Table of content

Mustansiriya Medical Journal

مجلة المستنصرية الطبية

ISSN: 20701128 22274081
Publisher: Al-Mustansyriah University
Faculty: Medicine
Language: English

This journal is Open Access

About

Mustansiriya Medical Journal MMJ, a semi-annual peer-reviewed journal, is the official Journal of the College of Medicine, Al-Mustansiriya University. The journal was first published during the academic year 2001 - 2002 as the "Journal of Basic Medical Sciences" . Later on, an in order to expand the scope of publication and attract more scientific articles, the editorial board decided in late 2007 to switch the name from “ The Journal of Basic Medical Sciences” to “Mustansiriya Medical Journal”, the official Journal of the Faculty of Medicine at the University of Mustansiriya. The first issue with this new name was published in May 2008.

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Iraq, Baghdad, College of Medicine, Al-Mustansiriya University, P.o.Box: 14132
Tel: 5413485
Fax: 5410584
email: mmj.mcom@yahoo.com

Table of content: 2016 volume:15 issue:2

Article
Management of DDH in children between age of (1-2.5) years old by open reduction & derotation osteotomy without pelvic osteotomy

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Abstract

Background; Developmental dysplasia of the hip (DDH) means femoral head subluxation or dislocation and/or acetabular dysplasia. Management of neglected (DDH) in children after the walking age is challenging to the orthopedic surgeons. It is usually surgically demanding procedures at this age group. There will be always children who reach walking age with DDH, either secondary to failed treatment or delayed diagnosis. Aims: To evaluate the results of open reduction & derotation osteotomy in treatment of DDH in children without pelvic osteotomy. Methods: At the Orthopedic Department in AL-Yarmook hospital from the period of December 2010 to November 2015. Twenty-three patients (3 patients had bilateral DDH) [26 hip joints] with DDH, the age of patients at time of the operation ranged from (12-30) months, treatment done in two stages open reduction (1st stage) and derotation osteotomy of femur (2nd stage), except Five cases, we did open reduction, shortening & derotation osteotomy in one session because of difficulty in reduction. Final functional & clinical evaluation of patients were done according to a combination of modified MacKay criteria and modified Harris hip score. Radiological evaluation at the end of follow-up was done according to the modified Severin radiographic criteria. Results: - The overall final clinical results were excellent in 8 hips (30.8%), good in 16 hips (61.6%), fair in one hip (3.8%) and poor in one (3.8%), satisfactory (excellent and good) in 24hips (92.3%) and unsatisfactory (fair and poor) in 2 hips (7.7%).The radiological end result was Class I (excellent) in 15 hipss (57.7%), Class II (good) in 10 (38.5%), Class III (fair) in one (3.8%). The results were satisfactory in 25 (96%) hips and unsatisfactory in one (4%) hip. Conclusion: We concluded that operative treatment of neglected DDH ( after the age of walking ) is a surgically demanding procedure but when it performed properly by an open reduction & derotation osteotomy with spending good time for cleaning of acetabulum & excise part of capsule with secure capsulorraphy without need for pelvic osteotomy for those children below age of 2.5 years old.


Article
Treatment of hyperhomocysteinemia and pregnancy outcome in patients with recurrent miscarriage

Authors: Esraa H. Humadi
Pages: 9-13
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Abstract

Background; Developmental dysplasia of the hip (DDH) means femoral head subluxation or dislocation and/or acetabular dysplasia. Management of neglected (DDH) in children after the walking age is challenging to the Back ground: During pregnancy hyperhomocysteinemia, can cause damage to the vascular system that support the placental function , and this damage might lead to miscarriage and other adverse pregnancy outcome. Objective: To investigate whether lowering homocysteine level in women with recurrent pregnancy loss and hyperhomocysteinemia can improve pregnancy outcome Patients and Method; this study ,initially include 80 women with history of three or more consecutive miscarriage between 8-20 weeks gestation Those with homocystein level >12μmol/l were include in this study (65women) ,they received folic acid 5mg per oral daily ,vitamin B6 40 mg per oral daily , vitamin B12 1000 μg per oral daily for two 2-3 months . After normalization of homocysteine 55 women completed the treatment course and same treatment was continued during pregnancy, 48 women get pregnancy and involved in this study .All participants were followed during pregnancy for any complications that might develop. Result: out of 80 women 48 women participated in this study, their age ranged from 18-42 years.Pregnancy outcome (alive birth) was significantly improved after normalization of homocysteine level and P value is 0.001. Despite that high incidence of complications still developed the most significantly frequent complications include : 16 patients delivered small for gestational age , 14 pregnancies complicated by pregnancy induced hypertension and preeclampsia, ,8 pregnancies ended with preterm labor ,placental abruption complicated around 6 pregnancies and no congenital abnormality neither still birth were reported in this study. Conclusion: Lowering homocysteine level would significantly improve pregnancy outcome (alive birth ) in women with recurrent pregnancy loss.


Article
Comparative study between two patterns of percutaneous K-wire fixation of supracondylar fracture of the humerus in children

Authors: Mushtaq Talib Hussein
Pages: 14-19
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Abstract

Background: Supracondylar fracture of the humerus is the second most common fracture in children. Failure to execute a appropriate treatment plan for these fractures may lead tovarus malunion. For that closed reduction and percutaneous pinning is the treatment of choice. Percutaneous K-wire fixation can be inserted either in a cross medial-lateral pattern or through a lateral entry only with each method having its advantage and disadvantage. Aim: Is to evaluate the results of two lateral parallel pin fixation versus cross medial lateral pin fixation in displaced supracondylar humerus fracture in children regarding complications (especially iatrogenic nerve injury, cubitus varus deformity), technique and other concepts. Patients and method: Between March 2010 to May2014, forty _ three (38) patients at Al-Yarmouk Teaching hospital were collected from emergency unite and from orthopedic outpatient to undergo surgery for displaced supracondylar fracture humerus (type B , C) according to gartland classification. it was an urgent operation with less than 24 hours, traumatic posterior supracondylar fracture humerus(type B,C) with no vascular or nerve injury for children aged less than 12 years old. They were divided into two groups [Group I(20 patients) closed reduction and percutaneous two lateral parallel k_wire fixation] and[Group II(18 patients) with two cross medial_ lateral k_wire fixation] and we compare the results between the two groups post operatively. Results: There were significant differences(P-value=0.0078)regarding complications postoperatively , there were typical cubitus varus deformity 2{10%} in group I while there were no such complication{0%} in group II, while we report one case {5.55%} with ulnar nerve neuropraxia in group II. Regarding functional results; there were significant differences between the two groups, we reported excellent results 11{55%} in group I, while it was 13{72.22%} in group II, good results were about 5{25%} in group I ,while it was 4{27.77%} in group II, fair results 2{10%} in group I, 1{5.55%} in group II. In addition there were significant poor results in group I as we reported 2 cases{10%} in group I, while there were no such results{ 0%} in group II. Conclusion: Closed reduction and medial-lateral percutaneous K-wire fixation is the treatment of choice for displaced pediatric supracondylar fractures of the humerus with extra precautions during medial wire insertion..


Article
Characteristics of Cerebrospinal Fluid Shunt–Associated Infections in Iraqi Children patients: A Retrospective Analysis over a 2-Year Period

Authors: Mohamed A. Al-Tamimi
Pages: 20-23
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Abstract

Background: Cerebral shunts are commonly used to treat hydrocephalus, the swelling of the brain would be either due to excess of CSF build up or to obstruction of its drainage. Aim: To evaluate the Iraqi paediatric patients with infected shunts, analyzing them according to their age, sex, sort of causative microorganism, clinical presentation and time of infection postoperatively teeming with causes of their hydrocephalus, investigating the etiological causes for their infection. Patients and Methods: In a retrospective study, 23 children 0–12 years of ages who underwent initial CSF ventriculo-peritoneal shunt placement with a discharge dates between January 1, 2001, and December 31, 2002 were identified from Neurosurgical hospital in Baghdad. For every child who developed shunt infection we extracted information from the medical record about patient factors including gender, age at initial shunt placement, sort of infection, causative microorganism and timing between initial CSF shunt and initial infection and analyze them Results: It was revealed that a higher incidence of infection occurred at a young age (<1 year old). The majority of them were shunted at first due to congenital hydrocephalus (with our without myelomeningocele 39.2% and 21,7% respectively). Most of the infection happened in the first week after shunt insertion (47.8%) presenting themselves mostly with meningitis (52.1%). Staphylococcus Epedermidis and Aureus were the most common isolated causative organism. Conclusion: patient factors such as age and pathological cause behind hydroce


Article
Are prophylactic antibiotics justified in pediatric patients with inguinal hernia repair?

Authors: Ali E. Joda
Pages: 24-29
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Abstract

Background: There are different studies highlighting the role of using prophylactic antibiotics in clean surgeries, but still there is conflicting evidence regarding whether prophylactic antibiotics are beneficial or not in preventing post-operative surgical site infection. Aim: This study aims to evaluate the use of peri-operative prophylactic antibiotics in preventing or reducing surgical site infection in the elective open repair of pediatric inguinal hernia. Patients and method: Over a ten-month period a total 150 pediatric patients underwent elective surgical repair for inguinal hernia were enrolled in this randomized prospective study, they were categorized into two equal Groups alternating at the time of operation. The patients in group A (Control) were followed a standard regimen of giving pre-operative parenteral antibiotic (in the ward or at the beginning of anesthesia) & then post-operative oral antibiotics for five days duration, while the patients in group B (Case) underwent the same surgery, but neither preoperative nor post-operative antibiotics were given. A written informed consent from the parents or child guardian was obtained after explanation. The rate of surgical site infection was compared between the two groups. A p value of less than 0.05 was considered to be significant statistically. Results: The total infection rate in both (case and control groups) was 3.33%, the rate of postoperative wound infection in "case group" was 4 % compared to that in "control group" which was 2.67 %. This noticed variance was statistically insignificant (P value by Chi-Square Test = 0.9883, Two –tailed p value using paired samples- t test was = 0.6578). 80% of the infections were mild (grade 1 & 2) & 60% was noticed in the 3rd post-operative day. Conclusion: This study pointed out that peri-operative prophylactic antibiotics are not justified routinely in pediatric inguinal herniotomy as there is no significant increased risk of postoperative wound infection in "group B" compared to "group A" (p value = 0.6578 using paired samples t- test), & this low risk of wound infection does not warrant the economic burden of their usage in such clean surgical operations.


Article
Does fecal continence improve with time after posterior sagittal anorectoplasty for high type imperforate anus?

Authors: Ahmed Zubar Zain
Pages: 30-33
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Background: anorectal malformation represent a spectrum of defects, which may be benign, non complex with a good functional prognosis, to more severe malformations involving the genitourinary system with poor prognosis for bowel and urinary function. Aim: to assess fecal continence after posterior sagittal anorectoplasty (PSARP) with its relation to the post-operative time and to describe the complications of PSARP. Patients and method: this prospective study was conducted in the pediatric surgery department of Al-Kadhymia teaching hospital. The duration of the study was five years from 1st January 2009 to the 31st December 2013.Kelly's methods was applied for assessing the grade of continence after 6 months, one year, and two years after closure of colostomy. Also we describe the complications of PSARP after closure colostomy. PSARP was performed according to Pena method & the results were evaluated after colostomy closure. Results: forty patients with high type imperforate anus were included in this study. They were 25 males (62.5%) and 15 females (37.5%). Genitourinary anomalies were the commonest associated anomalies. There was no accidental defecation in 12 cases (30%) after six months, and 15cases (37.5%) after two years, while there was constant defecation in 4 patients (10%) after 6 months , in 3 patients(7.5%) after 1 year, and in two patients (5%) after two years. Wound infection was the commonest complication and occurred in 8 patients (20%), followed by rectal prolapse in 7 patients (17.5%). Conclusion:Initial poor results should not discourage the surgeon as the condition of the patient and grade of the continence keeps improving as child grows.


Article
Views of Alcoholic Patients' about the Concept of Alcohol Addiction in Ibn Rushed Hospital in Baghdad City

Authors: Siham A. Hamoo
Pages: 34-39
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Background: Alcohol addiction contributes to a high burden on the society in terms of years that people spend with disability or in poor health because of alcohol-related illnesses or injuries. Aim: To describe the socio-demographic characteristics, assess views of alcoholic patients toward alcoholic addiction, to find out the significant variance of views of alcoholic patients' with regard to their demographic characteristics. Patients and method : descriptive analytic study carried out on a purposive “non probability” sample of (30) patients with alcoholic addiction, selected from in-patient in Ibn Rushed Psychiatric Hospital in Baghdad City, from June 2014 to July 2015. A questionnaire is constructed for the purpose of the present study which is distributed across 2 main parts. Part one included the demographic characteristics of the sample, and part two included knowledge about alcohol addiction. The overall items which were included in the questionnaire of this article are 53 items. Validity and reliability of the questionnaire were determined through the review of a panel of experts and the pilot study. Data were collected through the period from 2|8|2014 to 2|9|2014. It was analyzed through the descriptive statistics (frequency, percentage, and mean of score) and inferential statistics. Results: 100% of the sample were male. 36.3% of the sample were age range (40-49), and 6.6% were age 50 to over 60. 56.6% were primary school graduate, no one had advanced education. 60% were married, 76.7% were self-employmenT, and 20% of them had sufficient income. 40% had illegal house ownership. 96.6% was smoker, 73.3% had family history of drinking alcohol, and 80% had alcoholic friends. The patients had little knowledge regarding alcohol addiction (mean of scores =1.65), there was significant association between patients' knowledge with regard to their age groups, level of education, marital status, income, house ownership, while there was no significant association regarding occupational status. Conclusion: the study concluded that there was a low level of knowledge concerning alcohol addiction so education programs should be arranged about alcohol addiction to improve views of people knowledge, believes and attitudes towards alcohol addiction.


Article
Dermatological Diseases among children Attending Al-Yarmouk Teaching Hospital-Outpatient Department of Dermatology

Authors: Kawthar M.Taie --- Rzan A. Al-Battat
Pages: 40-45
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Background: Pediatric age groups are liable for different types of dermatological diseases but very few epidemiological study concentrate upon dermatological diseases in pediatric age group in our locality. Aim: to determine the pattern of dermatological diseases of both types (infectious and non-infectious) affecting Iraqi children attending Al-Yarmouk Teaching Hospital. Patients and method An observational cross-sectional study was carried in Al-Yarmouk Teaching Hospital- Outpatient Department of Dermatology, Baghdad, Iraq; registering the new cases of children aged (1-13) years who brought to the department over the period between 12-1-2009 to 12-6-2009 and excluding infants and follow up cases. The included cases were assessed by history dermatological examination and simple investigation (whenever needed) to achieve the diagnosis. Descriptive and analytical statistics were done to obtain the prevalence and relationship of their diseases to age, sex, order of the child in the family, family history of the same illness, hygienic standers and economic status. Results: Eighty three children included in this study; 37males and 46 females with a male to female ratio of1:1.24Their ages ranged from 1-12 years with mean age of4.8± 3.6 SD. Of them 37.3% have non infectious diseases, 32.5% have infectious diseases; and 30.1%have both infectious diseases and non-infectious in the same child. Of the non-infectious diseases eczema was the most common followed by papulosquamus disorders, pigmentary disorders and other diseases. Of the infectious diseases bacterial infection was the most common followed by the viral, the parasitic and then the fungal infections. There was significant association between eczema and family history of the same illness; also significant association was present between parasitic infestation and number of children sharing the same room.. Conclusion: The noninfectious conditions were slightly higher than infectious conditions; of them eczema was the most prevalent while bacterial infection was the most common among infectious conditions. There was significant association between eczema and family history of the same illness; also significant association was present between


Article
Cross sectional area of umbilical cord as a predictor for neonatal birth weight

Authors: Henan Dh. Skheel Al-Jebory
Pages: 46-51
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Background: In an effort to ameliorate the adverse outcomes associated with traumatic delivery, maternity care professionals continue to search for methods of predicting fetal weight accurately. Aim: This study was designed to clarify the relation between cross sectional area of umbilical cord measured by ultrasound and actual birth weight and compare it with that of hadlock's formula. Patients and method This ; prospective cohort study included 113 pregnant women with uncomplicated, singleton pregnancy and gestational age of 37-42 weeks, admitted with early labor or prepared for elective cesarean section. All were examined by ultra sound, during which fetal anthropometric parameters (BPD, FL, and AC) and cross sectional area of umbilical cord were measured. The estimated fetal weight calculated by Hadlock's formula and by cross sectional area of umbilical cord was correlated with actual birth weight. Results: There was a significant moderate correlation between umbilical cross sectional area with, maternal BMI and neonatal gender, gestational age, but there was no correlation with maternal age, height and parity p.( <0,001) . The umbilical cord cross sectional area and Wharton’s jelly area were found to be moderately correlated with neonatal actual birth-weight, and no significant correlation with umbilical vessels area P (<0.001) The correlation strength of the umbilical cord cross sectional with the estimated birth weight was higher than that by Hadlock’s formula with the value of Coefficient of determinant (R2= 0.3828) for umbilical cord area versus (R20.194 ) for Hadlock's. Conclusion: The cross sectional area of umbilical cord was more accurate in predicting birth weight than fetal anthropometric parameters Bi parietal diameter, femur length and abdominal circumference, (BPD, FL,AC)by Hadlock's formula.


Article
Urinary level of Matrix Metalloproteinase (MMP-9) as a biomarker in cystitis and schistosomal chronic cystitis patients

Authors: Huda Sadoon Jassim AL-Biaty
Pages: 52-55
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Cystitis means inflammation of the bladder, specifically inflammation of bladder wall. Evaluating the level of urinary MMP-9 as a prognostic biomarker in cystitis (schistosomal and non schistosomal) was the aim of the study. Urine samples and bladder biopsies were collected from 50 cystitis patients who were included schistosomal chronic cystitis and non schistosomal cystitis and also from 38 healthy individuals as control. Urinary concentration of MMP-9 was measured by ELISA technique. Specificity and sensitivity of marker were also calculated. The results showed that MMP-9 urinary level was significantly increased in cystitis patients (3842.90pg/ml) compared to healthy (634.80pg/ml), there was a significant differences in the mean levels of urine MMP-9 for different age groups of patients, but non-significant between females and males. MMP-9 was elevated in both schistosomal chronic cystitis and non-schistosomal cystitis patients and this elevation of marker was higher in schistosomal chronic cystitis but with non-significant, also urine MMP-9 showed significant increase in males than females schistosomal cystitis, and statistical differences between age groups. Matrix Metalloproteinase was specific (87.47%) and was more sensitive (93.22 %) in cystitis patients. We concluded that MMP-9 has a role in inflammation processes of cystitis.

Keywords

MMP-9 --- Cystitis --- Schistosoma --- Inflammation --- Urine --- Biopsy


Article
Vascular Endothelial Growth Factor as Predictive Marker for Hypertension in Iraqi Adults Patients

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Background: Vascular endothelial growth factor (VEGF) is considered the most potent angiogenic growth factor for the stimulation of collateral vessel growth in peripheral and myocardial ischemia and other coronary heart disease. Aim: The aim of the present study was first to assess the levels of VEGF in adult subjects with hypertension, second to find any correlation between VEGF and other studied biochemical markers. Patients & Methods: Thirty four adults with hypertension (age mean 34.55 ± 3.79 year) from outpatients of Al-yarmook Teaching Hospitals in Baghdad were selected randomly from March to April 2015. For comparison, (30) normotensive subjects which were matching to patients in age and BMI. VEGF levels were measured. Results: Biochemical parameters include FBG, HDL, and cholesterol, TG, HbA1c and PCV. Anthropometric measurements were also recorded. VEGF significantly higher (p ˂ 0.05) in patients group when compared to healthy group, as well as, significant elevation also shown in FPS, HDL and HbA1c, while TG, cholesterol, Creatinine and PCV not affected. Conclusion: VEGF can be used as diagnostic marker for the hypertension in adult patients.

Keywords

Hypertension --- VEGF


Article
Pharmacological modulation of dendritic cell function by anti-inflammatory dexamethasone but not by GSH depletion

Authors: Bassim I Mohammad
Pages: 60-68
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The principal function of dendritic cells (DCs) is to acquire antigens from the environment and present them to naïve T-cells to initiate an immune response. DCs also provide potent co-stimulatory signals to T-cells through expression of co-stimulatory receptors such as CD40 and CD86. Anti-inflammatory and other drugs that deplete intracellular glutathione (GSH) can affect the immune response. However, it is unclear whether these drugs can modulate DC function. In this study, we evaluated the effects of the anti-inflammatory drug dexamethasone and the GSH lowering compound as buthionine sulfoximine (BSO) on DC function. Mouse bone marrow derived dendritic cells (BMDCs) were generated and treated with dexamethasone or BSO. Expression of the co-stimulatory molecules MHCII, CD86 and CD40 was quantified by flow cytometry. Endocytic and phagocytic capacity of DCs was measured by dextran uptake and necrotic cell phagocytosis respectively. We found that dexamethasone reduces the expression of co-stimulatory molecules both in immature and mature DCs. Dexamethasone had a marginal increase in the endocytic capacity of iDCs but caused a decrease in phagocytic function. Reducing GSH levels did not affect co-stimulatory molecules expression, endocytic and phagocytic capacity of iDCs. We conclude that anti-inflammatory corticosteroids could modulate the immune response by down regulating DC co-stimulatory molecule and by inhibition of phagocytosis. Further work is needed to examine the ability of dexamethasone treated DCs to stimulate T-cell activation. These findings have


Article
Evaluation of CD69 as a prognostic factor and its relation with other prognosticatos in a sample of Iraqi patients with chronic lymphocytic leukemia

Authors: Maysem Mouayad Alwash
Pages: 69-74
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Background: Chronic lymphocytic leukeamia (CLL) is clinically heterogenous disease with variable prognosis . It is important to take into consideration the prognosis of presenting with CLL before starting suitable therapeutic option. Different studies proved that leukemic CLL cells have the surface membrane phenotype of activated and antigen experienced B lymphocytes with the overexpression of the activation markers such as CD69 . In one previous study, CD69 was assumed to be considered as a new promising immunologic prognostic factor in B-CLL. Aim: In this study we aimed to detect CD69 expression in newly diagnosed patients with CLL by flow cytometry and correlate it with some other clinical and laboratory parameters in order to evaluate its role as a prognostic factor. Patients and Methods: CD69 expression was investigated by flow cytometry in 26 untreated newly diagnosed patients with chronic lymphocytic leukaemia ,and compared this with other standard prognostic parameters (β2- microglobulin , lymphocyte count , Rai stage and CD38 ). Results: The present study shows that about (34. 61% )of the CLL patient were positive for CD69 expression , while (65,38%) of patient were negative. CD69 expression is significantly associated with CD38 (P-0.002), Rai stages (p-0.0001) , lymphocyte count(p-0.0001) , β2-microglobulin (P-0.012). Conclusion: The results of this study demonstrated that CD69 is significantly associated with poor prognostic factors . This supports its introduction in a laboratory assessment of newly diagnosed patient with CLL and, possibly, in a prognostic scoring system for chronic lymphocytic leukemia.


Article
Novel method for visualizing of the coated microbubbles using the electron microscopy

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The microbubbles have many important acoustics applications, some of these applications are in medical uses such as ultrasound contrast agents and drug delivery. The efficiency and stability of the microbubbles are depending on many factors one of them is the structure of their shells. There is a significant need to visualize this structure to understand and optimize the bubbles behavior. Direct observation such scanning electron microscopy (SEM) and transmission electron microscopy (TEM) pose a big technical challenge because of the vacuum environment required by these devices. In addition, the freeze-fracture technique with TEM is long and expensive. In the present study, a novel modified method was used to overcome these challenges and consider a simple,

Table of content: volume:15 issue:2