Table of content

KUFA MEDICAL JOURNAL

مجلة الكوفة الطبية

ISSN: 1993517X
Publisher: University of Kufa
Faculty: Medicine
Language: English

This journal is Open Access

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amedical and evaluted journalpuplished by the kufa college of medicine .
date of first issue (1989).
No.of issue (2).
No.of issue puplished between 1989-2012 (25) issue

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med@uokufa.edu.iq
07810586808

Table of content: 2017 volume:17 issue:1

Article
Middle Ear Effusion in Intensive Care Unit Patients at Al-Sadder Teaching Hospital in Al-Najaf City-Iraq (A Prospective Randomized Comparative Clinical Study)

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Abstract

Background: Middle ear effusion (MEE) is one of the commonest chronic otological conditions in childhood but has a lower incidence in normal adult. By definition it is an accumulation of non-purulent fluid in the middle ear. It is an inflammatory effusion behind an intact tympanic membrane that is not associated with acute otological symptoms or systemic signs. Aim: To explore factors related to the occurrence of MEE in the intensive care unit (ICU) patients with prolonged oral endotracheal intubation in Al-Najaf city/Iraq. Methods: Forty patients (80 ears) with a prolonged endotracheal intubation (> 5 days) in the ICU were studied. Information of the age, gender, level of consciousness, duration of endotracheal intubation and placement of nasogastric tube were retrospectively collected from history and patient`s data. All patients were subjected to otoscopic examination, tympanometry studies and acoustic reflectometry for evidences of MEE. Results: Out of the 80 ears examined, 46 ears had MEE (57.5%), 22 ears were normal (27.5%), and 12 ears (15%) had negative pressure in the middle ear by tympanometry. Patients who were intubated for more than 11 days and those with conscious disturbance had a significantly high incidence of MEE. No episodes of acute otitis media or systemic infection were encountered. Conclusion: Prolonged endotracheal intubation (more than 11 days), age advancing and conscious disturbance contribute significantly to the occurrence of MEE in adult ICU patients. Recommendation: Middle ear pathology like MEE in the ICU patients with prolonged intubation should not be underestimated


Article
Docetaxel Chemotherapy Induced Peripheral Neuropathy in Breast cancer Patients and its Amelioration by Vitamin E

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Background: Chemotherapy is used to treat different types of cancer. Its use is associated with neurotoxicity, the most common of them is peripheral neuropathy. Taxanes are recognized to cause peripheral neuropathy of which Docetaxel is studied. Aim: To evaluate the neurotoxicity of Docetaxel and assess the protective effect of vitamin E in breast cancer patients. Methods: In a prospective placebo controlled randomized study, 60 women with breast cancer were selected. Patients had surgery and planned for chemotherapy administration. Chemotherapy protocol used is TAC that includes Docetaxel, Doxorubicin and Cyclophosphamide given every 21 days. They are assessed for neuropathy clinically and by nerve conduction study at the baseline and after completion of chemotherapy. They are divided into 2 groups each composed of 30 patients. The 1st group is given Vitamin E and the second group is given placebo. Results: showed that the incidence of neuropathy is the same in both groups, but it was less severe in Vitamin E treated group compared to the placebo group. Conclusion: vitamin E ameliorates the severity of peripheral neuropathy and can be used for this purpose. Recommendation: We recommend large multicenter studies to be done and using other agents that possibly prevent or ameliorate Docetaxel induced neuropathy in the future.


Article
Clinical and Refractive Outcomes of Toric Phakic Implantable Collamer Lens Implantation for correction of myopic astigmatism

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Background: Currently there are four general approaches to correct refractive errors: refractive corneal surgery, crystalline lens surgery and implantation of an intraocular lens in anterior or posterior chamber. Aim: To evaluate the predictability, safety and stability of toric phakic implantable collamer lens implantation to correct moderate to high myopic astigmatism. Methods: Sixty eyes of 40 patients underwent implantation of a toric implantable collamer lens (V4c design) in the Eye Specialty Private Hospital, Baghdad, Iraq were studied. The mean spherical refraction was -11.32±3.17 diopter (D) with a range of -6.00 to -18.00 D and a mean cylinder of -2.61±1.16 with range of -1.00 to -5.50 D. The outcome measures that evaluated during a 12 months follow-up period include UDVA, refractive outcomes, CDVA, vault and adverse events. Results: At 12 months postoperatively, the mean Snellen decimal UDVA was 0.77±0.23 and the mean CDVA was 0.80±0.21, with an efficacy index of 1.16. Twenty nine eyes (48.33%) showed gain in CDVA with a safety index of 1.21. The treatment was highly predictable for spherical equivalent and astigmatic component. The mean SE dropped from -12.63±3.11 D to -0.11±0.20 D with 58 eyes within ±0.50 D and 60 eyes with ±1.00 D of the target correction. For achieved cylinder 60 eyes (100%) had ≤0.50 D and 51 eyes (85%) had ≤0.25 D with a strong positive linear correlation between achieved and expected cylinder (r=0.94). Conclusion: The results of the present study support safety, efficacy, predictability of toric implantable collamer lens implantation to treat moderate to high myopic astigmatism


Article
Effectiveness of adenotonsillectomy in improving of nocturnal enuresis in children with adenotonsillar hypertrophy

Authors: Kassim R Dekhil قاسم دخيل
Pages: 40-45
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Abstract

Background: Nocturnal enuresis (NE) is an old & common childhood condition. It has been found that, there is a relationship between adenotonsillar hypertrophy in children & nocturnal enuresis. Aim: This study was conducted to see the effects of adenotonsillectomy on nocturnal enuresis in children with adenotonsillar hypertrophy. Methods: This study was conducted in Diwaniyah teaching hospital, Diwaniyah city, Iraq, from May 2012 to August 2014. The total number of children admitted for adenotonsillectomy or tonsillectomy alone were 287 children, 76 out of the total number were included in the study. The children were followed- up by the same questionnaire for four months postoperatively, including, age, the number of night bed wettings, type of enuresis and the results of urine examination. Results: Of total 287 children who were submitted for surgery, 76 children were eligible for the study, 48(63.16%) of the total number included in the study were males and 28 (36.84%) were females. The mean age was 7.2 y. Adenotonsillectomy was performed in 64 children, and tonsillectomy in 12 children. A complete improvement of nocturnal enuresis (NE) & daytime incontinence was achieved in 32 (42.11%) children. A mild to moderate improvement was observed in 38 (50%), while no improvement seen in the remaining 6 (7.89%) children postoperatively. Conclusion: Children with nocturnal enuresis should be evaluated by ENT surgeon to rule out any adenotonsillar hypertrophy for possible adenotonsillectomy effect. However, a wide base studies are needed to clarify these results.


Article
Metastatic Cervical Lymphadenopathy in Najaf City: Clinico-Pathological Analysis

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Background: Cervical lymphadenopathy (LAP) is a common problem facing doctors. Most run a benign course. It is the job of these doctors to differentiate it from tuberculosis and metastatic lymphadenopathy. Different types of biopsies can be used to reach diagnosis including FNAC, incisional and excisional biopsies. Aim: The aim of this study is to describe the clinic-pathological patterns of metastatic cervical LAP in Al-Najaf city. Methods: A descriptive cross-sectional study was carried out for a period of one year from Jan 1, 2013 to Jan 1, 2014 in the general surgery and otolaryngology departments of Al-Sadar Medical City and surgical department of Kufa university-Faculty of medicine. The data was collected by using a predesigned form including information as age, gender, level of lymph node involvement, and other clinical features. Results: Among the total 60 patients included in the study, 28 patients were males and 32 were females. Their age ranging from 20 to 68 y with a mean age equals to 53.6 y. The highest age group was the sixth decade with 32 (53.3%) patients. A known primary site was discovered in 93.3% of the patients. The highest primary site malignancy was that of the larynx with 35.7% of total patients with known primary tumors. 38.3% of the patients had N3 stage at the time of presentation. Conclusion: Inflammatory neck disease is very common in our country, one should not forget the possibility of metastatic carcinoma in an adult presenting with a rapidly growing, hard, non-tender, lateral neck mass. Early diagnosis is paramount as any delay will eliminate the best opportunity for effective treatment with curative intent.


Article
Nephroprotective effect of vitamin E added to angiotensin receptor blocker in patients with diabetic nephropathy

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Background: Diabetes mellitus is a condition associated with increased oxidative stress as a consequence of hyperglycemia. Therefore, the use of antioxidants in people with diabetes has been advocated. Vitamin E is the most prevalent naturally occurring anti-oxidant. Aim: To evaluate the effect of the combination of angiotensin receptor blocker (ARB) and vitamin E on urine protein in patients with diabetic nephropathy. Methods: One hundred and six patients with diabetic nephropathy, who visited the Alsader medical city in Najaf governorate and Al-Furat Al-Awsat general hospital in Kufa, were investigated, 39 of them are type 1diabetics, and 67 of them are type 2 diabetics. Each patient was followed up for 3 months with valsartan (160mg/day), then for 3 months with addition of tocopherol (400mg). At the screening visits, proteinuria was determined in two 24 h urine sample, arterial blood pressure was measured twice at ten minutes rest with 2 minutes interval and serum level of potassium, sodium & creatinine were determined. Results: Proteinuria was significantly lowered when tocopherol 400mg was added to valsartan, as compared with valsartan without tocopherol. Valsartan alone caused a mean reduction of 24 h urine protein of 27% from the baseline, while the addition of tocopherol caused a mean reduction of 24 hour proteinuria of 30% from result of valsartan. That is mean the combination therapy of valsartan and tocopherol caused a reduction in proteinuria of 44% from baseline. Conclusion: The current study suggests that combination therapy of ARB and vitamin E offers an additional antiproteinuric and nephroprotective effect. Recommendation: Antioxidants, in particular vitamin E have promising nephroprotective effects. However, studies on other antioxidants like vitamin C are needed in the efforts of prevention of diabetic nephropathy.


Article
Significant role of Loss or Reduced BRCA1 gene expression in clinical implication of ovarian cancer

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Background: BRCA1 immunohistochemistry (IHC) provides a rapid initial screen to detect BRCA1 dysfunction in ovarian cancer that resulting from genetic alterations. Aim: To assess the expression of BRCA1 protein by IHC analysis among a group of Iraqi ovarian cancer patients to evaluate the patterns of expression and its correlation with the clinicopathological parameters in attempting to evaluate a significance role of BRCA1 gene implication in ovarian cancer. Methods: Forty three paraffin embedded samples of ovarian cancer cases were analyzed for BRCA1dysfunction by IHC analysis. The semi-quantitative approach using modified histochemical score (H-score) was achieved to assess the patterns of BRCA1 gene expression. Results: Complete loss of BRCA1 nuclear expression was detected in 30.2% of the cases while, reduced expression occurred in 46.5% of cases, giving rise to 76.7% of all cases detected with altered BRCA1 nuclear expression. Altered BRCA1 expression was found to be higher in age group ≤ 45 years (78.3%) in comparison with those of ages >45 years. Altered BRCA1 expression was significantly correlated with the high grade and with the unilateral tumor site when compared with the low grade and bilateral tumor site (P≤0.05), and was insignificantly correlated with the high stage ovarian tumors, 11.6% of cases were detected by cytoplasmic BRCA1 expression and no association was found between cytoplasmic expression and tumor grade, stage and tumor site. Conclusion: Altered BRCA1 expression may play a significant role in the progression of ovarian cancer. Recommendation: BRCA1 IHC is a clinically useful approach to detect the BRCA1 dysfunction and the H-score assessment reflects good estimation for BRCA1expression patterns.

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Article
The Effect of Hypertonic Saline in Treatment of Moderate Bronchiolitis in Children

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Background: Airway oedema and mucus plugging are the predominant pathological features in infants with acute viral bronchiolitis. Nebulized hypertonic saline (HS) solution may reduce these pathological changes and decrease airway obstruction. Aim: To assess the effects of nebulized hypertonic (3%) saline solution in infants with acute viral Bronchiolitis of moderate severity. Methods: This study was conducted in Al Zahraa teaching hospital for maternity and pediatric in the period between December 2013 till November 2014 at which 165 patients with acute viral bronchiolitis were included. The inclusion criteria were; Infants aged ≤18 months presented with a prodromal history consistent with viral upper respiratory tract infection followed by wheezing and/or crackles on auscultation. Patients were excluded from the study if they have the following criteria: born at ≤ 34 weeks’ gestation, previous history of wheezing, steroid use within 48 hours of presentation, history of apnea within 24 hours before presentation, oxygen saturation ≤85% on room air at the time of recruitment, history of a diagnosis of chronic lung disease, congenital heart disease, or immunodeficiency, consolidation or atelectasis on a chest X-Ray and infants with bronchiolitis severity score <4 or > 8. Result: We found that nebulized 3% HS decreases bronchiolitis severity score after 12h of treatment and its effect subsided after more than 48 h. In regard to hospital stay, the study shows a decrease in mean of hospital stay length from 42.2 to 36.3 h. Conclusion: Nebulization with 3% hypertonic saline is safe, can be widely generalized, and may be superior to current treatment for early outpatient treatment of bronchiolitis. Recommendation: Planning for a multicenter trial to explore the clinical benefit of this therapy with a large sample size is essential.


Article
Umbilical Artery Flow Velocity in Pregnancy Induced Hypertension at Third Trimester

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Background: Doppler ultrasound of umbilical vessels is a technique for evaluating fetoplacental blood flow which is very important in high risk pregnancies like hypertensive pregnancies and can predict both fetal and maternal morbidity and mortality. Since the traditional methods are not good enough to assess uteroplacental and fetoplacental circulation, blood flow studies are used to assess fetal well-being in normal and hypertensive pregnancies. Aim: To measure the blood flow indices of umbilical artery using Doppler ultrasound in patients with pregnancy induced hypertension (PIH) and healthy pregnant women. Methods: This is a case control study at which 60 participants, 40 with PIH and 20 with normal pregnancy at the third trimester were studied in Al Najaf Governorate. Doppler ultrasound of umbilical artery was performed for both, the patient and the control groups in which Resistive Index (RI), Pulsatility Index (PI) and Systolic to Diastolic ratio (S/D ratio) were calculated. Results: The mean ±SD of RI, PI and S/D of the umbilical artery were 0.63±0.11, 0.97± 0.33 and 2.9±1.38 respectively in the PIH group, they were higher than those of the control group (0.62±0.06, 0.91± 0.17 and 2.72 ± 0.41 respectively) at 33-36 weeks. However, differences were found to be insignificant as well as they were higher at 37-40 weeks. Conclusion: There are insignificant elevations of indices of the umbilical artery in PIH women with respect to those of normal pregnancy.


Article
Relation of insulin like growth factor and glycocylated hemoglobin at different gestational periods of pregnancy in diabetic pregnant women

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Background: Diabetes mellitus complicating pregnancy is one of the most common antenatal complications that are associated with significant perinatal mortality and morbidity. Insulin like growth factor-1 (IGF-1) has been implicated with micro-vascular complications during pregnancy. Glycosylated hemoglobin (HbA1c) is a reliable index, used to evaluate the glycemic control at the last 8 weeks. Aim: To find the relation between the level of insulin like growth factor and HbA1c at different gestational periods of pregnancy in diabetic pregnant women. Methods: The study was carried out on 190 pregnant women. They were 134 pregnant women with abnormal carbohydrate metabolism and 56 healthy pregnant women. Those of abnormal carbohydrate metabolism were also classified into two groups, those with gestational diabetes mellitus (70) and those with pregestational diabetes mellitus (64). IGF-1 and HbA1c levels were measured in the studied pregnant women at the second and third trimesters of pregnancy. Results: IGF-1 concentrations was found to be higher in patients with GDM when compared with those of PGDM and the control groups, in both 2nd and 3rd trimesters with a significant (P <0.001) difference among subgroups. HbA1c concentrations were found to be significantly (P< 0.001) higher in pregnant women with GDM and PGDM than in the control group. There was a significant (r=0.27, P<0.001) weak correlation between IGF-1 and HbA1c in both 2nd and 3rd trimesters. Conclusion: Both, IGF-1 and HbA1c levels elevate in pregnant women with GDM and PGDM, such rise is manifested by a weak positive correlation between the concentrations of the two parameters. Recommendation: It is useful to study the role of IGF-1 therapy in pregnant with diabetes mellitus especially those with vasculopathy.


Article
Role of Vitamin C Supplementation on Iron Overload and Oxidative Stress in Beta Thalassemia Major Patients in Maysan Province-Iraq

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Background: Vitamin C is a well-known powerful water soluble antioxidant and very powerful iron absorption enhancer. It was used for a long period in the management of thalassemia major (TM) patients hoping to decrease the oxidative stress initiated by iron overload resulted from hemolysis of erythrocytes and frequent blood transfusions (BT). Iron overload from BTs may be exacerbated in patients due to increased absorption of iron from the diet in response to ineffective erythropoiesis or vitamin C supplementation. Aim: To evaluate the impact of vitamin C supplementation on the iron overload and oxidative stress in beta thalassemia major patients Methods: Fifty five children were investigated in this study. Thirty two of them were patients with TM on frequent BTs and oral chelating drug (deferasirox), they were diagnosed by hemoglobin electrophoresis with a mean age of 9±4.3 y. Patients were attendees of the Blood Disease and Thalassemia center in Maysan Province-Iraq in the period between November 2013 and November 2014. Twenty three apparently healthy children with a mean age of 8±3.2 y were included as a control group. Patients were subjected to vitamin C supplementation (200mg/day) for 2 months. Serum; vitamin C, iron, malondialdehyde (MDA), ferritin and UIBC and complete blood count were determined. Results: There were significant increases of serum iron (P<0.05) and ferritin (P<0.05) levels with insignificant increase of serum MDA levels in samples of patients before supplementation when compared with those of the control groups. However, a significant decrease in serum vitamin C levels (P<0.05) and serum UIBC values (P<0.05) were evident during a similar comparison. The results of second samples, in comparison with the results of first samples referred to a statistically significant increase in serum vitamin C and serum iron (P<0.05), non-significant increase in serum ferritin and MDA and non-significant decrease in UIBC. The complete blood count remained the same in both samples. Conclusion Vitamin C is a powerful enhancer of iron absorption from GIT and releaser from intracellular stores than antioxidant agent. Vitamin C must be given with caution and continuous supervision to TM patients. Recommendation: It is essential to study both smaller and larger doses than 200mg with a longer periods and expanded age groups.

Table of content: volume:17 issue:1