through 10 mm epigastric port. The gallbladder specimen / spilled gallstones of every patient were retrieved inside a sterile male condom. Patients less than 15 years old and those with liver cirrhosis, gallbladder carcinoma and obstructive jaundice, were excluded. The follow-up period ranged from 2 to 42 months. RESULTS: Dissected gallbladders / spilled gallstones of the 306 patients; 279 (91.2%) were females and 27(8.8%) were males with a mean age of 39±12.5 SD (range 16-75) years, were safely retrieved through 10 mm epigastric port inside male condoms. Incidental perforation of gallbladders ,during their dissection from the hepatic bed, was observed11(3.6 %) patients. Perforation of the condom during retrieval of the gallbladder specimens/spilled stones occurred in 12(3.8%) patients. This study had no intraperitoneal nor port site infections. No mortality occurred during the follow-up period. CONCLUSION: Use of a sterile male condom as endobag for retrieval of gallbladder specimen and spilled stones is simple, inexpensive and safe technique. It also reduces the intraperitoneal and port site septic complications .


Article
Impact of Weight Loss Achieved Through Gastric Sleeve Surgery with Circulating Level of Ghrelin Hormone in Obese Subjects

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ABSTRACT: BACK GROUND: The epidemic of obesity is a major health problem in the developed world with a great influence on morbidity and mortality. OBJECTIVE: To evaluate serum ghrelin levels achieved through LSG and on insulin resistance and the serial changes of insulin concentration in obese patients following gastric sleeve. SUBJECTS AND METHODS: Twenty four patients underwent LSG with 25 controls were selected. Body mass index (BMI), waist circumference (WC), lipid profile, fasting blood sugar (FBS), glycated hemoglobin (HbA1c), fasting insulin, QUICKI and ghrelin hormone concentrations were measured for controls and patients prior LSG, then one month and three months post-surgery. RESULTS: A significant decline was noticed in BMI, WC, TC, TG, LDL-cholesterol, fasting insulin, and ghrelin, with significant increase in QUICKI in patients undergone LSG with significant differences in all studied parameters between patients and controls. A negative correlation was noticed between ghrelin and BMI in patients before sleeve gastrectomy. CONCLUSION: Ghrelin is a hormone closely linked with obesity taking into account the marked loss in appetite in the period after laparoscopic sleeve gastrectomy.


Article
Lipid Profile in Children with Chronic Renal Failure Undergoing Hemodialysis

Authors: Qahtan M. Ali, Nariman F. Ahmed Azat
Pages: 222-228
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ABSTRACT: BACKGROUND: Dyslipidemia is common in Patients with chronic renal failure undergoing intermittent haemodialysis and is considered a risk factor of cardiovascular disease in these patients. OBJECTIVE: To highlight the lipid profile abnormalities in children with end stage renal disease undergoing maintenance hemodialysis and know whether the hemodialysis duration and frequency of sessions per week has any impact on lipid profile in these patients. PATIENTS AND METHOD: A case-control study which was collected in the dialysis unit of (Al Karama Teaching Hospital, Child's Central Teaching Hospital , Al Kadhumia Teaching Hospital and Ibn Al Balady Hospital) for six months started on 1st June 2013 till the 1st of December 2013. Blood samples were obtained from 40 patients with end stage renal disease undergoing maintenance haemodialysis (2-3 sessions per week) and 40 matched healthy controls and analyzed for serum total cholesterol, low density lipoproteins, high density lipoprotein and serum triglyceride. RESULTS: A statistically significant decrease was found in serum high density lipoprotein level (Mean= 46.40mg/dl ,p < 0.025) in Hemodialysis patients when compared with healthy controls. A significant increase in serum triglyceride content of patients (p < 0.000) was also observed. It was found that improvements in lipid profile results were achieved with the use of more frequent (more than 2sessions of haemodialysis per week). There is no any impact of the duration being on HD on the lipid profile in the study. CONCLUSION: This study found that normal lipid profile is better maintained in patients undergoing adequate haemodialysis, and the frequency of haemodialysis sessions can affect the atherogenic states of the lipid profile which is probably the responsible for high incidence of atherosclerotic heart diseases among these patients.


Article
Prevalence and Risk Factors for Congenital Heart Anomalies Among Hospital Attendees in Mosul City

Authors: Eman Ghanim Sheet Al-Hyali
Pages: 229-236
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ABSTRACT: BACKGROUND : Congenital heart disease (CHD) define as abnormalities of heart structure that originate before birth, they are responsible for more deaths in the first year of life than any other birth defects. OBJECTIVE: To determine the prevalence of the identifiable CHDs and to identify risk factors that may predispose for its occurrence . METHODS: This is a case series hospital based study carried out in IB- IN- Al-Atheer teaching hospital of pediatric in Mosul city. during the period from April 2013 to April 2014 . 460 cases with CHD were compared with an equal number of controls selected from the general population and individually matched for age, sex, and family practitioner Information was obtained by Questionnaire sheets ,medical examination and investigations. RESULT: Out of 75320 attendants, 680 cases were referred to echocardiography unit where 460 cases of CHD were detected, the prevalence was (6.1/1000 patients). Atrial septal defect (42. %), ventricular septal defect was detected (30%) and Patent ductus arteriosus (9.3%) are the most common CHD detected. More than half of cases of CHD (86%) are detected at infancy with female- male ratio of 1.4:1 An association was found between family history, consanguinity and occurrence of CHD. Also an association was found between maternal risk factors such as mothers disease ,drug intake, obesity, smooking during pregnancy. CONCLUSION: CHD is a public health problem among infants and young children and there are many risk factors showed a significant effect on its occurrence such as positive family history, consanguinity and material risk factors during pregnancy So proper and timely counseling, regular antenatal care. folate supplementation especially during the most sensitive period of embryogenesis is essential to avoid congenital heart malformation


Article
Troponin Positive Acute Coronary Syndrome with and without Significant Stenosis on Coronary Angiography

Authors: Mohammed Hilal AL-Ali --- Hassan A. Farhan
Pages: 237-243
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ABSTRACT: BACKGROUND: Occasionally, coronary arteries without significant stenosis are observed during invasive treatment of acute coronary syndrome (ACS). OBJECTIVE: The aim was to study the frequency and to determine the most predictive factors of Troponin positive ACS without significant Stenosis on angiography. METHODS: The study involved one hundred twenty four patients admitted with Troponin positive ACS who underwent cardiac catheterization during hospitalization. The primary end-point was the estimation of coronary arteries without significant stenosis, and the secondary end-point was analysis of the most predisposing factors. In evaluating the primary end-point, the patients were divided into two groups according to the presence of ST elevation myocardial infarction (STEMI) or not. Also the patient who has no significant coronary artery Stenosis (< 50%) was subdivided to two groups: a- Myocardial Infarction with No critical lesion in Coronary angiogram (MINC) b- Normal coronary angiogram RESULTS: Overall, 20 patients (16%) had coronary arteries without significant lesions, from which 8 patients (6.4%) had MINC and 12 patients (9.6%) had normal coronary angiogram. The predictors were: female sex (P=0.008), age <45 years (P=0.001), and the absence of: diabetes (P=<0.001), hypertension (P=0.005) and absence of ST-segment elevation (P=0.001). Furthermore absence of regional wall motion abnormality (RWMA) is considered as another predictors for non-significant coronary artery lesion (P=0.008). Also the angiographic analysis of all lesions revealed that single vessels CAD are the commonest finding in Group I patients (P= 0.02). We further analyzed a suspicious angiographic lesions by using QCA {18 lesions (14.5%)} and FFR {6 lesions (4.8%)} technique. CONCLUSION: Overall, patients with Troponin positive ACS had non- significant coronary artery Stenosis on angiography, and female sex, age <45 years and the absence of diabetes, hypertension, ST- segment elevation or RWMA were all associated with coronary angiography showing no significant stenosis.


Article
Early Clinical Outcome of Urgent Coronary Artery Bypass Grafting at the Iraqi Center for Heart Diseases

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ABSTRACT: BACKGROUND : Coronary artery bypass grafting (CABG) can be divided according to it's timing into:elective, urgent, emergency and salvage.The purpose of urgent CABG is to reperfuse the coronary artery blood flow rapidly, improves areas of myocardial ischemia, repair ventricular dysfunction and prevent the spread of the infarction area. Urgent CABG has a higher morbidity and mortality than elective CABG. OBJECTIVE: The purpose of this study was to identify preoperative and peroperative risk factors associated with this morbidity and mortality, evaluate clinical outcomes and recommend the possible solutions. MATERIALS AND METHODS: This is a retrospective study that reviewed the hospital records of 50 patients who underwent urgent CABG at the Iraqi Center for Heart Diseases for three years (2008-2010). The main daignostic tools were coronary angiography and echocardiography. All underwent conventinal CABG on cardio-pulmonary bypass with cardioplegic arrest. Variables that may be related to operative risk were analaysed. RESULTS : Forty-three patients underwent isolated CABG, while six patients underwent postinfarction ventricular septal defect repair and one patient underwent mitral valve replacement in addition to CABG, Postoperative mortality was 20%. CONCLUSION: The most common cause of mortality was Low Cardiac Output Syndrome followed by Acute Renal Failure.Preoperative risk factors for perioperative mortality were age more than 65 years, preoperative cardiogenic shock and low ejection fraction below 40. KEYWORDS: urgent CABG, postinfarction VSD, low cardiac output syndrome.


Article
The Role of Gender in Early Onset Relapsing Remitting Multiple Sclerosis

Authors: Hasan Azeez Al-Hamadani
Pages: 250-257
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ABSTRACT: BACKGROUND: Multiple sclerosis is an autoimmune inflammatory demyelinating disorder of the central nervous system. Multiple sclerosis is now universally found to be more prevalent in women than men OBJECTIVE: The aim of the study is to clarify the role of gender in early onset multiple sclerosis PATIENTS AND METHODS: This retrospective study was conducted in the multiple sclerosis clinic archive system in the Medical City Hospital in Baghdad, Iraq. Data collection was carried out between March 2008 and March 2009. The patients diagnosed to have relapse remitting multiple sclerosis according to the revised McDonald’s diagnostic criteria for multiple sclerosis, and onset of disease must be before the eighteenth birthday. For each patient, the following information was gathered: age, gender, date of onset, and date of second attack, presenting symptom, and extended disability status scale and the date, and type and location of MRI lesions. A p-value <0.05 was considered the cutoff point to determine significant findings. RESULTS: Forty-eight of the patients where females (62.3%) and 29 patients where males (37.7%), with a female: male ratio 1.6:1. No significant difference was found regarding distribution of gender in each age group, and no significant difference was found when age at onset was compared between males and females, although in male patients a shift to children and a shift at adolescence in female were observed The comparison of different radiological sites between males and females shows a significant difference with more males having infratentorial lesions compared with females (P=0.033). No significant difference was found between the two genders regarding, age at onset the presenting symptom, mode of onset and no significant difference was found when interval between the first and second attack was compared between males and females. CONCLUSION: Female preponderance was highest for subjects with disease onset at adolescents. No significant difference was found when age at onset was compared between males and females, although in male patients, a shift to children and a shift at adolescence in female were observed. A significant difference in the time, between first and second attack between males and females. A significant difference in the MRI findings was the finding that males had a higher incidence of infratentorial lesion than females.


Article
Lung Cancer in Non- Smoker Patients in Baghdad Teaching Hospital

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ABSTRACT: BACKGROUND: Despite the predominance of tobacco smoking as its presumed etiology, lung cancer is also a significant health problem in those with no history of smoking. OBJECTIVE: To assess the clinical and epidemiological characteristics of lung cancer in non smokers patients. PATIENTS AND METHODS: This was a retrograde across-sectional study conducted at Baghdad teaching hospital during the period from 14th February 2012 to 8th January 2013. Including 100 patients with proved lung cancer all were never smokers.Medical records of those patients were revised, data were collected regarding sociodemographic characteristics of patients and medical history in addition to the clinical characteristics. Data analyzed with SPSS software, and the results were presented in tables and figures accordingly. RESULTS: In the current study 100 patients with different types of lung cancer were included, all were never smoker. Female gender was more common than males .In this study majority of the cases were aged 60 years and more.The prevalence of passive smoking among studied group was (39%),Urban residence was the dominant, 74%. On X-ray examination all the patients had positive findings; (99%) had unilateral findings and only one with bilateral.Adenocarcinoma was the predominant type, (51%) of the cases, which is much higher than the prevalence of other types. Adenocarcinoma was significantly predominant among females than males (64.7%) vs. (35.3%) respectively, P= 0.003. majority of the cases were of stage IV (78%) and stage III (22%), this reflected the late presentation of the patients.Vast majority of dead cases (96.5%) were died within 2 years, and only 3 patients were survived for three years while none of the cases were survived for more than 3 years. CONCLUSION: The prevalence of lung cancer in non smoker women was higher than in men. In this study the prevalence of lung cancer seemed to be increased with the advancing age. Passive smoking was an important risk factor for lung cancer in more than one third of studied group, and women were more likely to be affected.


Article
Growth Retardation in β-Thalassemia Major

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ABSTRACT: BACKGROUND: Thalassemia is an inherited autosomal recessive blood disease caused by genetic defects result in reduced rate of synthesis of one of the globin chains that make up hemoglobin. The combination of transfusion and chelating therapy has dramatically extended the life expectancy of thalassemic patients. OBJECTIVE: The objective of this study is to determine the factors associated with short stature in thalassemic patients and main endocrine complications. PATIENTS AND METHODS: A case-control study was performed prospectively in Ibn-Al Balady hospital in (Al- Sader city-Baghdad- Rasafa) for the period extended from the 1st of January to 31st of May (2013). Data were collected from 181 thalassemic patients, their ages were 10 to 20 years old being attended the hospital for regular follow up and blood transfusion. The control in this research work was one of the patients' relatives with the same age after thalassemia was ruled out in the control. Data collected in this study included: age, sex, height and weight were assessed by the National Center of Health statistics (NCHS) growth curves , history of splenectomy, times of blood transfusion , hepatitis infection, type of chelating agent. Serum ferritin, hormones level, fasting and random blood sugar and serum calcium were estimated. RESULT: It was founded that 79% of the β-thalassemic patients had short stature (their height equal or less than5rd percentile) with significant relation with high serum ferritin (P-value=0.006). Delayed puberty was the commonest endocrine complication in thalassemic patients (83.9%). CONCLUSION: High serum ferritin is associated with growth retardation and many endocrine complications . Aggressive iron-chelating therapy and regular measurement of hormones concentration are necessary for thalassemic patients mainly during puberty to avoid growth retardation.


Article
The Correlations between JAK2V617F Mutational Status and Serum Levels of Folate and B12 in a Group of Patients with Chronic Myeloproliferative Neoplasms

Authors: Haithem Ahmed Al-Rubaie
Pages: 274-280
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ABSTRACT: BACKGROUND: The Philadelphia-negative classical chronic myeloproliferative neoplasms are characterized by proliferation of one or more cell lines in the bone marrow and increased number of mature and immature cells in the peripheral blood. These myeloproliferative neoplasms include; polycythemia vera, essential thrombocythemia and idiopathic myelofibrosis, in which JAK2V617F is by far the most prevalent mutation. Because of the rapid turnover of cells in these neoplasms, derangement in the serum levels of vitamin B12 and folate is expected. OBJECTIVE: To assess the possible correlation of serum B12 and folate levels with JAK2V617F mutation in patients with polycythemia vera, essential thrombocythemia and idiopathic myelofibrosis. PATIENTS AND METHODS: This case-control study was conducted from December 2012 to December 2013, and enrolled 54 patients, diagnosed as polycythemia vera (36), essential thrombocythemia (6) and idiopathic myelofibrosis (12), attending Medical City, Baghdad Teaching Hospital. Twenty healthy volunteers were included as a control group. JAK2V617F mutation status had been reviewed at time of sampling. The following investigations were done: automated complete blood counts; serum B12 and folate were measured using the electrochemiluminescence immunoassay. RESULTS: The mean levels of serum B12 and folate were much higher in myeloproliferative neoplasm patients than control group (p-value of 0.028 and 0.004 respectively). Serum B12 level showed significant difference between polycythemia vera patients with positive JAK2V617F and negative mutation (p= 0.04), while no significant difference was found for serum folate level (p= 0.630). Insignificant differences were also found for idiopathic myelofibrosis patients (B12, p= 0.140; and serum folate, p= 0.098), and essential thrombocythemia patients (B12, p= 0.133; and serum folate, p= 0.800). Correlations of serum folate and B12 with hematocrit, white blood cell count, absolute neutrophil count, platelet count, mean cell volume, and mean cell hemoglobin in myeloproliferative neoplasm patients: significant correlations were only found in PV patients between B12 and total white blood cell count, absolute neutrophil count and platelet count (p= 0.009, 0.012 and 0.002 respectively). CONCLUSION: There is derangement in the levels of serum B12 in patients with polycythemia vera in relation to JAK2V617F mutation, thus we may propose that this mutation may have a possible impact on polycythemia vera patients, in particular, reflected by higher levels of serum B12 through the associated increase in absolute neutrophil count.


Article
Study of Pseudomonas Areuginosa Proteases Enzymes in Corneal Ulceration by Using Real - Time PCR

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ABSTRACT: BACKGROUND: Pseudomonas aeruginosa (P. aeruginosa) is the most frequently isolated bacteria in clinical cases of ulcerative keratitis. P. aeruginosa produces several proteases and toxins, the best characterized being exotoxin, elastase, alkaline protease and IV. These are all important factors in the establishment of bacterial infection and the amount of damage caused by the infection to the cornea. OBJECTIVE: The aim of the present study was to study the role of P. aeruginosa proteases ( elastase ( LasB) , LasA, Alkaline protease, and protease IV ) in corneal ulceration by using Real - time PCR. METHODS : One hundred - twenty clinical samples (corneal scraping) were collected from patients suspected with bacterial keratitis presenting to Ibn –Alhaytham Teaching Hospital from May 2013 until November 2013. Methods for isolation and identifying P. aeruginosa based upon culture coupled with biochemical tests and confirmed by new technique called Vitek 2 compact system. The role of proteases enzymes ( elastase ( LasB), LasA, alkaline protease and protease IV ) of P. aeruginosa in the corneal ulceration was studied by Real – time PCR. RESULTS : Real time aalysis demonstrated that three bacterial isolates of P. aeruginosa were possessed elastase gene (11.5%), one bacterial isolate was harbored LasA gene (3.8%), twenty bacterial isolates were possessed protease IV gene ( 76.9%) , and all bacterial isolates were possessed alkaline protease gene (100%). CONCLUSION: The presence of the alkaline protease and protease IV genes in almost bacterial isolates of P. aeruginosa improved the fact that these enzymes were not only tissue damaging but also very important colonizer agents to cornea.


Article
Effect of Hand Deformities on Hand Function in a Sample of Patients with Rheumatoid Arthritis

Authors: Khudair Z. Al-Bidri --- Mohammed S. Al-Omran
Pages: 288-295
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ABSTRACT: BACKGROUND: Rheumatoid arthritis (RA) is a chronic systemic autoimmune inflammatory disease that commonly affects the small joints of the hands and feet, and results in irreversible joint damage, deformity, and functional impairment. Hand function is an important domain of the health status of RA patients. Assessment of hand function, therefore, is an essential part in the follow-up of RA patients and in gauging their response to treatment. Numerous measures were developed to evaluate the hand function. One widely accepted measure includes simple clinical tests: Key grip, ball grasp, pen grasp, pinch grip and grip strength. OBJECTIVE: This study aims to determine the effect of hand deformities on hand function in a sample of patients with RA. PATIENTS AND METHODS: A cross-sectional study was conducted on 116 randomly selected patients fulfilling the 2010 ACR/EULAR criteria for Classification of RA. Patients with other conditions that can affect the hand function were excluded. Patients were evaluated for age, hand deformities and Disease Activity Index (DAS28). A novel score was used to combine all hand deformities into one value. Hand function was assessed by 3 subjective tests (key grip, pen grasp and ball grasp) and 2 objective tests (pinch strength and grip strength, measured by specialized dynamometers). RESULTS: Objective hand function tests (mean grip strength and mean pinch strength) had significant moderate negative correlations with the score of hand deformities (p<0.001, r=-0.459 or better), while the mean ranks of impairment of subjective hand function tests (key grip, pen grasp and ball grasp) showed significant weak positive correlations with the score of hand deformities (p=0.002 or less, r=0.283 or more). CONCLUSION: The presence and degree of hand deformities are significantly associated with poor hand function in patients with rheumatoid arthritis.


Article
Validity of the Ratio of Serum Concentration of Interleukin 6 to Transforming Growth Factor-Beta1 in a Sample of Patients With Rheumatoid Arthritis

Authors: Nizar Abdulateef Jassim
Pages: 296-301
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Abstract

ABSTRACT: BACKGROUND: Interleukin 6 (IL-6), a pro-inflammatory cytokine, plays a key role in the development of rheumatoid arthritis (RA). Transforming growth factor-beta1 (TGF-β1) is an anti-inflammatory cytokine which is considered to be an important (down) regulator of inflammation in RA. OBJECTIVE: To evaluate serum concentration of IL6 to TGF-β1 ratio in a sample of Iraqi patients with RA. METHODS: A case control single center study was conducted for 11 months. A total of 50 patients with RA diagnosed according to the 1987 American College of Rheumatology (ACR) and 30 individuals matched in age and sex as control group were included. Serum concentration of IL-6 to TGF-β1 ratio and serum IL-17 were determined in both RA groups using enzyme-linked immunosorbent assay (ELISA). The cut off value was assessed by receiver operating characteristics (ROC) test and correlation by spearman's Rholinear correlation coefficient. RESULTS: Frequency of females was more than males in patients and controls (88% and 76.7% respectively). Ages of patients range between 20-70 years with a median 43.76 years while in controls, ages range between 20-60 years with a median 37.67 years. Serum concentration of IL-6 toTGF-β1 ratio was significantly more in patients than those in controls (p=0.018). Area under the curve (AUC) at value 0.686 was statistically significant (p=0.018) and had intermediate accuracy. Serum IL-6 to TGF- β1 ratio≥ 2.4pg/ml was the optimum cutoff value that can differentiate between RA and healthy controls with accuracy 71.9%. There was a significant positive linear correlation between IL-6 to TGF-β1 ratio and IL-17( r=0.56, p<0.001) and simple linear regression analysis showed that for each 1unit increase in IL6 to TGF-B1 ration there was a significant increase of 0.7 pcg/ml in IL-17(R2=0.467, P < 0.001) CONCLUSION: Serum concentration of IL6 to TGF-β1 ratio was significantly higher in Iraqi sample of RA patients compared to controls. This may help in early diagnosis of RA and suggest potentially an early effective treatment.


Article
Leptin Levels in Women with Uterine Leiomyomas

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Abstract

ABSTRACT: BACKGROUND: Uterine leiomyomas are important, common pathological conditions that impose a major healthcare burden. Leptin, a product of the obese (Ob) gene, is produced predominantly in adipose tissue and expressed in several tissues and organs and in myomas and the surrounding myometrium. OBJECTIVE: To assess serum leptin levels in women with and without uterine leiomyomas. METHODS: This prospective case- control study was carried out on ninety women in their reproductive age. They were divided into two groups; the study group consisted of 45 women with uterine leiomyomas proved by histopathology after operation, and a control group consisting of 45 healthy women without uterine leiomyomas proved by ultrasound examination. Body mass index (BMI) was calculated in all women. Blood samples were collected from all women in both groups in the proliferative phase of their menstrual cycle. Hemoglobin, blood urea nitrogen, serum creatinine, fasting blood sugar and serum leptin levels were examined. Serum leptin levels were determined by Radioimmunoassay and compared in myomatic and normal women. RESULTS: The mean serum leptin levels were significantly lower (p=0.0001) in the myomatic women (7.57± 2.88 ng/mL) than in the normal women (9.56± 1.77 ng/mL). The mean ratios of serum leptin levels / body mass index in the myomatic women (0.267± 0.09) were significantly lower (p=0.0001) than in the normal women (0.34±0.05). In addition, a significant correlation was found between serum leptin levels and body mass index in both the myomatic women (r=0.587, p=0.0001) and the normal women (r=0.608, p=0.0001). CONCLUSION: In myomatic women compared to normal women, the lower serum leptin levels observed were independent of body mass index with no significant up-regulation of leptin production in response to increased adiposity. K


Article

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Abstract

ABSTRACT: BACKGROUND: Coriandrum Sativum is a native of Mediterranean region and is grown in North Africa, central Europe, and Asia as culinary herb and medicament. In addition to the other health-supporting reputation, coriander has hypoglycemic, hypolipidemic, and aphrodisiac effects. OBJECTIVE: To study the effect of Coriandrum Sativum on process of spermatogenesis. MATERIALS AND METHODS: Coriandrum sativum was given daily to mature male rats in a dose of 50mg/ 100g body weight for 14 days. 10% formalin fixed paraffin-embedded tissue sections were performed for histological and morphometrical studies. RESULTS: Histological study showed wider seminiferous tubules & increased spermatocytes population with an increased sperm density in the lumen of the tubules. Morphometrically, the diameters & thickness of the germinal epithelia of the seminiferous tubules were significantly increased in coriander treated rats than that of the control group. CONCLUSION: Coriandrum sativum appeared to be stimulant to the process of spermatogenesis.

Table of content: volume:14 issue:2