Table of content

Iraqi Academic Scientific Journal

المجلة العراقية للاختصاصات الطبية

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

This journal is Open Access

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Table of content: 2016 volume:15 issue:4

Article
Orbital Hydatid Cyst: An Easier and Safer Removal Through Anterior Orbitotomy Approach

Authors: A Hadi Al Khalili
Pages: 385-388
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ABSTRACT: BACKGROUND: Hydatid Cyst of the Orbit is a rare manifestation even in endemic areas. It presents as a silent proptosis with or without visual function impairment. Many surgical procedures have been implemented for cyst removal including transcranial, lateral orbitotomy, tansmaxillary sinus, rhinotomy, and anterior orbitotomy. Post-operative complications endangering visual function and locally were reported with some of these approaches. A new simple, easy, and quick procedure was improvised with no significant complications. The procedure is described in details. .


Article
Outcome of Levator Advancement Procedure for Treatment of Congenital Blepharoptosis

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ABSTRACT: BACKGROUND: Eyelid Ptosis is classified according to etiology as congenital or acquired, simple congenital ptosis is the most common form characterized by fatty dystrophy and fibrosis of the levator muscle which leads to a restricted elevation in upgaze and a lid lag in downgaze. The choice of operation depends on the grade of ptosis and the levator function. OBJECTIVE: To evaluate the effectiveness of levator advancement technique for treatment of congenital blepharoptosis. PATIENTS AND METHODS: A prospective study done in Surgical Specialities Hospital-Medical City and Rizgary Teaching Hospital between June 2012 -June 2016; levator advancement technique was applied for treating all patients with congenital blepharoptosis with fair to excellent levator function. In this study 69 patients (77 eyelids) were included, 8 patients (11.6%) had bilateral ptosis and 61 patients (88.4%) had unilateral ptosis, some cases presented primarily for revision of ptosis. Patients ages range is (4.5-52 years), the post-operative follow up period was from 3 months up to 24 months . RESULT: In the 69 patients with congenital ptosis who were treated by levator advancement technique 7 eyelids (9% of total operated eyelids) was found to have levator dehiscence ,we found that success rate was (80.5%) as a final outcome after both the primary and revision surgery , the most common complication was under-correction in 8 cases, surgical revision performed in 8 cases (10.3%) for different reasons. Statistically significant relationship between preoperative and post-operative vertical palpebral fissure height (P < 0.0001) and degree of ptosis (P <0.0001) was observed. CONCLUSION: Levator advancement with/without resection has a high success rate and few complications in the surgical treatment of congenital ptosis with all degree of ptosis with fair to good levator function. .


Article
Surgically Treated Ankle Fracture, Danis – Weber Type C: A Short Term Functional Outcome

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ABSTRACT: BACKGROUND: Fractures of the ankle are fairly common injuries. Large comparative studies that have evaluated long-term functional outcome of operatively treated ankle fractures are lacking. OBJECTIVE: This study is performed to analyse the functional outcome of gender, weight and age of patient with Weber C in the early follow up time. PATIENTS AND METHODS: This retrospective review of 18 patients (13 males and 5 females), age ranges between 19-78 years (average 38.9 years) with Weber type C ankle injury that were treated by open reduction and internal fixation in Medical city Complex from October 2013 to February 2014. All patients were followed up for a mean time of 15.5 months (12- 30 months) after index surgery. The body mass index (BMI) of all patients ranges from 19.9-36.7 (mean 27.4), of these patients, 6 (4 females and 2 males) had BMI more than 30 (mean 33.5), the other 12 patients had BMI of less than 30 (mean23.4). Outcome measurements were determined using the Olerud and Molander scoring system and Linear Analogue Scale for all patients. RESULTS: According to the (OMAS) scoring system, there were 12 patients had excellent outcome, 3 had good, 2 had fair and one patient had poor results.14 patients of less than 50 years their average OMAS score was 82.8, while those of more than 50 years 57.5 (P value =0.001); LAS score for patients less than 50 years average score was 8.07 while those more than 50 years was 5.5 (P value =0.0007).Male gender in this study was 13 patients, average OMAS score was 91.5, and average LAS was 9, female patients were average scored 40 and 3.6 by OMAS and LAS respectively. (P value=0.0022).Regarding the BMI, patients of less than 30 had average OMAS score 85 and LAS score 8.25. On the other hand, patients who had more than 30 BMI had average OMAS 61.6, and average LAS 6. (P value =0.0001). CONCLUSION: The early follow up time shows better results in male gender, younger age group, and non-obese patients. A long follow up time is required for this type of injury in order to base the evidence of these parameters and to evaluate the functional outcome.


Article
Dynamic Hip Screw Versus Proximal Femoral Nail in the Treatment of Stable Intertrochanteric Fractures

Authors: Mohammed Hatem Salal
Pages: 406-412
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ABSTRACT: BACKGROUND: Intertrochanteric fracture is a common injury among older age group , it occupy a high percentage of fragility fractures admitted to the casualty department , lots of methods have been used over decades. Dynamic hip screw (DHS) was the gold standard technique since its invention, however after introduction of the proximal femoral nail (PFN) to the markets in the 90s, this represented a major turning point in the management of intertrochanteric fracture especially the unstable ones. OBJECTIVE: To compare the results of DHS versus PFN in the management of stable intertrochanteric fractures. PATIENTS AND METHODS: Prospective study included 35 patients who underwent operation by either DHS or PFN, all patients sustained stable intertrochanteric fracture and operated within one week. Closed reduction was done in all patients, PFN cases were done through small incisions under fluoroscope guidance, while DHS cases were operated through standard lateral approach. Patients were assessed according to intraoperative parameters of blood loss, duration of surgery and postoperative parameters regarding partial and full weight bearing, amount of shortening in mm, rate of union, functional score using palmar and proud score , rate of infection and implant complication. RESULTS: Significant differences were noted regarding blood loss and weight bearing in favor of PFN, while duration of surgery was less in DHS. No significant differences were noted regarding other parameters. CONCLUSION: The study revealed significant difference in favor PFN regarding blood loss, weight bearing and shortening. .


Article
Saving Versus None Saving of Anterior Cruciate Ligament Remnant in Arthroscopically Assisted Anterior Cruciate Ligament Reconstruction(ACLR)

Authors: Majed Aswad Jasem Alsaad
Pages: 413-418
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ABSTRACT: BACKGROUND: Anterior Cruciate Ligament injury is one of the most common injuries of the knee and reconstruction is a commonly done surgical procedure. Successful outcome depend on factors that affects the stability like anatomic graft placement and secure fixation and other factors that affects the proprioception and revascularization of the graft like preservation of the ACL remnant which is used to reduce repeated graft rupture. OBJECTIVE: To compare the effect of saving of ACL remnant versus none saving on functional outcome and stability of the knee joint postoperatively. PATIENTSANDMETHODS: A prospective comparative non randomized study was used on 30 patients (28 male and 2 female) who underwent arthroscopic ACLR. The patients were divided into 2 groups (A and B), in group A (15 patients), reconstruction was done without saving of ACL remnant and in group B (15 patients), saving of the ACL remnant was performed. In one year follow up the result was compared according to the anterior drawer, Lachman, Pivot shift tests and Lasholm score changes (preoperative and postoperative). RESULTS: Regarding to Lasholm score the result was better in group B than in group A which was statistically significant (p value = 0.025). The knee stability was better in group B than in group A which was statistically insignificant. CONCLUSION: It is recommended to save the ACL remnant if possible with better knee joint functions and less repeated graft rupture.


Article
Variability of Vertical and Horizontal Facial Measurements Among the Population of Basrah

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ABSTRACT: BACKGROUND: Anthropometry is the systematic quantitative representation of the human body, it is used to measure the absolute and relative variability in size and shape of the human body. Scientists were studying this knowledge in medicine for both diagnosis and treatment. The people of Basrah are a mixture of Semites, Arian, and there are the mixed group result from interracial marriages. OBJECTIVE: To quantitatively measure the human face in different ethnic groups of local population and to identify the differences between individuals of different races and sexes, also to identify the differences between the people of Iraq and other people worldwide. MATERIAL AND METHODS: This study is a cross sectional study conducted in Basrah governorate. The data was randomly collected for the period from February to July 2013, from 1000 Iraqi adults (526 females and 474 males) living throughout Basrah governorate. They were between the ages of 18- 40 years, and had to meet certain criteria. This sample was used to create a database for statistical analysis. RESULTS: The results show that the measurements of the three sections and four sections facial profile are unequal as stated by neoclassical canons. The ears are longer than the nose. There are slight differences between the intercanthal distance (ICD) and alar width. The palpebral fissure length is equal to the ICD. The mouth width is 1.4 times the nose width. The facial width (zy- zy) is 3.4 times the nose (alae) width. CONCLUSION: There are differences in facial measurements, although slight, between different ethnic groups in Iraq, and between Iraqi population in general and the population of other countries, therefore, aesthetic measurements applied to all races are inapplicable. These slight differences could be attributed to interracial marriages and or environmental effect.


Article
Rapid Sequence Induction using Rocuronium in Adult Patients

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ABSTRACT: BACKGROUND: Several studies using rocuronium as an alternative to suxamethonium for endotracheal intubating conditions in rapid sequence induction are available in literature, all claiming obvious advantages, but intubating conditions after suxamethonium and rocuronium have not been assessed in our hospitals yet. OBJECTIVE: The aim of this study was to assess the efficacy of rocuronium for rapid sequence induction by comparing the endotracheal intubating conditions with suxamethonium, following induction with sodium thiopentone as the sole induction agent in elective, otherwise healthy, adult patients. MATERIALS AND METHODS: The patients were divided into two groups, each consisting of 40 patients: group A patients received rocuronium bromide 0.6 mg/kg IV, and group B patients received suxamethonium chloride 1.5 mg/kg IV. In both groups, jaw relaxation and vocal cord relaxation were considered for atraumatic laryngoscopy at 60 seconds . Induction of anesthesia achieved with thiopentone as a sleeping dose for all patients. RESULTS: All the patients in the suxamethonium group have excellent intubating conditions, while in the rocuronium group, 90% of the patients were excellent and 10% were good regarding the intubating conditions. CONCLUSION: It is concluded from this study that intubation can be performed under good to excellent conditions at 60 seconds after a bolus dose of rocuronium of 0.6 mg/kg. The result of this study indicates that this nondepolarizing neuromuscular blocking agent may be considered as a valuable alternative to suxamethonium for rapid sequence induction, i.e., within 60 seconds, even after induction with thiopentone as the sole anesthetic agent.


Article
Effect of Pressure Support Ventilation Usage at the End of Surgery on the Recovery from General Anesthesia in Extra Peritoneal Surgery

Authors: Raghad Hannon Shinen ALSudani
Pages: 437-440
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ABSTRACT: BACKGROUND: Recovery speed and quality from general anesthesia has been proposed as possible measure of quality of anesthesia. Recovery is affected by many factors; patient status, drugs used, surgical procedure and time of it. OBJECTIVE: To assess the effect of using pressure support ventilation at the end of surgery on the recovery from general anesthesia in extra peritoneal surgery. METHODS AND RESULTS: 100 patients had enrolled in study from 1st/11/2014 till 20th/1/2016 in medical city complex hospitals. All patients were received general anesthesia with endotracheal tube and same anesthetic management and considering score of 10/10 from modified aldrete criteria as aim in recovery. Patients were divided into two groups: 50 patients had received pressure support ventilation at end of surgery. Other 50 patients had continued with muscle relaxant and controlled mechanical ventilation. RESULT: Patients with support ventilation had shorter recovery time 11.8 min than those with controlled ventilation 17.7min,this was statistically significant P value was 0.000 and clinically of importance by decreasing recovery time and decrease use of reversal of muscle relaxant. CONCLUSION: Pressure support ventilation at the end of surgery enhances recovery and decrease time of stay recovery site. .


Article
Effect of Midazolam on Heart Rate in Pediatric Anesthesia

Authors: Sanaa Fareed Qassim
Pages: 441-445
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ABSTRACT: BACKGROUND : Midazolam is one of benzodiazepines. It is most lipid soluble as a result has a rapid onset and short duration of action, used in anesthesia for sedation or intravenous induction according to the dose used. OBJECTIVE: Is to notice if there is an effect of midazolam on heart rate in pediatric patients with using ketamine as induction agent under general anesthesia. PATIENTS AND METHODS: 60 peadiatric patients undergoing surgery randomly allocated in 2 groups(A and B). Aneasthesia was standardized for all patients (except addition of Midazolam in sedative dose (0.03 mg/kg) i.v. preinduction to group( B). Heart rate measured preoperatively as abaseline and 5 and 15 minutes after induction. RESULTS: Adding midazolam associated with a reduction in HR by an average of 10 beats/min 5 and 15 minutes after induction of anaesthesia. This effect failed to reach the level of statistical significance although it was clinically significant. CONCLUSION: Midazolam have well known sedative effect but have no significant effect on heart rate in paediatric patients.


Article
CD71Expression Pattern in Lymphocytes Among Rheumatoid Arthritis Patients

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ABSTRACT: BACKGROUND: Abnormal lymphocyte activation status have been described in rheumatoid arthritis. Suggesting an increased need for iron as a source of energy. OBJECTIVE: To evaluate the cellularexpression pattern ofTransferrin receptor(CD71)proteinin the peripheral blood lymphocytes, PATIENTS &METHODS: This study involved forty-six rheumatoid arthritis patients 42 female and 4 male, age ranged from 25-66 years collected from AL-Kadhemia teaching hospital were examined and compared with 17 healthy control individuals of similar ages. Lymphocytes were separated from peripheral blood samples,the assessment of their cellular expression of cluster of differentiation 3 and CD71by immunofluorescent staining method. RESULTS: The results showed abundant accumulation of CD3 T lymphocytes in the peripheral circulation of rheumatoid arthritispatients in comparison with controls with increased transferrin receptor expression in rheumatoid arthritisgroup (p<0.001).Furthermore,the diffuse pattern was not significant (0.280), lower percentage of intercellular pattern among RA patients (21.31±16.23) than controls (45.43±12.95) with highly statistical significant difference (p<0.001). While, membranous pattern was higher among RA patients (51.22±28.43) than controls (23.77±18.57) with highly statistical significant difference (<0.001). CONCLUSION: This study demonstrate increased expression in CD71 with membranous expression pattern amongrheumatoid arthritis patientsthan thatcontrols, suggesting its important role in up taking transferrin from blood as a source for energy. .


Article
Overweight and Obesity in A Sample of Primary School Children in Baghdad

Authors: Riyadh Alredainy*, Faris Al Lami**
Pages: 452-458
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ABSTRACT: BACKGROUND: Obesity is one of the most serious public health problems of the 21st century, that has many serious long-term consequences for health. The prevalence of childhood obesity has been increasing at worrying rates across the globe. OBJECTIVE: To measure the prevalence and identify potential risk factors of overweight and obesity among a sample of primary school children in Baghdad, Iraq. METHODS: This cross-sectional study was conducted on a random sample of 10 primary schools from different localities of Baghdad, followed by a systematic random sample of 620 children aged 10 years or more of both sexes. A questionnaire sent to the parents to gather information on socio-demographic characteristics, dietary habits, daily physical activity, steroids use, family history of obesity and parents` education and job. Children's height (cm), weight (Kg), and BMI-for-age were measured and parents` height and weight were obtained through a questionnaire sent to the parents and accordingly BMI (Kg/m2) was calculated. Child's weight status was categorized based on WHO 2007 Growth Reference. RESULTS: The prevalence of high BMI was 30.3%, including 16.3% overweight and 14% obesity. Following application of binary analysis, the significant risk factors included in the logistic regression model that revealed the following significant risk factors: not having regular sports (OR: 4.1; P=0.000), child inactivity (OR: 3.1; P=0.001), high meal frequency (OR: 2.6; P=0.006), positive family history of obesity (OR: 2.5; P=0.01) and more sweets and bicarbonate beverages (OR: 2.2, P=0.002). CONCLUSION: The prevalence of overweight/obesity was high among primary school children. Children should be considered the priority population for intervention strategies and to combat early childhood obesity. .


Article
The Role of Alpha Blockers in the Treatment of Children with Voiding Dysfunction

Authors: Dhia A. Kareem *, Omar A. Hassan**
Pages: 459-464
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ABSTRACT: BACKGROUND: Voiding dysfunction is an important problem in chil¬dhood due to its relatively high prevalence and the fact that it may cause upper urinary tract dete¬rioration with renal scarring. Pharmacological therapy is considered as one of the important measures to improve bladder emptying ,Several reports have supported the effectiveness of α-blockers in treating voiding dysfunction in children. OBJECTIVE: To evaluate the safety and efficacy of using selective alpha blocker therapy for children with voiding dysfunction. PATIENTS AND METHODS: A prospective study conducted from January 2011 to December 2013 in Al- Ramadi teaching hospital. 24 children with mean age 9.9 years had voiding dysfunction. Patients were evaluated by history, clinical examination, laboratory investigations, radiological examination, cystoscopy and urodynamic study. Treatment was initiated with doxazocin (selective α-adrenergic blocker) 0.03 mg/kg body weight and increased according to the response, but not more than 2mg, patients were followed monthly for 12 months. RESULTS: 24 children (16 patient male and 8 female), all patients had high postvoiding residual volume and abnormally low maximum flow rate. 18 patients (75%) had vesicoureteral reflux and hydronephrosis, after the starting of doxazocin 20 patients (83%) showing improvement in their symptoms. Upper tract dilatation improved in 12 patients (66%), Mean postvoiding residual volume reduced by 72.7% of the pretreatment mean PVR (p = 0.0001),The increment in the maximum flow rate was 68.4% (p 0.0001) from the pretreatment maximum flow rate. Failure rate was reported in 4 patients(16%) subjectively and 6 patient (25%) objectively. No patients was reported to had any serious side effects to doxazocin. CONCLUSION: Selective α-blocker therapy seems to be well tolerated in children and appears effective for improving symptoms and bladder emptying in various pediatric voiding disorders.


Article
Echocardiographic Assessment of Left Ventricular Remodeling Process Among Acute Myocardial Infarction Patients

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ABSTRACT: BACKGROUND: Echocardiography is use for assessment of left ventricular remodeling after myocardial infarction, which is the focus of this thesis. We investigated the influence of various traditional echocardiographic parameters to assess the process of left ventricular remodeling such as left ventricular volumes and ejection fraction, wall motion score index, mitral regurgitation and diastolic dysfunction OBJECTIVE: To invistigate the usefulness of two-dimensional echocardiography for accurate evaluation of left ventricular (LV) remodeling after acute ST elevation myocardial infarctions (STEMI). METHODS AND RESULTS: Two-dimensional echocardiography was performed within 5 days on a 100 patients admitted to the hospital with a first ST-elevation AMI. Several clinical and echocardiographic variables were analyzed. Baseline demographic data, blood pressure, and pulse were obtained. Various traditional echocardiographic parameters have been shown to provide diagnostic information, such as left ventricular volumes and ejection fraction, wall motion score index, mitral regurgitation and left atrial pressure. A left ventricular wall motion score index was derived from analysis of regional wall motion; an index of 1.5 or more within 5 days of admission identified patients at high risk for remodeling and LV dysfunction. Predictors of early LV remodeling were older age, male gender, history of diabetes mellitus or hypertension, high leukocyte count, high admission blood glucose level, high wall motion score and anterior location myocardial infarction. CONCLUSION: After acute ST-elevation myocardial infarction, early determination of the wall motion score index by two-dimensional echocardiography is useful for identifying patients at high risk for complications and to differentiate patients with and without development of LV remodeling accurately and early on the basis of wall motion score index as a measure of infarct size, a highly predictive variable. .


Article
Angiographic Predictors of Success of Revascularization by Percutaneous Coronary Intervention (PCI) Using the Japanese Chronic Total Occlusion Score

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ABSTRACT: BACKGROUND: Chronic total occlusions (CTOs) are considered as the most complex lesions to treat via percutaneous coronary intervention (PCI), due to the indications, costs and technical difficulties related to these procedures. As a consequence, only about 10% of all coronary artery diseased patients (CAD), clinically eligible for revascularization, are currently being treated via percutaneous coronary intervention (PCI). The majority is treated either medically or by coronary artery bypass graft (CABG) surgery. OBJECTIVE: This study sought to estimate the value of application of J- CTO score as a model to stratify the complexity and predict success rates at Iraqi Center for Heart Disease. METHODS: One hundred patients with chronic total occlusion were enrolled in this study form October 2014 - May 2015 who were attending Iraqi Center for Heart Disease. Data were collected on demographic, clinical and angiographic characteristics and reviewed by experienced Chronic total occlusions(CTO) operators. Descriptive analyses were performed using Statistical Package of Social Sciences (SPSS) to assess the relationship between procedural success and any variable of the demographic, angiographic and/or clinical characteristics. The level of significance was set at 95% or higher. RESULTS: Sixty-one patients out of 100 patients (61%) had a successful PCI. Univariate analyses showed significant differences of Electrocardiography and number of diseased arteries with J-CTO score between the group with successful PCI compared with those with failed PCI. Angiographically, using Japanese chronic occlusion score we found that a “blunt stump” (42 vs. 75%, p=0.001), “calcifications” (37 vs.70%, p=0.003), “tortuosity” (21 vs. 67%, p=0.001), “CTO length” (44 vs. 84%, p=0.000) and a “re-attempt” (33 vs. 65%, p=0.036) all had a significant negative impact on procedural outcome. CONCLUSION: The J-CTO score is valuable tool for predicting successful revascularization of chronic total occlusion by Percutaneous coronary intervention (PCI).


Article
Body Surface Area and Sheath Size as a Risk Factors for Vascular Complications After Coronary Angiography Via Femoral Approach

Authors: Salah Mahdy Majeed
Pages: 481-485
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ABSTRACT: BACKGROUND: Vascular complications have been recognized as an important factor in morbidity after diagnostic and percutaneous coronary interventions. OBJECTIVE: This study sought to evaluate vascular body mass index and sheath size as risk factors for vascular complications after diagnostic coronary angiography via femoral approach. PATIENTS AND METHODS: This historical prospective cohort study was carried out from February 2012 till January 2013, at the Iraqi Center for the Heart Disease. A total number of 2400 patients underwent 3600 procedures, diagnostic coronary angiography (2196) and PCI(1404) via their common femoral arteries. Result: Body surface area > 2m2 is a statistically significant factor for vascular complications, and <1.6m2 is also an important statistically significant risk for vascular complications. The results of the current study according to sheath size show:- during the diagnostic coronary angiograph procedures, sheath size 5F was the least(n=34), in which no reported vascular complications. Sheath size 6F (n = 1661) with (75) 4.5% complicated vs. (1586) 95.5% didn’t, sheath size 7F used among (501) patients, vascular complications developed in (171) 34.1% vs. (330) 65.9%. In comparison between the incidence of vascular complications among sheath sizes (6F, 7F) vs. 5F the P value < 0.001 for both. During the PCI procedures, sheath size 6F was used among (140) patients, with vascular complications in one patient (0.7%). 7F used among (1219), with vascular complications in (115) 9.4%, and 8F used in (45) patients with vascular complications in (45) 100%. By using 6F as a referent, sheaths 7F&8F were statistical significant(p


Article
CD49d as Prognostic Marker in B-Cell Chronic Lymphocytic Leukemia in Correlation with the Expression of CD38, ZAP-70 and Clinical Binet Stage

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ABSTRACT: BACKGROUND: Chronic lymphocytic leukemia (CLL) is a heterogeneous disease with highly variable clinical course and outcome. A number of clinical and biological features have been used to separate patients with CLL into subgroups with different prognoses. CD49d, CD38 and ZAP-70 expressions have shown to independently predict prognosis in CLL. OBJECTIVE: To assess the expression of CD49d in CLL patients and correlates them with CD38 and ZAP-70, and with clinical Binet staging. PATIENTS AND METHODS: This study was conducted on 30 newly diagnosed CLL patients. Diagnosis was based on lymphocyte count of > 5×109/L and immunophenotyping. The expression of CD49d, CD38 and ZAP-70 were investigated using four-color flow cytometer. RESULTS: The expression of CD49d, CD38 and ZAP-70 were detected in 60%, 56.7% and 30% of patients, respectively. The correlations between the expression of CD38 and both CD49d and ZAP-70 were both statistically significant (P= 0.002). A higher significant correlation was found between CD49d and ZAP-70 (P= 0.001). There was a statistically significant relationship between CD49d expression and Binet staging (P =0.035), while no significant relations were found between both CD38 and ZAP-70 and Binet staging (P >0.05). CD49d was more sensitive (76.5%) than the other two markers in prediction the intermediate and advanced stage with accuracy of 70%. CONCLUSION: CD49d expression was higher than that of CD38 and ZAP-70 and was significantly correlated with both of them. The adverse prognostic impact of CD49d was demonstrated by higher expression levels in intermediate and advanced-stage patients. CD49d has the highest sensitivity and accuracy with considerable specificity when compared with CD38 and ZAP-70, rendering CD49d a reliable biomarker for prognostication of CLL.


Article
Post-Mortem Assessment of Glycemic Control in Sudden Diabetic Deaths Using Glycated Hemoglobin (HbA1c)

Authors: Saad kadhum Kareem
Pages: 493-498
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ABSTRACT: BACKGROUND: Post-mortem diagnosis of uncontrolled diabetes and its complications remains a common problem due to lack of unequivocal biochemical or histological proof of hyper or hypoglycaemia.In this study we evaluated glycated hemoglobin (HbA1c) as a post-mortem tool to identify uncontrolled diabetes. OBJECTIVE: To assess the use of glycated hemoglobin as an indicator for glycemic control in sudden diabetic deaths. METHODS: A cross-sectional study was carried out in the period from January 2015 to December 2015 on 47 sudden diabetic deaths and 22 natural non diabetic deaths at the Medico-Legal directorate in Baghdad. Information was collected from relatives, medical and police reports. A blood samples were drawn from the right ventricle of the heart of each decedent included in this study during autopsy. Blood was collected into sealed plastic tubes containing EDTA as anticoagulant and stored at 4ᵒc temperature. These samples were analyzed within a period of 48 hours. One micro liter sample of thoroughly mixed whole blood was placed into the glass capillary tube provided in the HbA1c reagent kit and analyzed with variant-Hb- testing system. Data were recorded in the SPSS for window 11.0. RESULTS: The study showed that the mean age group of diabetic sudden death was 50.28+-10.01 while 44.36+-16.11 year was non diabetic sudden death. Male gender was the predominant in both groups (diabetic and non diabetic) 27.30%, 21.30% respectively. %HbA1c was significantly deferred in diabetic and non diabetic group, when it was positive 100% in diabetic group, while it’s negative in non diabetic group (the cut off point is 6.5). Type 2 diabetes was the predominant over type 1 with 59.60% and 40.40% respectively. The main system involved in sudden death in both study groups was the cardiovascular system accounting for 48.94% in diabetic group and 40.91% in control group, with the predominance of ischemic heart disease as the main cause of death in the system involved in both study groups accounting 40.43% for diabetic group and 22.73% for control group. CONCLUSION: HbA1c considered more reliable than post mortem glucose levels and provide guidance in the diagnosis of chronic diabetes mellitus in medico-legal autopsy cases. c


Article
Relationship between Amniotic Fluid Lactate and Delivery by CS Due to Dystocia

Authors: Manal Madany A. Qader
Pages: 499-505
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ABSTRACT: BACKGROUND: Lactate level in uterine muscles can be visualized by analysis of amniotic fluid lactase which used as bedside test with partogram to acquire good prediction of labour outcome. OBJECTIVE: To assess the relationship between amniotic fluid lactase level of full term pregnant women and their mode of delivery. PATIENTS AND METHODS: A cross sectional study carried out in Labour room of Al-Yarmouk Teaching Hospital through the period from the 1st of July to the end of December, 2015 on a convenient sample of 100 women of term pregnancy. Each woman participated in the study was in an active phase of labour with cervical dilation > 4 cm and before artificial rupture of membranes .By coscus speculum the cervix was visualized with 2-3 ml of liquor was taken by a syringe while the amniotic fluid still in the uterus to prevent vaginal contamination, then collected liquor in plain tube after centrifuge was stored in refrigerator at -20° for not more than 3 days before it sent to a private laboratory for analysis of lactase. RESULTS: Mean maternal age was 26.5±5.4 years and mean gestational age was 38.6±1.1 weeks. Thirty three pregnant women had elevated lactase level and 31 women were delivered with cesarean section. A significant association was observed between elevated amniotic fluid lactate level (≥10nm) among pregnant women and cesarean section delivery mode (p<0.001). Amniotic fluid lactate was a significant predictor of delivery mode (p=0.001) with odds ratio (5.5). CONCLUSION: Amniotic fluid lactate could be a significant predictor of labour outcome for term pregnant women.


Article
Maternal Height and ‘Shoe Size’ as Predictors of Intrapartum Complications in Labor with Occiput Posterior Malposition

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ABSTRACT: BACKGROUND: Although most women have anormal labour and birth, there are sometimes complication occurring due to multiple factors,occiput posterior postion represent achallenges in diagnosis,labour& intrapartum complication care OBJECTIVE: To evaluate maternal height and shoe size correlates with complications associated with occiput posterior ma position during labor. Type of the study; case control METHODS: A total of 45 primigravida women with android pelvis were chosen versus 45 with gynecoid pelvis according to clinical pelvimetry,Their shoe size and height were recorded. In addition women in both groups were scrutinized for occiput posterior and labor complications associated with condition including secondary arrest of dilatation, deep transverse arrest and cesarean for failed assisted vaginal delivery. Labor duration with regard to the first and second stage was also recorded for both groups and linked to shoe size and maternal height. RESULTS: The odd ratio for secondary arrest of dilatation, deep transverse arrest and failed assisted vaginal delivery were significantly higher among women with android pelvis than gynecoid ; 4.8, 5.6 and 4.5, respectively. A significant correlation between shoe sizes, maternal height versus duration of the first and second stage; P Value is P < 0.0001. Cluster analysis showed that women with shoe size between 37 cm to 40 cm are most likely to have intrapartum complication and failed assisted vaginal delivery. The rate of complications was higher in the android group than control gynecoid pelvis. CONCLUSION: Some correlation could be concluded between maternal shoe size and possibility of cesarean section for deep transverse arrest among women with android pelvis. However due to the anthropometric variations among women the results of this study could only be applied to patients covered by AL Yarmook Teaching Hospital including south and west of Baghdad city. Further studies are required to have better understanding of this vital subject.


Article
Tracheobronchopathia Osteochondroplastica Associated with Anosmia

Authors: Mustafa Nema*, Mudher Al-Khairalla
Pages: 512-515
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Abstract

ABSTRACT: Tracheobronchopathia osteochondroplastica is a rare disorder consisting of multiple hard nodules in the submucosa of trachea and main bronchi. This rare disease remains an under recognized entity due to lack of awareness. One case of such disease reported in this report KEYWORDS:tracheopathia osteochondroplastica, trachea, tracheopathia osteoplastica, hemoptysis, chronic cough, anosmia. INTRODUCTION: Tracheobronchopathia osteochondroplastica is a disease characterized bysubmucosal osseous nodules overlying the cartilaginous rings of the trachea and main bronchi and -on rare occasions-the larynx(1) . In some situation, calcifiednodular densities will protrude into the tracheal lumen(2).However, majority of TPO patients were asymptomaticthroughout their lives. The recurrence or chronic resolvingpneumonia may appear with the deterioration of airway stenosisaccompanied by such symptoms as dyspnoea, hoarseness,persistent, productive cough and haemoptysis (3,4). CASE PRESENTATION: A 55-year-old non-smoker single woman was referred for evaluation of a persistent dry cough for more than one year's duration. These symptoms were thought to be caused by asthma and had been treated with various medications with no significant response. Her medical history was significant for persistent nasal congestion, postnasal drips and anosmia with no history of TB contact. Laryngeal polypectomy and nasal septetomy done at 1990 and 1991 respectively with no endotracheal tube complications. Her history of anosmia dated back may years before these operations. Multinodular goiter diagnosed 5 years ago, for which thyroid function was normal and fine needle nodule aspirate showed a benign process.No history of head trauma, neurological disorders, or nutritional *Baghdad College of Medicine. Baghdad Teaching Hospital. **Doncaster Royal Infirmary.South Yorkshire. England. disorders. Clinical examination revealed average body built. There was multinodular goiter. Otonasolaryngological examination showed features of allergic rhinitis. Chest auscultations revealed scattered expiratory rhonchi. Neurological examination was within normal. Pulmonary function tests including a flow volume loop proved normal. Her sputum cytology was negative for both malignant cells and acids fast bacilli stain and culture. Computed tomography of the chest with 3D multidetecror views showed multiple, different sizes calcified nodules projected from the tracheal wall involving the whole length of the trachea with sparing of the posterior tracheal membrane and extending to both main bronchi (Figure 2and 3 ). Brain CT was normal. Laboratory tests including a complete blood count, liver and kidney functions were normal. Recent thyroid function proved normal. Fibreoptic bronchoscopy showed large numbers of "rock-like" different sizes nodules extended throughout the trachea and main bronchi and lower lobe bronchi with copius frothy secretions ( Figure1). Bronchial wash sample showed small number of mature lymphocytes and was negative both for infective microorganisms and malignant cells. Microscopic examination show non-specific chronic inflammation. Cardiothoracic consultation was arranged and rigid bronchoscopy performed with biopsy samples taken from areas in between these nodules in the trachea and main bronchi and were negative for amyloid stain, but no osseous tissue could be seen in these samples. Serial chest radiographs had been within normal. Added together, these findings are compatible with the diagnosis of tracheobronchopathia osteochondroplastica. Differential diagnosis of nodular excrescences includes tracheobronchial amyloidosis, endobronchial sarcoidosis, calcificating lesions of tuberculosis, papilomatosis, tracheobronchial calcinosis and relapsing polychondritis. Our patient didn't have any of the systemic symptoms that usually point out to the

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Table of content: volume:15 issue:4