Table of content

Medical Journal of Babylon

مجلة بابل الطبية

ISSN: 1812156X 23126760
Publisher: Babylon University
Faculty: Medicine
Language: English

This journal is Open Access

About

Medical Journal of Babylon (MJB) is a quarterly medical journal concerned with clinical and basic medical researches. MJB follows the Publication Ethics Statements suggested by Committee on Publication Ethics (COPE) and International Committee of Medical Journal Editors (ICMJE).

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العنوان البريدي: العراق-محافظة بابل- الحلة –ص ب 473 جامعة بابل –كلية الطب – مجلة بابل الطبية
عنوان البريد الالكتروني medjbabylon2004@gmail.com

Table of content: 2016 volume:13 issue:2

Article
Types and Outcome of Congenital Diaphragmatic Hernia in Children in Basrah

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Abstract

A prospective study that review the types of congenital diaphragmatic defects in pediatric age groups in Basra and their outcome, to describe the demography of diaphragmatic defects and to assess their mortality and morbidity. This study was conducted at the neonatal intensive care unit and surgical ward of the Basra children specialty hospital. The medical records of 67 diaphragmatic defects patients, admitted to the hospital from July 2013and July 2015. Data for patient demographics, associated congenital anomalies, and mortality were collected in this study in addition to the types of diaphragmatic defects. In this study Bochdalek hernia is the commonest type of diaphragmatic defects in all age groups (64.2%), followed by diaphragmatic event ration (13.4%), hiatus hernia (11.9%), Morgagni hernia (4.5%), congenital central hernia (4.5%), and finally absent hemi diaphragm (1.5%). Male is affected more than female in all age groups. Shortness of breath is the presenting feature in all age groups with predominance in neonates. Vomiting is the second presenting feature, especially in infant and older children. Associated anomalies occur in about 19.4%. Overall complication rate was 24.1 and the survival rate was 80.3%. It may not reflect the real survival because many fetal and post-delivery deaths occurred and not registered in our society.One should have a high index of suspicion regarding diaphragmatic defects especially those neonates presenting with shortness of breath. Most neonates with diaphragmatic defects are diagnosed by plain chest x-rays (88.2%) so that we should avoid injudicious use of contrast study or CT scan for the diagnosis of diaphragmatic defects. High survival rate may not reflect the real event because many patients died before, during, or just after delivery so that prenatal diagnosis and management of diaphragmatic defect must be encouraged.


Article
Clear and Fixed Retainer's Outcomes After Orthodontic Ally Treated Open Bite Cases : Clinical Study

Authors: Arkan Muslim Al-Azzawi
Pages: 271-276
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There is currently a lack of scientific evidence to about prolong retention of open bite malocclusion, from this point of view the idea of this paper start to feel free to change the protocol of wearing of clear retainer in open bite malocclusion because great satisfactions of patients to this type of retainers to see the final outcome of clear and fixed retainer in retention of orthodontic ally treated open bite cases. A sample of 15 orthodontics patients suffer from open bite malocclusion included in this study and 10 of them selected to be involved in this comparative study and 5 cases excluded because the discontinue the consent form of this research. Patient’s age ranging from 16 -20 years old. The overbite measurements were done over three time frames these were zero day time of removal of fixed appliances and after six months and after one year by digital vernia. The result of the present study was encouraging to change the protocol of wearing of clear retainer with the help of fixed upper and lower from canine to canine retainer thus repeated measures ANOVA test shows highly significant difference between overbite measurements over three periods of time and Bonferroni test clarify there is highly significant difference between time frame measurements. In conclusion to this paper the holy recommendation for retention after orthodontically treated open bite cases is using clear retainer in upper arch and upper and lower canine to canine fixed retainers with change of protocol of wearing of clear retainer to 24 hours except meal time at least for six month and if extended to one year this will give marvelous result in regards to overbite measurements this will apparently improve the overbite measurement.


Article
Value of Ultrasonography in Acute Appendicitis in Patients with Modified Alvarado Scoring System Score of 5 & 6

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Acute appendicitis is one of the most common and challenging surgical emergencies. Ultrasound [US] is widely available , highly accurate imaging modality in patients suspected to have acute appendicitis, this study was done to assess the value of US in evaluation of suspected acute appendicitis patients with Alvarado Scoring System [MASS] of 5 & 6 . In this prospective study a total of (100) patients with clinically suspected acute appendicitis and with Alvarado score between 5 &6 underwent US examination of the abdomen The accuracy of ultrasonography in the diagnosis of appendicitis was compared with clinical diagnosis, laparotomy findings and histopathological examination reports.. The patients were divided into two groups: group A included those for whom surgery was done & the final diagnosis was established depending on the surgical finding &/or histopathology results & this group comprised (65) patients . Group B comprises patients who did not underwent surgery ,these patients were followed up until their improvement & discharge from the hospital & this group included (35) patients. The overall specificity of ultrasound was 88% and the sensitivity was 89% in the diagnosis of acute appendicitis in patients with MASS of 5 & 6 . US is a valuable tool in diagnosing acute appendicitis in patients with MASS (5 & 6). When the clinical sign and symptoms are combined with US, the diagnostic accuracy is significantly high.


Article
Self Management of Pregnant Women Regarding Minor Discomforts in Primary Health Care Centers in Erbil City

Authors: Kareem Fattah Aziz --- Shaymaa Samir Maqsood
Pages: 284 -293
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Self-management regarding minor discomforts and practices during prenatal period is beneficial for pregnant women so knowledge and practices of women about self management is necessary for their health protection and the aims of study is to assess knowledge and practices of pregnant women regarding minor discomforts during pregnancy. The current study is a descriptive study conducted for 370 healthy pregnant women at four Primary Health Care Centers (Nazdar bamarni- Nawroz- Brayati- Kurdistan) in Erbil City from October 2014 to November 2015. Data were collected through interview by using questionnaire methods. Questionnaire was designed and divided into four parts; the first part includes socio-demographic characteristics of pregnant women, the second part contains obstetric history, the third part deals with knowledge about minor discomforts and the fourth part comprises ten areas of practical care regarding minor discomforts during pregnancy. The questionnaire contains 53 items using 3 Likert scales. Reliability was determined by 24 experts. The results showed that the majority of the study sample was between 18-25 years old, secondary school graduates, housewives and nuclear families. The evidence from this study showed that self management was poor and pregnant women had fair knowledge. Finding of the study revealed that self management practices of pregnant women regarding minor discomforts were very poor also. There was a significant association between knowledge and age group, level of education and gestational age. While there was no significant association between self-management practices regarding minor discomforts and age group.


Article
Factors That Predict The Morbidity of Colostomy in Patient with Ano-Rectal Malformation in Children in Baghdad

Authors: Amer Abd Allah Ejrish
Pages: 294 -306
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Colostomyis surgically fashioned colo-cutanous fistula for the diversion of the feces and flatus away from distal pathology or a surgical site either temporary or permanent type, indication of colostomies in our study were ARM. Identify the most common complication of colostomy in patient with ARM and how to be avoided, and which colostomy type carries a low risk of complication. Prospective study of 100 cases ARM that underwent colostomy was conducted at Medical City Children Welfare Teaching Hospital of department of pediatric surgery between January 2014 – November 2015. Most of colostomies (75%) were done in the neonatal period and mainly for recto urethral fistula in male (45%), the most common type of colostomy was a loop sigmoid colostomy (69%) this may be due to simplicity in creation and closure, in addition to surgeon's preference. Divided colostomy was done in 26 patients, and mainly for male patients. Seventy patients (70%) develop different complications and the most common were prolapsed (39%).others were skin excoriation, UTI, wound sepsis, parastomal hernia and bleeding. Prolapsed and skin excoriation were most in loop colostomies, while skin dehiscence was commonly seen in divided types. Associated anomalies were seen to be related to increase incidence of colostomy related complication. Mortality rate was (5%); the causes of death were septicemia, associated congenital anomaly and complex malformation. To decrease the incidence of prolapsed, it better to created divide rather than loop sigmoid colostomy for complete diversion of faces. We recommend divided proximal sigmoid colostomy for complete diversion of feces for protect definitive PSARP.


Article
Blood Pressure Assessment in Undergraduate Medical Students: Impact of Gender, Body Mass Index and Family History of Hypertension

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Increase blood pressure is considered to be a silent killer which lead to increase in morbidity and mortality, so it is necessary to determine the subjects with high risk at an early stage in order to inhibit the disease progression and its co-morbid conditions. This study aimed to measure the blood pressure of undergraduate medical students and its relation to specific risk factors (gender, body mass index and family history of hypertension). The study was performed in College of Medicine in Babylon University in the period from December 2014 to April 2015 and included 330 students. Some variables were taken from the history in addition to measurement of weight, height, systolic and diastolic blood pressure. The results revealed that regarding systolic blood pressure, 15% of students had prehypertension and 8% of students were hypertensive while for diastolic blood pressure, 32% had prehypertension and 4% were hypertensive. There was significant correlation between systolic and diastolic blood pressure with male gender, body mass index and family history of hypertension (P ≤ 0.05).This study revealed high prevalence of prehypertension and in less extent hypertension among college students and this problem represented a neglected issue.


Article
Methylene Blue Coloration to Eliminate Bile Duct Injuries During Laparoscopic Cholecystectomy

Authors: Sajid Hameed Abd Al-Helfy
Pages: 316 -322
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Laparoscopic cholecystectomy has superiority over classical cholecystectomy in surgical management of gallbladder diseases. The main disadvantage of LC is an increased number of bile duct injuries. Many techniques have been used to eliminate this complication; however, most of these need specific equipment or expert specialists to interpret the results. The current study aimed to evaluate the efficiency of gallbladder coloration with methylene blue during laparoscopic cholecystectomy in reduction of bile duct injuries.A total of 98-symptomatic cholelithiasis patients were undergone laparoscopic cholecystectomy using methylene blue for delineation of the gallbladder. The gallbladder fundus was grasped and held tight towards the anterior abdominal wall. All the bile was aspirated and 50% or more methylene blue was injected slowly into the gallbladder which was then removed from the abdominal cavity. Operation time, hospital stay and complications, if any, were recorded. In addition, the coloration of different parts in different status of gallbladder was also evaluated.The results showed that mean operation time and hospital stay were 55min and 26hrs respectively. No bile duct injury was recorded, and coloration with MB was visible in four main anatomical parts of the gallbladder (gallbladder, cystic-Hartmann's pouch, junction, cystic duct and common bile duct). In uncomplicated gallstone, almost all parts of the gallbladder colored well; however, a noticeable reduction in coloration was observed especially in cystic duct and common bile duct in complicated cases. Based on these results, it can be concluded that injection of MB could be considered as safe, effective and cheap technique to reduce or even eliminate BDIs during LC.


Article
Anal Fissure Treatment by Medication and Surgery

Authors: Ali Abdulhaleem Kadhim
Pages: 323 -329
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Anal fissure is a most common cause of anal pain [1].This prospective study includes 236 patients complaining of anal fissure treated from a period of September 2013 to December 2015 to assess options of management of anal fissure. Male patients were 121 (51%) and female were 115 (49%). All patients were clinically assessed in an outpatient clinic and conservative treatment started to all patients that shown to be effective in 141 patient (60%). Surgical treatment applied to 95 patients (40%)whom not responded to conservative treatment, or, patients with recurrent fissure. Lateral sphenectrotomy was the surgical procedure applied in open or close method (62 and 33 patients respectively), under local or general anesthesia (54 and 41 respectively). Local anesthesia was associated with a significant low duration of admission from 1 to 24 hours (mean of 3 hours) while general anesthesia with a significant higher duration of 12 to 36 hours (mean of 19 hours). The healing rate following surgery in a local or general anesthetic approach was 95%. No difference in a healing rate between open or closed technique of sphenectrotomy. Flatus incontinence was reported in 3 patients. Initial treatment of anal fissure should be conservative, lateral sphenectrotomy is a safe procedure with a high cure rate, low incidence of complications and could be performed under local or general anesthesia.


Article
Comparison between Single and Double Dartos Layers Snodgrass Technique for Hypospadius Repair : Results of Our Experience

Authors: Ali Hadi Sabhan
Pages: 330 -336
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To compare our results with single versus double dartous layers Snodgrass technique for hypospadius repair, a comparative study was done and the results were compared in term of : the overall success and complications rates, percentage of each complication (urethrocutaneous fistula, meatal stenosis, urethral diverticulum and glandular or complete neourethradehiscence) with final cosmetic appearance and straightening of urinary stream.The study was extended from January 2013 to June 2015; including a randomly selected fourty three children with median age of 29 months (range from 12 to 66 months) with a primary hypospadias. Patients were divided into 2 groups: Group 1 include 21 patients that were selected to be operated by a single layer TIP technique.Group 2 include 22 patients that were selected to be operated by a double layer TIP technique.All patients under went Snodgrass technique urethroplasty in the surgical theater of Al-Diwaniya teaching general hospital under general anesthesia.The results shows a higher overall success rate and cosmetic appearance with lower complications for patients in group 2in comparison to those in group 1with no statistically significant difference. The neourethral covering in TIP hypospadias repair(Snodgrass technique) with double-dartos flap yield a better cosmetic and functional results in comparison to single dartos flap cover in terms of increasing success rate and minimizing complications specially in decreasing the rate of urethrocutaneous fistula formation which is the most common complication following this type of surgery.


Article
Relationship between Thyroid Function, Cystatin C and Different Oxidative Stress in Iraqi Patients with Chronic Kidney Disease

Authors: Israa Ghassan Zainal
Pages: 337 -346
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Chronic Kidney Disease (CKD) is associated with slightly higher frequency prevalence of primary hypothyroidism , but at the same studies on thyroid hormone status in uremic patients has reported conflicting results. This study was undertaken during the period from February 2014 to January 2015to quantify thyroid hormones (T3,T4 and TSH) ,cystatin C, different oxidative stress parameters like serum Ceruloplasmin (CP), Carbonyl, Thiol and total protein (TP) and four trace elements (Molybdenum (Mo), Cadmium (Cd), Manganese (Mn) and Magnesium (Mg) and explore correlation between these parameters in (75) non- dialyzed CKD patients’ verses (52) healthy controls. Results indicated that the levels of (T3, T4,CP, TP,thiol,Mo ,Cd and Mg were significantly reduced (p≤ 0.05)while the levels of TSH ,cystatin C ,carbonyl and Mnweremildly significantly increase(p≤ 0.05) in patients group compared to healthy controls.The correlation coefficient ( r ) test is used to describe the association between these parameters,T3 and T4 were negatively correlated with cystatin C ,carbonyl, Mn and Mg, positively correlated with(thiol and protein) .T4 positively correlated with CP while T3 not correlated with CP.TSH positively correlated with (CP, carbonyl,thiol,protein), finally, CP negatively correlated with cystatin C and positively correlated with Mn and Mg.

Keywords

CKD --- antioxidants --- cystatin C --- ceruloplasmin --- Mo --- Cd --- Mg --- thyroid hormones


Article
Effectiveness of Zinc Supplementation in Regulating Serum Hormonal and Inflammatory Status in Hypothyroidism Patients

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This study was designed to investigate the serum level of thyroid-stimulating hormone,thyroxine, triiodothyronine, interleukin-6 and tumour necrosis factor-α” in hypothyroidism patients, and to reveal their relationship with serum zinc level in 27 patients with hypothyroidism, and 27 control group. The results disclosed that serum zinc, interleukin-6 and tumour necrosis factor-α levelsin hypothyroidism patients are significantly lower (p˂0.05) than the control group. While serum thyroid stimulating hormone level, was significantly higher in hypothyroidism patients than the control (p˂0.05). After zinc administration, the patients group showeda significant increase in “interleukin-6 and tumour necrosis factor-α” level (p˂0.05) in comparison with control group."

Keywords

Zinc --- TSH --- T3 --- T4 --- Hypothyrodism --- TNF-α --- IL-6


Article
Role of HEF1 Gene Expression in Prognosis of Urinary Bladder Transitional Cell Carcinoma

Authors: Athraa Falah Hasan --- Alaa Salah Jumaah
Pages: 354 -365
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Urinary bladder carcinoma is a common malignant tumor of the urogenital system worldwide. In 2015 ; it is the fourth most common cancer in men in the United State, while in Iraq it is one of the ten most common cancers in 2011. Human enhancer of filamentation 1 (HEF1) is a multidomain scaffolding protein of the Cas family; it is also an integral player in normal and pathological cell biology. The HEF1 protein has been implicated in the regulation of cell polarity, adhesion, motility, and invasion in multiple cell types. The main objective of the current study is to analyze HEF1 gene expression levels in urothelial carcinoma specimens and to study the impacts of HEF1 gene as genetic factors that contribute to development and prognosis of bladder cancer. Sixty samples of malignant bladder tumors as well as 60 samples of non-tumorous bladder tissues were investigated. Ages of patients were (62.95±12.839 s.d.) year. Total mRNA was extracted from FFPE blocks by using a specific kit. HEF1 gene expressions were estimated by using real-time PCR. Results were normalized to GAPDA gene as housekeeping gene. The gene expression data were analyzed in relevance to the patient's information obtained. Several statistical analyses were applied to analyze the data and found that the expression folds of HEF1 gene were found to be 11.219 folds in malignant bladder tumors in relation to non-tumorous bladder tissue. HEF1 genes were observed to be expressed excessively in high grade and advanced stage tumors which indicate that HEF1 gene may represent a novel bladder tumor marker with prognostic significance that could be introduced in plans of bladder cancer management.


Article
Rhinocerebral Mucormycosis: A Review of 32 Cases In Mosul

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The aim of the present study is to evaluate the effectiveness of oral systemic antifungal (fluconazol) with nasal antifungal wash and aggressive surgical debridement in treatment of rhinocerebral mucormycosis. In a prospective hospital based study, we reviewed the management of 32 patients with rhinocerebral mucormycosis in Mosul general hospital and Al-Rahma Hospital (Mosul_Iraq), over a period of 7 years (Jan 1995 - Dec 2001). Diabetes mellitus was the main underlying cause in our patients and the main causative agent was mucor sp..The mortality rate was 56.2%. In Conclusion management of patients with rhinocerebral mucormycosis by oral antifungal (fluconazol) with nasal antifungal wash by mixture of clotrimazol and 20% sodium bicarbonate solution and aggressive surgical debridement after the control of the underlying disease, seems to be effective.


Article
Causes and Prevention of Missing a Diagnosis and Late Management of Acute Appendicitis

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A delay in diagnosis and late management of appendicitis with appendectomy is still high with subsequent some serious sequelae. This study is to identify and prevent a causes of delay in diagnosis of appendicitis. Aprospective cross section study includes 308 appendectomies performed in a Hilla teaching hospital from January 2013 to July 2015 by same surgical team; 143 (46%) male and 165 (54%) female. Delayed diagnoses was considered when the duration of pain was more than 48 hours, or operative finding show obvious features of delay, like perforation, gangrenous appendix, abscess collection or mass formation. Average duration of symptoms for delayed patients was 96 hours and for early diagnosed was 29 hours, Reasons fordelay were sought and divided into two groups; the first is patient behavioral reason, and the second is medical assessment reason. Twenty one percent of appendectomised patients show delayed management despite more than 48 hours abdominal pain (3-10 days, average 4 days), 69%of them was male, and, 31% female. Average duration of hospitalization in a delayed cases was 3.5 days, while average duration of admission for early treated cases was 1.3 day. Mortality rate was zero. As a reason for delay in diagnosis; patient assessment was the main reason for delay diagnosis (44 patients, 68%); while patient behavior cause was 32% (21 patients). The patient assessment is the main cause of delay in diagnosis and should be improved by examining patients with abdominal pain by expert surgical team considering atypical presentation with proper follow up and investigations.Quality improving program is advised to reduce missed diagnosis of appendicitis.


Article
Effect of Exercise on Untreated and Treated Hypertensive Patients in Babylon Province

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Normal blood pressure at rest is diastolic a range of 60-90 mmHg and systolic 100-140 mmHg. Hypertension is chronic elevated arterial systolic blood pressure > 140 mmHg, and diastolic blood pressure > 90 mmHg. Epidemiological indicate studies that elevated blood pressure leads to strike, heart coronary disease, congestive failure heart and end stage of renal disease. There are two types of hypertension; primary (essential) of cause unknown which includes more than 95% of all cases of hypertension, and secondary hypertension which is due to underlying disorder it accounts less than 5% of hypertensive cases. Response to moderate exercise protocol in hypertensive patients. To study the effect of exercise on systolic, diastolic, and lipid profile elements in treated and untreated hypertensive patients. The study was conducted in Marjan medical city in Hilla from April to September 2015. The random sample of 30 patients of hypertension including 16 males and 14 females, their ages from 40 -60 years. Regular treated patients were 23, none treated 7. Patients were recruited from outpatient clinic. History and physical examination were obtained from all patients. Lipid profile tests, BMI, measurement of blood pressure were performed before and after exercise.


Article
Management of Thyroid Isthmus During Tracheostomy

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A tracheotomy is a surgical procedure which consists of making an incision on the anterior aspect of the neck and opening a direct airway through an incision in the trachea (windpipe). As with any surgery, there are some risks associated with tracheotomies. Early Complications that may arise during the tracheostomy procedure or soon thereafter include bleeding, pneumothorax, and subcutaneous emphysema.The aim of this study was to evaluate the use of cautery knife instead of artery forceps in management of thyroid isthmus during tracheostomy with regard to time of operation, post-operative bleeding, and surgical emphysema. This study was a cross-sectional research performed on 60 ICU patients in need of tracheostomy through a period started from January 2009 to January 2012. The patients were divided into two groups each formed of 30 patients, one group(group A) dealt with by traditional tracheostomy through clamping of the thyroid by artery forceps and transfixion to expose tracheal rings, and second group (group B) had a new method of management through cautery knife. Time of both procedures and early complications were registered in questionnaires and the data were analyzed for both groups. A tracheostomy was performed in 60 morbidly ICU patients. The two groups had no significant difference in age, sex, and vital signs. Average duration of the procedure was 10-20 minutes in group A patients using the traditional procedure and 5-10 minutes in the second group (group B) using a cautery knife. Three patients out of thirty in group A got post-operative bleeding, while no patient in group B got bleeding. There was a significant difference between the two groups regarding time of procedure and post-operative bleeding, otherwise there was no significant differences between the two groups regarding occurrence of surgical emphysema. The use of cautery knife for thyroid isthmus management during tracheostomy minimize operation time and reduce occurrence of postoperative complication especially bleeding.

Keywords

Tracheostomt --- cautery knife --- ENT


Article
Foreign Body Inhalation in Pediatric Age Group

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Bronchoscopic removal of foreign body inhalation is treatment of choice. Development of anesthesia and endoscopic techniques supported by finer ,purposeful instruments and better understanding of the problems made the management easier, safer and surer and mortality claimed to be 1-2% compare to 50% before advent of endoscopy until 1800 foreign body inhalation removed by bronchotomy. over period of 2 years 2012-2014, 230 patient below 5 years received at our department to do bronchoscopy ,190 have definite history of foreign body inhalation proved by bronchoscopy , 40 cases suspected inhalation with persistence of chest infection. The most frequent affected group by foreign body inhalation 5 monthes-2 yearsmale to female ratio 1.8-1 most patient have definite history of foreign body inhalation . Recurrent chest infection with negative history foreign body inhalation needs bronchoscopy . Radiology should be done prior procedure . Bronchoscopy is procedure of choice for foreign body inhalation when a suspected, sometimes it's lifesaving.


Article
Examination of Third Molars Eruption Circumstances by OPG

Authors: Ayman Hameed Uraibi
Pages: 398-404
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Third molars or wisdom teeth, as they are more commonly known, are the teeth which are most often missing, impacted and with altered morphology.The aim of this study is to evaluate third molars eruption circumstances which include number, angulation, level, and amount of room for eruption of wisdom teeth per subjects. A total of 300 subjects (150 male and 150 female students within the age group of 17-26 years were selected . Any case who had history of extraction of any of the third molars or who rejected to give approval for participation were excluded, for each subject, panoramic imaging were obtained. The Results showed that the level of occlusal plane of third molar similar to that of adjacent tooth was seen in (40.79%)in male and (51.94)in female, also the results showed that 3.3%of the third molars were congenitally missing, and nearby (90.3%) of the students had all four third molars.0.66%had one third molars and 2%had two third molars, third molar agenesis showed no difference between male and female. Angulations position was maximum with vertical position in maxilla (73.45%) and mesio-angular position in mandible (41.6%) level of occlusal plane of third molar similar to that of adjacent tooth was seen in (45.8.%) in maxilla and (42.73%)in mandible. The present study concluded that panoramic imaging is a valuable radiographic modality in detection of third molars eruption variability.


Article
The Implication of Duke Treadmill Score (DTS) on the Extent of Coronary Artery Lesions by Angiography

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Exercise testing is used to evaluate patients with coronary artery disease. The Duke treadmill score (DTS) is a composite index for diagnostic and prognostic estimates based on results of the exercise test. A cross sectional study used to assess patients referred to The Iraqi Centre for Heart Diseases with chest pain by exercise test and coronary angiography during the period from May 2013 to April 2014. A significant coronary artery lesion: ≥50% left main stem stenosis or, ≥70% stenosis in other epicardial vessels. Significant lesion in the left main stem or three vessels defines an extensive coronary artery disease (CAD). Non extensive disease means significant lesion in one or two vessels. 80 patients included in the study (40 patients with high risk DTS, and 40 patients with non-high risk DTS). 61 patients were males (76%), 19 patients were females (24%). 38 patients of the high risk group (95%) had a significant coronary artery disease, 13 patients of them (32%) had extensive coronary artery disease. More than half of the non-high risk group (58%) had no coronary lesion, 17 patients (42%) with significant coronary disease, with one patient with extensive coronary disease (P˂0.001). The Duke treadmill test provides diagnostic and prognostic information for the evaluation of symptomatic patients for clinically suspected ischemic heart disease.


Article
Diagnostic Tonsillectomy Versus Follow Up in Asymptomatic Unilateral Tonsillar Enlargement in Children/ A study in Kurdistan Region of Iraq

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Children with only tonsil asymmetry are unlikely to have lymphoma, although traditionally a vast majority of these patients end up with tonsillectomy. The debate is whether asymmetry on its own just ifies the need for tonsillectomy. Objective to investigate whether we are appropriately diagnosing asymmetrical tonsils and whether the diagnosis of asymptomatic asymmetrical tonsil should be an indication for tonsillectomy. A prospective study was carried out in Sulaimani City/Kurdistan region of Iraq. A total of 75 children were included. Brodsky measurement was initially recorded for all cases. Children were divided into 3 equal groups, 25 cases each, group having tonsillarasymmetry and subjected for tonsillectomy, group having tonsillar asymmetry and subjected for follow and control group having symmetrically enlarged tonsils and subjected for tonsillectomy. Tonsil size was measured by fluid displacement in a 20-mL syringe. During two years of follow up the increase in size was recorded in five patients only which was due to the patients had fracture nasal bone, septal deviation, and unilateral sinusitis. A strong correlation between clinical tonsil grading and objective tonsil volume was observed. For mild and moderate tonsillar asymmetry in children, if not associated with signs and symptoms follow up is sufficient.


Article
Study The Interaction between LH, FSH, and TSH with New Synthesized Magnetic Nanoparticles Coated with Dextran

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Nanoparticle (NP) was used in vivo and in vitro in contact with the body fluids that contain different types of proteins. The proteins have the ability to adsorb on NPs surface, and alter its activity due to the modification of the secondary and tertiary structures. In this study, the interaction between coated magnetic nanoparticles (MNP@Dextran) and the hormones (LH, FSH, and TSH) were studied in details. The possible change in the secondary and tertiary structure of these parameters is discussed. The (MNPs) were prepared using co-precipitation method of Fe3O4 followed by reacted these MNPs with Dextran under an optimum conditions to produce coated MNP@Dextran. Different concentrations of each hormone were incubated with a known amount of MNP@Dextran and the quantity of the hormones adsorbed was calculated. The experiments were repeated at different temperatures to calculate the thermodynamic parameters. Secondary structures of hormones were examined using circular dichroism (CD).Tertiary structures of protein were measured using fluoroscopy technique.The adsorption process obeyed Freundlich adsorption isotherm indicating heterogeneity of the MNP@Dextran surface,and it associated with the changing in the secondary and tertiary structure of hormone after adsorption on MNP@Dextran.


Article
Outcome of Vascular Access in Pediatric Haemodialysis of Baghdad Hospitals

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Vascular access is the ability to enter the vascular system. Three types of vascular access are used: arteriovenous fistula (AVF), arteriovenous grafts (AVG) and central venous catheters (CVC) as permanent or temporary. The Aims of this study are to study the number of each type of vascular accesses,correlationwith some demographic data,complications, survival time and correlation with dialysis adequacy. This is retrospective study based on 55 pediatric patients with CRF receiving maintenance HD in four pediatric HD centers in Baghdad from 1stMarch 2013 till end of March 2014. As for Central venous catheters (CVC), we investigated: number of catheters inserted, insertion site; survival time and; and complications.As for arteriovenous fistula (AVF), we investigated: the number of failed and patent AVF, survival time and the complications.Adequacy of dialysis (Kt/V and URR) was calculated. There was 172 HD vascular accesses in 55 patients; 38 (69.1%) were males and 17 (30.9%) were females. Mean age was 11.9 years. TDL was the commonest VA among patients below 20 Kg (40%), while PDL was commonest among patients with 20 – 30 Kg and above 30 Kg body weight (41.2%) and (47.8%) respectively. For 120 patients (69.8%) temporary dual lumen (TDL) were inserted, and for 27 patients (15.7%) AVF, and for 25 (14.5%) permanent tunneled dual lumen (PDL). Majority of TDL were inserted in right internal jugular veins in 42.98%, and left internal jugular veins in 35.54%. Infection and thrombosis are commonest complications observed in both dual lumen (41.9%, 27.9%),) and AVF (33.3%, 30.1%). Six out of 27 AVF failed to mature (22.2%), Survival time of AVF was 456.3±80.1 days which is more than that of PDL (187.2±36.3 days) and TDL (132.3±1.13 days).Adequate dialysis was seen in 50% of patients dialyzed by AVF, in 26.7% with PDL and in 23.3% with TDL.CVC are the main type of VA used. Infection and thrombosis are the most common complication. AVF provide longer survival time than CVC.


Article
The Value of Wrist-Palm Median Motor Conduction Velocity in The Diagnosis of Carpal Tunnel Syndrome

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Carpal tunnel syndrome is the commonest entrapment neuropathy. Typically patients presented with acroparasthesia and pain mainly at night. The study aims to find the value of wrist-palm median motor conduction velocity in the diagnosis of carpal tunnel syndrome. 171 patient suffer from classical symptoms and signs of carpal tunnel syndrome enrolled in the study and compared to 100 healthy control. All patients and controls undergo neurophysiological testing including wrist-palm median motor conduction velocity measurement. The study results show that most patients with carpal tunnel syndrome show abnormal wrist-palm median motor conduction velocity with sensitivity of 91% and specificity 80%. The study concluded thatmidpalm-wrist median motor conduction velocity is an easily performed electrophysiological technique. It don’t require additional equipment or expertise and give high sensitivity and specificity in the diagnosis of CTS.


Article
The Association of Methylenetetrahydrofolate Reductase (MTHFR)/C677T Polymorphisms with The Development of Peripheral Neuropathy in Type 2 Diabetes Mellitus

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One of important microvascular complication of patients with T2DM is neuropathy, commonly diabetic peripheral neuropathy (DPN). MTHFE/C677T polymorphisms affect MTHFR enzyme activity with subsequent elevation in the toxic homocysteine concentrations that result in vasculopathy and nerve ischemia. This case control study was planned to estimate the association between the MTHFR/C677T polymorphism and the occurrence of peripheral neuropathy in type 2 diabetic (T2DM) patients in a group of Iraqi people Eighty three Iraqi subjects were included in this study, 36 had diabetic peripheral neuropathy, 25 without peripheral neuropathy and 22 were healthy control.Genomic DNA was isolated from fresh whole blood and genotyped using the polymerase chain reaction–based restriction fragment length polymorphism assay for the MTHFR gene C677T mutation. The distribution of MTHFR/ C677T mutated genotypes between DPN and healthy groups was statistically differed with increased risk of occurrence of DPN (OR= 3.1, 95% CI: 1.02-9.4, p=0.05), while this risk was highly increased by seven folds when comparing DPN group with those without DPN& 2 (OR= 6.7, CI=2.1-20.8, p=0.0008).MTHFR/C677T polymorphism is highly associated with development of peripheral neuropathy in T2DM Iraqi population


Article
Evaluation of Pulmonary Artery Pressure in End Stage Renal Disease in Babylon Province

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Abstract

Pulmonary hypertension (PHT) is a serious cardiac complication and highly prevalent in end-stage renal disease (ESRD).The aim of this study is to evaluation the PHT in ESRD and its relation with left and right side echocardiographic cardiac indices. Fifty patients with ESRD were included in the study. Echocardiography was used to evaluate systolic pulmonary artery pressure (sPAP),Tricuspid annular plane systolic excursion (TAPSE), cardiac output (CO),left ventricular mass(LVM). Cardiac index (CI) and left ventricular mass index(LVMI) were obtained by dividing CO and LVM onbody surface area (BSA).The results are : Percentage of PHT in ESRD is about 50% . Percentage of abnormal LVM , LVMI ,and TAPSE are: 76% (167-498 g), 78.9% (109-287g/m2),and 18.4% (1.1-1.8 cm) respectively. Correlation study between PHT and TAPSE showed statistically significant negative correlation (r = -0.38, p < 0.05). Correlation studies of PHT with LVM and LVMI were weak correlation and statically non-significant, but technically showed a positive correlation (r = 0.109, 0.094) respectively. The conclusion: pulmonary hypertension is extraordinary common Among hemodialysis patients and volume overload have played an important role in the mechanism of pulmonary hypertension in end stage renal disease .

Keywords

PHT --- ESRD --- LVM --- LVMI.


Article
Detection and Estimation of Vitamin D2 in Catharanthus Roseus by HPLC and other Molecular Spectra Instruments as A Source of Vitamin D3 Production

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Abstract

Vitamin D is one of fat-soluble vitamins, considered a steroid hormone. It is regulate and responsible for improving the metabolism and absorption of calcium, iron, magnesium, zinc, and phosphate in small intestine. SHIMADZU High-Performance Liquid Chromatography was used for qualitative and quantitative estimation of vitamin D2 in aqueous extracted of Catharanthus Roseus plant; (20µl, 2.5 IU/gm) standard material of pure vitamin D2 (Ergocalciferol) injected and measured at reference conditions to fix retention time (RT), then 20µlof extracted plant sample was injected and measured at the same conditions. An intensive analysis conducted on aqueous, alcoholic extract and dry powder of plant leaves using modern and sophisticated instruments. Quantitative results from HPLC shows thatVit.D2 in drying weight of plant up to 187.840 IU/gm. Qualitative results from HPLC, UV-VIS, IR, ATR-FTIR shows match the effective groups of pure standard Vit.D2 and alcoholic extract, dry powder of C. Roseus plant. This study aimed to investigate the presence of vitamin D2 in C. Roseus, in addition to qualitative and quantitative detection in aqueous, alcoholic extract, and dry powder of plant leavesto use it in practical as a major source for Vit. D3 production in industrial scale; in order to use it in the medical, pharmaceutical and what is called alternative medicine (Herbs) fields.


Article
Effect of Conventional Polishing Procedure in Water Sorption of Cold and Heat Cured Acrylic Denture Base Material

Authors: Azad Mohammed Ridha Al-Muthaffer
Pages: 481 -488
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Abstract

Acrylic resin is almost universally for partial or complete denture base construction due to its favorable properties. Unfortunately some disadvantages such as water sorption have been reported which causes dimensional changes that may subject the acrylic denture base to internal stresses, so the water sorption is a physical property of importance. Forty square shaped specimens (twenty specimens for heat and cold cured acrylic material) were prepared. Ten specimens from heat cured acrylic (HP) and cold cured acrylic (CP) material were polished, and ten specimens from heat cured acrylic (Hx) and cold cured acrylic (Cx) were not polished as control group. At room temperature, all specimens were weighed; this weight value was considered the initial weight of the specimen (W0). All specimens were kept in distilled water bath for 24 hours, and then specimens were weighed(W1)then the specimens were kept out of water bath for 24 hours to dry to (W0), and all samples return back to water bath for 24 hours to weigh again (W2). This manner was repeated till (W4).There is a significant difference (p=0.018) between (CP) and (Cx) and a significant difference (p=0.047) between (HP) and (Hx) and no significant difference between cold and heat cured acrylic before (p=0.699) and after polishing (p=0.52) at (p ≤0.05).


Article
The Use of Conventional and Color Ultrasound in The Differentiation of Thyroid Diseases

Authors: Hero Othman Haj --- Maysaloon Shamman Saeed
Pages: 489 -496
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Abstract

Thyroid diseases has become widely distributed in the general population, examined and investigated by different methods. Due to its anatomically superficial location, with its informative, safe,non-invasive characters, Ultrasound has become an indispensable tool in evaluating different thyroid diseases, describing their natures, helping in their differentiation. The objective of the study is to evaluateul trasonically different thyroid diseases , characterizing their natures , describing their consistencies, internal vascularities, and the state of thyroid tissues surrounding the nodular form of them, helping to reach their diagnosis , compared with the fine needle aspiration (FNA) results. This is a cross-sectional study conducted from May 2014–February 2015. A total of 100 patients with diffuse and nodular thyroid diseases, were collected between 18 –58years age, inDuhok city. Examined by Conventional and Color ultrasound , divided into diffuse, nodular, mixed (combination of diffuse and nodular ) forms , the nodules were divided by their consistencies into (solid, cystic, mixed) , echogenicities were described as (hyperechoic, mixed , hypoechoic) relative to strap muscles , their surrounding halo of reactive thyroid tissues were recorded , their internal vascular arrangement also was detected, compared with FNA results , to reach their exact diagnosis. Thyroid diseases were more commonly seen in females, all of the diffuse form of thyroid diseases were of chronic inflammatory and benign natures , in the nodular form of thyroid diseases most of the solid nodules and all of the cystic lesions seen to have benign behavior, hypoechogenicity, microcalcification , internal central vascularity and absent halo sign (related to thyroid tissue reaction ) were higher in malignant thyroid nodules. Ultrasound provide useful informations about the behavior of different thyroid diseases, significant correlations were found between different ultrasonic thyroid findings with their final diagnosis, incomparison with FNA results.

Keywords


Article
Evaluate The Cytokine IL-1α as an Inflammatory Indicator against Isolated Fungi From Patients with Abdominal Pain

Authors: Zeana Shaker Al-Hindi
Pages: 497 -503
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Abstract

Acute abdominal pain generally refers to previously undiagnosed pain that arises suddenly and is of less than 48 hours. Fungal infections are considered as one of the most common causes in gastrointestinal disease, but virtually all fungi have been reported to cause infection in immune competent persons as well. Microbiological study was carried on 94 patients having abdominal pain by taking stool and blood from them. At periods from 9-2013 to 2-2014 in General Teaching Hilla Hospital.. This study is done to determine the pathogenesis of fungi and the type of immune statue for abdominal pain caused by fungi by estimating concentrations of IL-1α as an immune marker and immuonoglobulins IgG and IgM . The rate of samples that gave positive results for fungal isolate was 60% , while 40%were negative , also the total number of isolated fungi was 12 genera. Cl.cladosporides have a highest rate of isolated fungi was 39.36%,another fungi also appear in stool samples wereCl.nacrosporum20.2% , Al.alternata 13.82% , Candida spp. 11.7%, Cryptococcus 5.31% ,Penicilum2.12% ,Candida albicanus2.12% ,Aspergillus flavas,Aspergillus fumigates ,Candida trubicalis , Candida crusi and Aurobasidium pull in rate 1.06% for each one. Immunological tests to sera of patients with abdominal disorder refer to significance increasing in the concentration of IL-1α for all patients at different age groups, compared to control and the highest concentration of them in the age group 19-26 years (51.371 ± 1.813pg/ml), The immunological study also included measuring the concentrations of each of the serum immunoglobulin IgG and IgM, the concentrations of highest 329 ±83.007, 1388.5 ± 391.645, mg / dL respectively, for different age groups and no significant difference compared with control for IgG while their present in IgM , This study refers to the role of both cellular and humeral immune response through fungal infection with different fungi. Distribute the fungal infection appear in both sex at female60% and male40% .


Article
Effectiveness of Breast Cancer Prevention Instructional Program on Female Secondary Student's Knowledge among a Sample in Baghdad City

Authors: Athraa Hameed Shaker --- Basim Hussein Bahir
Pages: 504 -512
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Abstract

Breast Cancer is the most common cancer among women, comprising 23 percent of the female cancer globally. AQuasi –experimental study was conduct at four female's secondary schools after obtained permission from Directorate general education in Baghdad city during the period from 15 February to 1 April 2014 to assess knowledge of female's students about breast cancer prevention and to find out the impact of instructional program on students. The study include 200 students from four schools and carried through four phase pre-test, planning the instructional program, implementation the program and evaluation the program as post-test .Results shows that level of students' knowledge on breast cancer is limited and inadequate with defect in responses in some items., it also indicates that the students are very enthusiastic to learn about breast cancer and its prevention. After implementation the instructional program post-test revealed that there was a highly significant improvement in the knowledge and also high significant differences between means of their knowledge in pre and posttest in all items. In conclusion most students reported inadequate knowledge in pre-test with highly significant improvement of their knowledge in the post-test indicating effectiveness of the instructional program and the limited level of students' knowledge might be an obstacle to screening program and early diagnosis. Awareness program should be developed including lecture, and on hands training.


Article
Evaluation of Leukemia Inhibitory Factor, Interleukin6 and Leptin in Acute and Chronic Myeloid Leukemia in Babylon Province

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Abstract

Leukemias are a group of diseases described by augmented numbers of white cells in the blood and bone marrow as a result of unregulated clonal proliferation of immature malignant cells .These abnormal white blood cells that not completely developed are called (blasts), or (leukemia cells), The diagnosis of Leukemia was confirmed by blood investigation and by bone marrow biopsy. Leukemia inhibitory factor may play an important role, along with Interleukin-6 and granulocyte colony stimulating factor , in the regulation of early hematopoietic stem cells. Leptin has been implicated in the differentiation and proliferation of hematopotietic cells. In this case control study, we evaluate, the levels of LIF, IL6, Leptin in serum of patients with myeloid leukemia and assess the relationship between leptin level & body mass index in myeloid leukemic patients, in the current study involved 96 individuals; 48 patients with myeloid leukemia and 48 controls. Leukemia inhibitory factor, Interleukin 6 and Leptin levels are measured by ELISA assay in both patient and control groups.The mean LIF,Il6 in the AML and CML groups were significantly higher than control group (p<0.05). while Leptin in the AML and CML groups was significantly lower than control group (p<0.05).And the mean (BMI)in the AML and CML groups were significantly lower than control group (p<0.05).In this study, we conclude thatLIF, IL6 and Leptin play an important role in pathogenesis of Leukemia, LIF, IL6 levels in myeloid leukemic patients more than controls while Leptin level in myeloid leukemic patients less than controls and There is significant relationship between Leptin and body mass index.


Article
Percutaneous Treatment of Liver Hydatid Disease, Clinical Experience with 22 Patients

Authors: Ibrahim Falih Noori
Pages: 522 -530
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Abstract

The purpose of this study was to assess the efficacy and validity of the puncture-aspiration –injection and re-aspiration (PAIR)and catheterization in the percutaneous treatment of hydatid cyst disease of the liver. This is aprospective study that had been performed in a major hospital in Basra city, Iraq for the period between April 2010 and May 2014 in which 22 patients with a diagnosis of hydatid cystic disease of liver subjected to a percutaneous treatment using PAIR technique or catheterization method under ultrasonographic guidance and under cover of albandazol or mebandazol before and after intervention .Following aspiration of the cystic fluid ,hypertonic saline 20% was injected into the cystic cavity and re-aspirated .Subsequent follow up and observation was carried out by ultrasonic examination to assess the efficacy and of this approach.Twenty four cyst (72.7%) in this study was GharbiIcyst, 4 patients (18%) had type II and 2 patients only had type III. The mean reduction in the volume of the cyst after 9-12 months follow up period was 92.6% and 87.5% in catheterization and PAIR method respectively .All patients were in very good condition. Liver and blood tests were normal after intervention. Solidification and pseudotumor was seen in 18 patients (81.8 %) and calcification was seen in 12 patients (54.5%).The mean hospitalization time was 3 days. Percutaneous treatment for selected patients with type I –III Gharbi hydatid liver cyst is effective and safe procedure .It offers complete cure with infrequent complications and short hospitalization. Surgery however, remains the gold standard treatment for multivesicular, infected and complicated cases of hepatic liver cysts.


Article
Burn Scars Treatment Using Fractional Carbon Dioxide “CO2” Laser

Authors: Naseer Issa Mousa
Pages: 531 -539
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Abstract

Burns are generally classified into four types: Thermal burns (flame, flash and contact with hot objects), Scald burns (hot fluids), Chemical burns (necrotizing substances like acids and alkali) and Electrical burns (intense heat from an electrical current). Skin burns can leave scar tissue ranging from mild to extensive. This study is an attempt to show the effect of fractional carbon dioxide laser (10.6 µm) as a treatment modality in regard to dose and application parameters to treat post-burn scars in different body regions like face, neck and chest.(31)Patients complaining from post-burn hypertrophic and atrophic scars were examined and treated in Al-Wasity Teaching Hospital from June 2011 to September 2012 using fractional carbon dioxide laser system (ALT). The sites of post-burn scars were: the face, neck, chest and some in the back, upper and lower limbs. After treating patients with fractional CO2 laser, the results are easy and short duration procedure with no or minor complications, very good patients’ response and high satisfaction because of its unique healing properties and depth of penetration. At the end of this study, we found that fractional CO2 laser resurfacing of burn scars proved to be a therapeutic option for the extensive scarring and provides faster healing and recovery than the traditional treatments.

Keywords

Burn --- Scars --- Fractional --- CO2 laser --- Complications


Article
The Role of Bronchial Wash Carcino-Embryonic Antigen Assay In The Diagnosis of Non-Small Cell Lung Cancer

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The bronchogenic cancer is one of the most common cancers in human kind & it represents a diagnostic challenge because of the most available tests are either yielding in the late stages or it is some of invasive nature ,so the need for diagnostic test in the early stages is mandatory, aim of the study is to assess the significance of bronchial carcino-embryonic antigen ( CEA) as a tumour marker for aiding the diagnosis of non-small cell lung cancer (NSCLC) and to see if there is any difference between the serum & bronchial CEA and between tumour and non-tumour sides Thirty patients were involved in this study ,divided into 3 groups according to their diagnosis as cancer ,airway disease & Tuberculosis groups, assessment of their socio-demographic features ,clinical features chest X ray ,computerized tomography (CT) scan , fibro-optic bronchoscopy were done & the carcino-embryonic antigen (CEA) level were tested in the samples taken from serum, tumour& non-tumoursides. There was a statistically significant difference in the level of the carcino-embryonic antigen in the bronchial wash of cancer patients group comparing to the serum of the same group & to the bronchial wash level in the other groups in favor of the cancer group patients, but no difference between the tumour& non tumour sides in the cancer group patients. The carcino-embryonic antigen assay in the bronchial wash may be helpful in the diagnosis of non-small cell lung cancer& may be take into consideration in the future work up


Article
Evaluation of Risk Factors For Acute Periprosthetic Infection Post Total Knee Replacement Iraqi Patients

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Periprosthetic joint infection (PJI) is one of the most challenging complications after total joint arthroplasty, with an incidence of 1% to 4% after primary TKA. This complication poses challenges on many aspects, one of which is the difficulty in reaching a diagnosis. Although variation exists, the majority of them rely on the results of joint aspiration or deep tissue culture; serologic tests, namely erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP); and the appearance of the joint during surgery (with regard to presence of purulence); presence or absence of a sinus tract; and the result of histologic analysis of tissue obtained during surgery (frozen section). Taken together, these findings suggest incorporating synovial WBC and PMN% results into a set of diagnostic criteria may improve the strength of those criteria for diagnosing PJI. The Objective is To evaluate the risk factors for peri-prosthetic infection post total knee replacement for Iraqi patients. This prospective study consists of 264 patients (51 males and 213 females) ages ranged from 49-75 years (mean 62 years) had been performed unilateral primary total knee replacement between January 2012 to September 2013 in the Nursing Home Hospital arthroplasty Department, in Baghdad, that are divided into three groups according to the primary pathology, Group I are 207 patients had primary osteoarthritis, Group II are 42 patients had rheumatoid arthritis, and Group III are 15 post-traumatic arthritis. 264 patients with 51 (19.3 %) males and 213 (80.6 %) females’ patients had primary OA 207 case (74.8%), Rheumatoid arthritis 42 case (15.9%) and posttraumatic 15 cases (5.6%). These patients were allocated into 3 groups according to their primary pathology: In Group I, 182 patients (non-diabetic), 4 patients had deep infection, whereas 3 of 25 diabetic patients developed deep infection. In Group II, 34 non diabetic patients, and 8 diabetic patients one and 2 patients had deep infection respectively. Group III, 12 non-diabetic and 3 diabetic patients had one patient each with documented deep wound infection. As a total number of documented acute deep infections during 6 weeks of TKR is 12 cases (4.5%). We conclude that: Diabetic patients are more risk in early postoperative infection than non-diabetic patients. Rheumatoid arthritis adds more incidence of infection to diabetic patients in the TKR. posttraumatic arthritis patients considered as a risk for early postoperative deep infection.

Table of content: volume:13 issue:2