Table of content

Iraqi Academic Scientific Journal

المجلة العراقية للاختصاصات الطبية

ISSN: 16088360
Publisher: The Iraqi Borad for Medical Specialization
Faculty:
Language: English

This journal is Open Access

About

publisher Every Three Months 2000

Loading...
Contact info

Mobil:07903960529
E-mail:IPMJ2000@yahoo.com

Table of content: 2016 volume:15 issue:2

Article
The Frequency of Autonomic Neuropathy in Type 2 Diabetic Patients

Loading...
Loading...
Abstract

Abbas K. Ressan, Asaad Abdullah Abbas,Ali HAshim Hussein INTRODUCTION: Autonomic nervous system (ANS) The ANS supplies and influences every organ in the body and closely integrate vital processes, such as Blood Pressure (BP), temperature and adaptation to environmental change (1). Accordingly, sensory, motor, visceral and neuroendocrine function can be modulated by this system (2). Baghdad Teaching Hospital. The clinical signs and symptoms that occur in disturbances of autonomic response which is influenced by the organ involved. The normal balance of sympathetic (ST) and parasympathetic (pst) innervations, the nature of underlying illness and stage of progression of the disease (3). To investigate the prevalence of D.A.N. was defined by simple non- invasive tests in type 2 diabetic Iraqi patients and it is relation to the duration of the disease. ABSTACT: BACKGROUND: Autonomic Nervous System Innervates vascular and visceral smooth muscle, exocrine and endocrine glands and parenchymal cells through out the various organ system. Diabetic autonomic neuropathy is classified as subclinical or clinical upon the presence or absence of symptoms Awide spectrum of symptoms affecting many different organ system can occur including CVS, GUS, pupillary, automotor and neuroendocrine systems. OBJECTIVE: To investigate the frequency of diabetic A.N.P as defined by simple non – invasive test in type 2 diabetic Iraqi patients and it is relation to the duration of disease. PATIENTS AND METHODS: Fifty type 2 diabetic patients , were evaluated with a five bed side tests to detect autonomic neuropathy and a history of related symptoms was taken there were 30 ( 60%) males and 20 ( 40%) females in the age range 30– 70 years . The five tests were carried out were, heart rate variation during deep breathing, HR response to valsalva, HR response to standing, BP response to sustained hand grip, BP fall in response to standing. Resting ECG (to measure QTc interval) fasting plasma glucose and 2hr., post prandial plasma glucose were done to each patient. RESULTS: Of these 50 patients 34(68%) had evidence of neuropathic abnormality of parasympathetic involvement 19(38%)patients 13(26%), patients had evidence of combined parasympathatic and sympathatic involvement and only 2(4%), patients had only sympathetic involvement. Increase incidence was seen in older age group and poor glycemic control. Autonomic neuropathy more common in patients who had the disease for more than 5 yrs. There was no correlation with prolonged QTC intervals. CONCLUSION: Diabetic ANP is a common complication and related to poor diabetic control and the duration of diabetes. While it is not associated with prolonged QTC interval .


Article
Eye Complications in Children and Adolescent with Type 1 Diabetes Mellitus

Loading...
Loading...
Abstract

ABSTRACT: BACKGROUND: Diabetes mellitus is characterized by hyperglycemia and glycosuria and is an end point of a few disease processes. The most common type occurring in childhood is type 1 DM, which is accompanied by chronic and dangerous micro vascular changes affecting most body systems, especially the eye, leading to cataract and diabetic retinopathy. Diabetic retinopathy without appropriate management is emerging as one of the leading causes of blindness. Therefore, it is necessary to identify relevant risk factors, improve the early diagnosis and management of diabetic retinopathy to reduce the risk of blindness. OBJECTIVE: To estimate the presence of eye complications (cataract and retinopathy) among children and adolescent with type1 diabetes mellitus and to study the effect of various factors on their occurrence. PATIENTS AND METHODS: This study was carried out over nine months period(from first of May till the end of January) at Children Welfare Teaching hospital/Medical City .It included 150 children who had type1diabetes mellitus for at least 4 years in children with pre pubertal onset of diabetes and two years in children with pubertal onset .History was taken, physical examination and investigations were done, then ophthalmological examination looking for eye complications (cataract or retinopathy) performed by ophthalmologist. Statistical analysis done using T test, Chi square, P value <0.05 regarded as statistically significant RESULTS: This study included 150 patients with type 1 diabetes mellitus, their age ranges from 4.5 - 19 years, with duration ranges from 2-18 years. Female to male ratio was 1.8:1.Out of 150 diabetic patients, 24/150 (16%) had eye complications, 9 (6%) of them had retinopathy while other 15 (10%) had cataract .The age of all patients who had eye complication was >10 years which is highly significant (P value: 0.009) and the incidence of eye complications increases with increasing duration of diabetes (p value 0.04). Twenty two (14.7%) female and two (1.3 %) male had eye complications, which is highly significant (P value: 0.002). HbA1c >10 in 17/24 (70.8%) patients with eye complications. there were significant association between the presence of eye complications and macroalbuminuria (p value: 0.02), and limited joint mobility (p value: 0.001) .out of 24 patients with eye complications, 16 (66.6%) patients had short stature and 7(4.7%) patients had celiac disease. CONCLUSION and recommendations: The incidence of eye complications (cataract and diabetic retinopathy) increases with increasing age and duration of diabetes and it is more common in female and it is associated with the presence of other chronic complications (LJM, nephropathy and short stature).So screening all patients with type 1 DM according to the guidelines is required for early detection and treatment of eye complications using new methods like fundal photography.


Article
Noncompliance With Antihypertensive Drugs Among Patients with Essential Hypertension in Sulaimani City

Authors: Omed H.K Hawrami --- Manar Hisham Abdulla
Pages: 140-147
Loading...
Loading...
Abstract

ABSTRACT: BACKGROUND: Hypertension is a common chronic disease in Iraq, noncompliance with medications is one of the most important reasons for uncontrolled hypertension. OBJECTIVE: This study was designed to detect the percentage and the causes of noncompliance with antihypertensive drugs among the study sample. PATIENTS AND METHODS: A cross-sectional study was conducted during the period from August 1st 2012 to February 28th 2013, at four primary health care centers in Sulaimani city, 309 patients were included in the study. Non compliance was tested by using self reported Morisky- Green adherence scale. RESULTS: 54.7% of the patients were non compliant with the antihypertensive drugs, ( 55%males and 45% females), Statistically significant factors were: young age( 62.5%), female gender (63.3%), low educational level (80.5%), being unemployed (71.7%), duration of hypertension > 10 years( 65.2%), and when the source of medication was from health care centers (75.6%). CONCLUSION: A significant percentage of the patients were non compliant with their anti-hypertensive drugs, the main causes of non compliance were patient, physician, and drugs related, respectively.


Article
A Statistical Radiological Analysis in Patients with Sputum Smear Positive Pulmonary Tuberculosis

Loading...
Loading...
Abstract

ABSTRACT: BACK GROUND: Tuberculosis (TB) a multi-systemic disease with various presentations and manifestations; is due to infection with the acid fast bacillus mycobacterium. Disease occurs in only (10%) of infected individuals, it is associated with overcrowding and immune-compromised states OBJECTIVE: To identity the main findings in plain chest X-ray and CT-scan of the chest of pulmonary tuberculosis patients with sputum smear positive in relation to certain factors and clinical conditions including : gender, age , smoking , alcohol- consumption , co-morbid diseases e.g. diabetes mellitus and steroid medication for more than 4 weeks . PATIENT AND METHOD: Across sectional study of randomly collected (100) patients all were new cases of pulmonary tuberculosis disease with sputum smear positive, A plain chest radiography was done to all of them , and a randomly chosen (30) patients (out of the same sample of the study) were examined also by ( high resolution CT-scan ) of the chest to compare the radiological findings.The sample of patients collected consisted of (68)males and (32) females , aged between (12 -82) years.The study was done in the specialized chest and respiratory diseases center in Baghdad during the period from first of March 2012 ,to the end of August 2012. RESULTS: 100patients with sputum smear positive – pulmonary tuberculosis disease were collected, 68 patients (68%) were males and 32 patients (32%) females. From our study97 patients(97%)of total number presented with positive radiological findings whether by plain chest X-ray and /or CT-scan of chest, And 3 patients(3%) of the sample studied were with normal both plain chest X-ray and CT-scan of chest .The radiological findings of all of the patients studied were as :Infiltrative lesion48 patients( 48% )Cavitary lesion(: 37%)Consolidation ( 32%)Pleural effusion (17%)Miliary shadowing( 1%)Clear radiological was found that 28 patients (28%) had radiological abnormalities in the right side of the chest and 25 patients were with left sided radiographic abnormality, while bilateral chest radiological finding had been shown in44 patients (44%). CONCLUSION: The CT- scan of chest is more sensitive than plain chest X-ray for evaluation of abnormal or obscured radiological findings. There is no specific pattern for radiological finding in the chestthe direct sputum examination is remained the 'gold standard' for the diagnosis of pulmonary tuberculosis.


Article
ECG Changes After Alteplase Therapy in Patients with Acute Myocardial Infarction

Loading...
Loading...
Abstract

ABSTRACT: BACKGROUND: Acute myocardial infarction is a major cause of death throughout the world. Many important advances have become available to Coronary Care Units enabling them to reduce mortality and improve the prognosis, Reperfusion therapy is one of these important advances. OBJECTIVE: This study sought to identify the Electro-cardiographic (ECG ) changes which occur after receiving Alteplase therapy and its relation to response to thrombolytic therapy. METHODS : Seventy-three patients with ST- elevation Acute Myocardial Infarction (AM I) who received Alteplase within 12 hours from the start of symptoms in coronary care unit were included in this study. Electro-cardiographic (ECG) was done to all patients at time of arrival to the coronary care unit(CCU), Alteplase therapy was given to all patients plus heparin intravenously, followed by electro-cardiographic (ECG ) every 30 minutes for 2 hours. RESULTS: Fifty-seven and half percent of our patients showed 50% reduction in the ST segment elevation in the worst lead after 2 hours from starting Alteplase therapy and regarded as responders. Other ECG changes like rapid appearance of Q wave, T inversion, accelerated idioventricular rhythm (AIVR) are found to be specific for reperfusion with a high predictive value when the gold standard criteria was reduction 50 % in the ST segment elevation Resolution of reciprocal changes is sensitive and specific with high predictive value. CONCLUSION : Some ECG changes after thrombolytic therapy can predict the response in addition to the already known changes. .


Article
Fiberoptic Bronchoscopy Findings, Safety and Clinical Presentation of 101 Patients Referred for Lung Tumor Evaluation in Baghdad Teaching Hospital

Authors: Mustafa Nema
Pages: 163-168
Loading...
Loading...
Abstract

ABSTRACT: BACKGROUND: Bronchoscopy is widely used diagnostic and therapeutic tools in pulmonary medicine. Findings related to tumor effect, safety profile and patient presentation were explained for patients referred to bronchoscopy unit. OBJECTIVE: To evaluate the bronchoscopic findings combined with clinical presentation and radiological appearance as well as determining safety for patients referred to bronchoscopy unit. METHOD: Fiberoptic bronchoscopy arranged for 101 patients included, 69 males and 32 females. Age range 50.7-67.3 years at the bronchoscopy unit in Baghdad teaching hospital. Review of history and clinical examination performed. Inspection of tracheobronchial tree and appropriate sampling of visible lesions were performed. RESULTS: Cough was the major presenting symptoms (64.3%), followed by dyspnea (28.7%) and hemoptysis (17.8%). Involvement of vocal cord seen in 12.8%, tracheal lesions in 15.8% of patients. Carinal distortion observed in 2.9%. The right bronchial tree involved more than left one (39.6% and 29.7% respectively). Mass and/ or nodules are the main findings detected (82%), followed by bronchial narrowing due to tumor effect in 42.5%. In tumors located in the main bronchi 96% were more than 2cm from the carina. No mortality was recorded, while bleeding occur in 2.9%, hypoxemia in 4.9%, and fever in 0.9% of patients. CONCLUSION: With flexible bronchoscopy, endobronchial mass and associated neoplastic bronchial wall lesions were frequently found in patients referred for lung tumor evaluation. It is a very safe procedure. Cough, dyspnea and hemoptysis were the commonest presenting symptoms for patients referred for bronchoscopy.


Article
Early Experience of Metabolic Surgery

Loading...
Loading...
Abstract

ABSTRACT: BACKGROUND: Laparoscopic sleeve gastrectomy LSG is known to be a highly effective treatment for morbid obesity and many related conditions including type 2 diabetes mellitus (T2DM) and the metabolic syndrome. OBJECTIVE: To assess the effectiveness of (LSG) on glucose homeostasis in morbidly obese diabetic patients and it shows early experience of metabolic surgery. METHODS: Prospective clinical case series study conducted in Al-Jumhoori Teaching Hospital and involved 20 patients (17 females and 3 males); their age (22-54 average 37 years) underwent LSG and the level of glucose evaluated at different times by measuring fasting blood glucose level, glycosylated hemoglobin (HbA1C). RESULTS: The initial body weight 70-142(110Kg); BMI 31.8-53.9 (45.16Kg/m2); two patients with diabetes mellitus and BMI less than 35Kg/m2 involved. The mean level of fasting blood glucose assessed and found to be (202,165,130,107,96 mg/dl) in preoperative ,one-day postoperative,10 days, three and six-months interval; while the level of HbA1C were( 10.2,9,7.2,6.1) in the preoperative ,10 days,3 and 6 months interval respectively. CONCLUSION: LSG is an effective procedure to decrease weight for morbid obesity and it resolve T2DM in 90% while improvement of T2DM occurred in 10 % so LSG is an effective procedure to treat T2DM and the level of glucose declined significantly started from early postoperative and continued till 6 months. .


Article
Sacrococcygealteratoma in Newborns: Management and Outcome

Authors: Hasan K.Gatea*, Moaied A. Hassan**
Pages: 174-179
Loading...
Loading...
Abstract

ABSTRACT: BACKGROUND: Sacrococcygeal teratoma is the most common tumor in the newborn.. Approximately 90% of sacrococcygeal teratomas excised during the neonatal period are benign. The risk of malignancy increases in lesions removed after 6 months of age. OBJECTIVE:: To discuss the management of newborns with sacrococcygeal teratomas and the importance of early surgical intervention in avoiding the risk of malignant transformation. PATIENTS AND METHODS: 11 neonates with sacrococcygeal teratomas were managed during the period from April 2008 through April 2013. In all cases, age, sex, mode of delivery, details of surgery, extent of resection, macroscopic tumor appearance, tumor histology, Altman classification and postoperative morbidity and mortality were all documented and analyzed. A two years follow up plan was designed to assess any complication and tumor recurrence. RESULTS: Classical sacrococcygeal approach was performed in all of the patients operated upon and complete excision of the tumor along with the coccyx was possible in all cases. According to the Altman classification 8 (72.7%) of the tumors were of type I. Macroscopically, 7(63.6%) tumors were mixed,. Histopathological examination of the excised tumors revealed the diagnosis of benign mature teratoma in all cases. All of the newborns survived with the exception of one patient with a giant sacrococcygeal mass who died because of heart failure . No tumor recurrence was documented in all of the patients operated on. CONCLUSION: Early detection including antenatal diagnosis is essential to define fetuses with poor prognostic signs and deciding the appropriate mode of delivery, and in some centers even fetal intervention. Early excision of these tumors during the neonatal period is essential to avoid the risk of malignant transformation.


Article
Evaluation of Sublay Mesh Repair in Comparison with Onlay Mesh Repair for Incisional Hernias

Authors: Haider Abdulhussein Ahmed
Pages: 180-184
Loading...
Loading...
Abstract

ABSTRACT: BACKGROUND: Incisional hernia after abdominal surgery is a well-known complication and the incidence of incisional hernias continues to be 2-11% after laparotomy. The repair of incisional hernia has always been a challenge to the surgeon. Various operative techniques for the repair of incisional hernia are in practice; however, the management is not standardized. The sublay technique, popularized by Rives and Stoppa in Europe, has been reported to be quite effective, with low recurrence rates and minimal complications. OBJECTIVE: To study the advantage and complications of sublay mesh repair of incisional hernias in comparison to onlay mesh repair. METHODS: Record of 110 patients undergoing repair of incisional hernia from 1st Jun 2013 to 1st Jun 2015, excluding very large incisional hernia with defect more than 10 cm. 62 cases of incisional hernias were managed by onlay mesh repair and 48 cases of incisional hernia were managed by sublay mesh repair. RESULTS: Post-operative complications like seroma and wound infection were comparable in both groups. In sublay group, Seroma formation was 2 patients (4.3%) . wound infection was 2 patients (4.3%). No septic mesh was removed in the series. In onlay group seroma formation was in 12 patients (19.4%) most of seroma occur in large incisional hernias repair, wound infection was in 5 patients (8.1%) and 2 septic mesh was removed. In sublay, recurrence rate was one patient (2.1%), in onlay, recurrence rate was in 5 patients (8%). CONCLUSION: Sublay mesh although it is more time consuming and technically more difficult, however it carries low recurrence rate and few post-operative wound complication . .


Article
Second and Third Trimester Placental Thickness: Correlation with Placental and Birth Weights

Loading...
Loading...
Abstract

ABSTRACT: BACKGROUND: The placenta is a materno-fetal organ; it is closely related to the fetus and the mother, it acts like a mirror, reflecting the statuses of both the mother and the fetus. Placental evaluation by ultrasound has been used to characterize placental morphologic changes as the placenta matures. Using different parameters such as placental thickness, weight, and volume have exhibited significant and positive relationship with gestation and birth weight. OBJECTIVE: To investigate the relationship between placental thickness during the second and third trimesters and placental and birth weight. METHODS: This Prospective Longitudinal study involved pregnant women who presented at Al-Yarmouk Teaching Hospital antenatal clinic. All recruited women were assessed at their 1st trimester visit for baseline demographic and obstetrical data. At the second and third trimesters, maternal weight, weight gain, body mass index, body mass index gain, placental thickness measured by ultrasound, and thickness change were recorded. Statistical analysis was performed to establish the degree of relationship between placental thickness and placental and birth weights. RESULTS: Of 150 recruited participants, 100 women were able to complete the study. The mean maternal age was 32.1±4.2 years. Ultrasonographic measures of placental thickness in the second and third trimesters and thickness changes between them were 2.44±0.57, 3.58±0.59 and 1.14±0.38 cm respectively. Values of mean birth and placental weights were 3433± 350.99, and 457.95±46.82 grams respectively. A significant positive correlation was found between placental thickness and birth weight in the second and third trimesters (r=0.0237, p=0.018, r=0.399, p<0.001) respectively. CONCLUSION: According to the present study, birth weight has a positive correlation with both second and third trimester placental thickness; however, placental thickness change could not predict low or high birth weights.


Article
Management and Outcome of Stroke in a Sample of Children Admitted to Children Welfare Teaching Hospital/Baghdad

Loading...
Loading...
Abstract

ABSTRACT: BACKGROUND: Stroke in children is a serious disorder in which little has been published. Population-based estimates of the annual incidence of childhood stroke (ischemic and haemorrhagic) range from 2•3 to 13•0 per 100 000 children and incidence rates in neonates are closer to 1 per 5000 live births CONCLUSION: To determine clinical presentation, etiologies, diagnostic procedures, treatment options and outcome of children with stroke. METHODS: Descriptive study of patients with stroke admitted to Children Welfare Teaching Hospital/Baghdad from October 2011 to September 2012 was conducted. Cases were classified radiologically into ischemic stroke (IS) and hemorrhagic stroke (HS) and their management modalities were studied. RESULTS: Out of 21 patients; 13 (61.9%) had hemorrhagic and 8 (38.1%) had ischemic stroke. Female:male ratio was 1.3:1. Haemorrhagic stroke was more among males and infants; ischemic stroke was more among females and older children. In 16 (76%) patients, the diagnosis was established after more than 24 hours of onset. Patients with ischemic stroke spend longer time in hospital. Seizure was the commonest clinical feature in both types (17 patients (81%)) followed by altered mental status (16 patients (76.2%)). CT-scan was abnormal in 20 patients and MRI in 11 patients. Complete recovery was noticed in 7 (54%) patients with hemorrhagic type, while 7 (87.5%) patients with ischemic type recovered with sequelae. CONCLUSION: Stroke was more common among female and children younger than 12 months. Seizure and altered mental status were the commonest presentations. A delay in performing neuroimaging was obvious in the current study. Patients with ischemic stroke tend to spend longer time in hospital. Antibiotic were the medication most often used. The majority of children were discharged well. .


Article
Assessment of Disease Activity in Rheumatoid Arthritis: A Comparative Study of Clinical Evaluation with Ultrasonography

Loading...
Loading...
Abstract

ABSTRACT: BACKGROUND: In patients with rheumatoid arthritis (RA) a poor relation on an individual joint basis, has been observed between clinical signs of synovitis and ultrasound measures of synovial disease. OBJECTIVE: To compare the traditional clinical measures of disease activity with the ultrasound (US) features of synovitis, and investigate the relationship between composite US measures and disease activity score in 28 joints (DAS28), clinical disease activity index (CDAI), their components and other variables of disease activity in RA. METHODS: Fifty patients with RA were enrolled in this study. The following 28 joints including bilateral glenohumeral, elbow, wrist, metacarpophalangeal (MCP), proximal interphalangeal (PIP) of the hands, and knee joints were assessed for tenderness and swelling. DAS28 and CDAI were determined for each patient. A systematic US examination was carried out by a radiologist for the 28 clinically examined joints. Each joint was evaluated for the presence of synovial hypertrophy (SH), power Doppler (PD) signals, and effusion. The following composite US measures of synovial disease were made: SH joint count (SHJC), effusion joint count (EJC), PD joint count (PDJC), SH index (SHI), and PD index (PDI). RESULTS: Joints with tenderness only showed significantly less PD scores than other groups. SH and PD signals were detected in 32.1% and 27.8% of the Nil group respectively. SHJC and SHI showed moderate correlation with TJC and high correlation with SJC, evaluator global assessment (EGA), patient global assessment (PGA), DAS28, CDAI, and erythrocyte sedimentation rate (ESR). PDJC and PDI showed moderate correlations with tender joint count (TJC), and high correlation with swollen joint count (SJC), EGA, DAS28, and ESR. PDI showed high correlation with PGA, and CDAI. CONCLUSION: Traditional clinical signs used in the evaluation for disease activity may bear different relation to the US features of synovitis (SH, PD signals). Composite US count and indices for SH and PD relate significantly to the DAS28-ESR, CDAI, and their components. .


Article
Evaluation of the Analgesic Effect of Four Intra-Articular Ozone Injections in Knee Osteoarthritis

Authors: Iyad Abbas Salman
Pages: 211-214
Loading...
Loading...
Abstract

ABSTRACT: BACKGROUND: Knee osteoarthritis (OA) is a degenerative disease of the knee joint. There is no cure for the disease, but some treatments attempt to slow disease progress. Intraarticular ozone injection is increasingly being applied. In knee osteoarthritis it represents a complementary treatment method which provides pain relief, decongestion, subsidence of bruises (hematomas), a reduction in temperature and an improvement in motility. OBJECTIVE: To evaluate the analgesic effect of 4 subsequent intra-articular ozone-oxygen injections in knee joint osteoarthritis. PATIENTS AND METHODS: It was a prospective, randomized clinical study, done on 30 knee joints, all patient were with history of OA of knee joint & suffering from long standing pain & they have long history of medical therapy. After taking patient consent, 5 weekly sessions of intra-articular 5 ml (25 μg/ml ) ozone injections were done under complete aseptic technique. Numerical Analog Pain score has been assessed and recorded before each session. RESULTS: It was found that there was highly significant difference between each 2 subsequent sessions and the p-value was below 0.01 in all times. CONCLUSION: Subsequent Intra-articular ozone injection had significant analgesic effect in knee joint osteoarthritis


Article
Treatment of Freckles Among Patients with Dark skin Complexions. A Comparison of Intense Pulsed Light, Q-Switched 532 nm Laser and Phenol 80% Spot Peel

Authors: Husam Ali Salman
Pages: 215-219
Loading...
Loading...
Abstract

ABSTRACT: BACKGROUND: Intense pulsed light (IPL), Q-switched 532 nm laser and phenol peels are useful for pigmentary lesions but with limited comparative studies in dark skin peoples and a presumed pigmentary changes. OBJECTIVE: To compare the efficacy and safety of IPL, Q-switched 532 nm laser and phenol 80% peel in the treatment of freckles METHODS: Twenty six patients with freckles were enrolled in the study. They had Fitzpatrick skin type III and IV. From each patient, the freckles on the right and left cheeks were treated with a single session of IPL or phenol 80% spot peel respectively. Freckles on the midface were treated with Q-switched 532 nm laser. Patients were seen after 1, 2, 6 and 16 weeks RESULTS: Nineteen (73.07%) patients were females and 7 (26.92%) were males, their ages ranged from 19-36 (27.53±5.88) years. Immediate darkening was seen at the IPL treated lesions. Frosting was the result at the laser and phenol ones. Dry scab developed on all lesions and falls after 5-7 days. At 16 weeks of follow up, score 1 was maintained in 18 (69.23%) versus 6 (23.07%) patients at the IPL and phenol sides respectively, while at the laser treated lesions 19 (73.07%) patients were having score 2. No one had score 1. After 16, good satisfaction was obtained in 61.53%, 38.46% and 26.92% on the IPL, phenol and laser sites respectively. CONCLUSION: ll 3 modalities are beneficial, but intense pulse light was more effective and safe. .


Article
Depression in Patients with Acquired Heart Diseases in Baghdad

Loading...
Loading...
Abstract

ABSTRACT: BACKGROUND: Both heart diseases and depression are highly prevalent, Depression can add to the suffering already present due to the physical condition of the cardiac patients and it affects the outcome. OBJECTIVE: Is to find-out the prevalence of depressive disorder among patients with three different categories of heart diseases in three different Iraqi Hospitals; to find out gender differences, some demographical data and the difference between first time affected patients and recurrent cases of heart problems, in regard to the prevalence of depression in these patients. PATIENTS AND METHODS: A case control study was conducted using 100 patients, with an age range from 30-89y who has been diagnosed by Qualified Internists, this group was compared with another 100 control group with the same age and at the same time, both groups were examined for the presence of depressive disorder using ICD-10 diagnostic criteria and then assessing the severity of the depression in the depressed group by using Beck Depressive Inventory. RESULTS: The present study revealed that (24%) of study patients compared to (4%) of the control group were depressed and there was a significant association between the severity of depression and the different types of heart diseases, also females were more severely depressed than males. CONCLUSION: There is a high rate of depression among patients with different types of heart diseases, which is often goes unrecognized, untreated, and under estimated, early detection of depression is critical, because of adverse outcome attributed to depression. .


Article
Prevalence of Mental Illnesses among Adults Attending Primary Health Care Centers in Baghdad

Loading...
Loading...
Abstract

ABSTRACT: BACKGROUND: It is gradually becoming recognized that mental disorders are a public health problem throughout the world. Psychiatric epidemiological studies are therefore crucial for the planning and development of psychiatric services. OBJECTIVE: To determine the prevalence and determinants of mental illness among adults attending Primary Health Care Centers (PHCCs) in Baghdad, Iraq. METHODS: A cross sectional survey was conducted in two primary health care centers in Baghdad governorate. Participants were interviewed and data filled using a questionnaire for socio-demographic variables, Self Reporting Questionnaire (SRQ-20), and WHO guide to mental health in primary care. RESULTS: A total of 527 PHCCs attendees were approached. The prevalence of mental illness was 36.8%. Depression (49.48%) and anxiety (20.62%) were the major categories of mental illness. The highest proportion of mental illnesses was seen among the older age groups (80%), females (37.9%), widows (84.6%), higher education level (96.7%), and retired (77.8%). CONCLUSION: In accordance with other studies, about one third of adult attending PHCCs had mental disorders. The study emphasized strengthening mental health services in PHCCs through establishing metal health care units.


Article
Immunohistochemical Localization of Epstein Barr Virus- Latent Membrane Protein 1 in Breast Cancer Tissues

Loading...
Loading...
Abstract

ABSTRACT: BACK GROUND: Epstein- Barr virus (EBV) is well known to infect the vast majority of the world's adult population and has recently been reported in many literatures for its association with a broad spectrum of benign and malignant tumors, including breast cancer. OBJECTIVE: To analyze the relations and impact of Epstein Barr Virus- latent membrane protein 1(EBV-LMP 1) expression on a group of tissues with primary invasive breast cancers. PATIENTS AND METHODS: Forty- nine (49) formalin-fixed, paraffin- embedded breast tissues were obtained in this study; (34) biopsies from breast cancers (BC) and (15) from apparently normal breast autopsies control group. Detection of expression of Epstein Barr Virus- latent membrane protein 1(EBV-LMP 1) was done by HRP/DAB immunohistochemistry detection kit (an immunoenzymatic antigen detection system for immunohistochemistry techniques) using specific primary antibodies for EBV-LMP 1. RESULTS: Detection of EBV-LMP 1 - immunohistochemical (IHC) reactions in tissues with BC was observed in 11 out of 34 (32.4%), while in healthy breast tissues in the control group was detected in 13.3% (2 out of 15). The difference between the percentages of EBV-LMP 1 detection in BC tissues & control group was statistically not significant (P >0.05). While no significant differences were observed between EBV-LMP 1 detection in BC tissues & the age of patients as well as grade of invasive breast cancers (P value > 0.05). CONCLUSION: Our results indicate that EBV could have a role in the pathogenesis of subset of breast cancers and contribution in their carcinogenesis. .


Article
Immunohistochemical Evaluation of the Frequency of Human Papillomavirus in Cervical Lesions in a Sample from the North Iraqi Population

Loading...
Loading...
Abstract

ABSTRACT: BACKGROUND: Human papilloma virus has been linked to many types of cervical lesions, ranging from the relatively innocuous lesions to fatal invasive squamous cell carcinoma. There is growing evidence of Human papillomavirus being a relevant factor in other anogenital cancers (anus, vulva, vagina and penis) as well as head and neck cancers. OBJECTIVE: To assess the feasibility of immunohistochemical staining paraffin sections for the presence of Human papilloma virus with monoclonal antibodies (clone K1H8, IgG) raised against the major coat fusion capsid proteins and to detect the frequency of human papilloma virus immunoexpression in benign, preneoplastic and neoplastic cervical lesions in patients living in Erbil city ( North of Iraq). MATERIALS AND METHODS: A total of 75 paraffin blocks samples of cervical tissue were retrieved retrospectively from the Pathology Department of Maternity Teaching Hospital and some private laboratories in Erbil city, during a period spanning from September 2013 to June 2014. They were categorized as: Benign cervicitis (10) samples, cervical intraepithelial neoplasia, CIN I (33) samples, CIN II (10) samples, CIN III (13) samples, cervical squamous cell carcinoma (6) samples and three samples with cervical adenocarcinoma Immunohistochemistry was performed on those samples using the avidin -biotin-peroxidase complex in which primarily monoclonal anti Human papilloma virus antibodies was used. RESULTS: None of the 10 samples of benign cervicitis were positive for Human papillomavirus protein while 21 out of 33 (63.6%) samples of CINI, 9 out of 10 (90%) samples of CIN II and 9 out of 13 (69.2%) samples of CIN III were positive for HPV. Also Human papillomavirus positivity observed in all six samples of squamous cell carcinoma (100%), mostly in sheets of less mature squamous cells and in 1 out of 3 (33.3%) samples of adenocarcinoma , mostly focal and in single cell. CONCLUSION: The immunohistochemical staining technique revealed a significant detection of HPV protein in cervical intraepithelial neoplasia and cervical carcinoma. .


Article
Estimation of Ionized Calcium Concentration in Critically Ill Patients

Loading...
Loading...
Abstract

ABSTRACT: BACKGROUND: Hypocalcaemia is a commonly encountered problem in critically ill patients, and it has been shown to correlate with increased ICU stay and mortality. OBJECTIVE: This study is to estimate serum ionized calcium level and to evaluate whether calcium adjusted for albumin accurately predicts ionized calcium concentrations. PATIENT AND METHOD: Cross sectional study conducted to 47 randomly selected adult patients admitted in Baghdad teaching hospital/ ICU from June 2014-october 2014. Ionized Ca level was determined using ion-specific electrode methodology, on heparinised plasma. The total Ca concentration was adjusted for serum Albumin. RESULTS: From total 47 patients, 40 patients were showed low serum calcium level (mean 6.79 mg/dl), and 28 were showed low corrected s.calcium (mean 7.77 mg/dl). Low serum albumin was independently associated with hypocalcaemia on admission. 30 patients (63.83%) reported low total S. alb. mean s. albumin where 2.8mmol. .


Article
Effect of Caudal Block on Minimum Alveolar Concentration (MAC) of Inhalational Anesthetic and Recovery in Pediatric Age Group for Inguinal Hernia Repair

Loading...
Loading...
Abstract

ABSTRACT: BACKGROUND: Caudal block is the commonest regional technique in pediatric patients. It provides excellent analgesia with minimal side effects. It is typically combined with general anesthesia. There are a number of advantages to this practice because anesthetic depth can be reduced by regional anesthesia, thereby potentially reducing the complications of both forms of anesthesia. It is commonly used for procedures below the umbilicus. OBJECTIVE: The aim of the study is to evaluate the effect of caudal block in reducing the anesthetic requirement when it is combined with general anesthesia and its effect on the recovery period. PATIENTS AND METHOD: Forty healthy unpremedicated children, ASA Ӏ, aged (2-5 years) undergoing inguinal hernia repair, were randomized to either Caudal group [using 1ml/kg of 0.25% bupivacaine] (n=20), or control group ( without caudal block) (n=20). In both groups anesthesia were induced and maintained with halothane, the vital signs were recorded ( heart rate, respiratory rate) every 5 minutes, and according to stability of the vital signs the inspired halothane concentration was followed. We also compared the recovery in both groups. RESULTS: At surgical incision; in group 0 [ control], there were increases in heart rates [15-20%] and in respiratory rates [6-8%] from zero time, while in group1 [caudal], the heart rates increased only by [ 2-3%] and respiratory rates by [1-2%]. After 15 min. from zero time, the vital signs remained around the zero time in group 0; while in group 1 the vital signs decreased below the zero time by [13-14%]. At 30 minutes there was further fall in the vital signs in group1 [16%], so we decreased inspired halothane concentration to 0.6 till the end of surgery. In group 0, the measurements remained around the zero time or just slightly changed [less than 5%], while inspired halothane concentration remained at 1.1% till the end of surgery. The recovery in group1 was smoother and faster than in group 0 with lesser complications . CONCLUSION: Caudal block using 1ml/kg of 0.25% bupivacaine, when combined with general anesthesia for inguinal herniotomy in pediatric age group, is sufficient to reduce the halothane requirement [MAC] intraoperatively and insures smoother and faster recovery without any major airway-related complications or hemodynamic instability. .

Table of content: volume:15 issue:2