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: 2017 volume:16 issue:2

Article
Subdural Hematoma and Effusion in Children

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ABSTRACT: BACKGROUND: Blood gathers between the inner layer of the dura mater and the arachnoid mater. Usually resulting from tears in bridging veins which cross the subdural space, subdural hemorrhages may cause an increase in intracranial pressure (ICP), which can cause compression of and damage to delicate brain tissue. A subdural effusion is a collection of cerebrospinal fluid OBJECTIVE: To gate an opinion about the types of surgical procedures which had been done for the collected cases into 2 centers in Baghdad METHODS: This is a prospective study conducted at 2 Neurosurgical Hospitals in Baghdad, between September 2012 to December 2013, on 21 children and infants of subdural collection of fluid excluding abscess ages ranging from 40 days to 13 years . Clinical data was collected including symptoms and signs, in addition to assessment of radiological picture and subdural tab and diagnostic burr hole proved the diagnosis .treatment ranged from conservative to surgical interference included burr hole ,subdural peritoneal shunt and craniotomy. condition of the patients during discharge from the hospital was evaluated RESULTS: In this study , the higher percentage of patient were under the age of one year. no great difference in the sex of patients , disturbance of consciousness was the more type of presentation , unilateral subdural collections were more than bilateral collections. only 12 patients had surgical interference , of these 12 the majority had subdural peritoneal shunt , which seemed to be the most convenient procedure in chronic cases but in acute cases burr holes were the most convenient procedure. craniotomy was also used in treating chronic cases. CONCLUSION : Most of the patient were under one year old , brain ct scan was the diagnostic procedure , brain ultrasound was also useful in diagnosis of subdural collection. the most convenient surgical treatment in acute cases was the burr holes and in chronic cases was the subdural -peritoneal shunt , and to arrange for surgical interference when decided as early as possible to gate better outcome


Article
Recovery and Vomiting after Pediatric Tonsillectomy with or without Adenoidectomy: Comparison between TIVA using Propofol and Thiopentone Induced Halothane Maintained Anesthesia

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ABSTRACT: BACKGROUND: Vomiting in the first few hours after recovery is considered as the main factor that delayed hospital discharge in pediatric outpatient surgery . Children having tonsillectomy with or without adenoidectomy operations have a high incidence of vomiting. Propofol has a short duration of action with rapid recovery and a proved antiemetic effect. Using propofol in total intravenous anesthesia, the incidence of vomiting is lower than the traditional thiopentone induced halothane maintained technique. OBJECTIVE: The aim of the study is to compare recovery characteristics and vomiting between total intravenous anesthesia using propofol as the sole anesthetic agent with the anesthetic technique using thiopentone for induction and halothane for maintenance to assess which is more suitable for outpatient pediatric surgery. PATIENTS AND METHOD: Forty healthy unpremedicated children, ASA Ӏ, aged 7-12 years undergoing tonsillectomy with or without adenoidectomy were randomly allocated into 2 groups. Group (1) children were induced with 2-3 mg.kg-1 propofol while group (2) children were induce with thiopentone 5-6 mg.kg-1 . Maintenance was 0.2 mg.kg-1 propofol in group (1) and 0.8% halothane in group (2). Both groups received 0.5mg.kg -1 atracurium to facilitate intubation and maintain muscle relaxation. Oxygen 100% was administered to both groups. Other treatment and procedures were standardized intra and postoperatively . Extubation time, time for spontaneous eye opening and the state of recovery after thirty minutes were compared. Results of postoperative vomiting were analyzed in the first 6 hours and beyond that. RESULTS: Extubation time in group (1) was 4.75 ± 0.89 minutes and in group (2) it was 8.87 ± 1.86 minutes. The time for spontaneous eye opening in group (1) was 5.5 ± 1.22 minutes and in group (2) it was 13.125 ± 1.69 minutes. Both were significantly different . Nevertheless, both groups had a comparable modified Aldrete score which consists of 10 points and a score of 8-10 is considered ready to discharge to the general care unit. All patients in group (1) had a score of 10, while 1 patient had a score of 10, 14 patients with 9 and 5 patients with 8 in group (2). The incidence of vomiting in the first 6 hours after recovery was significantly lower in group (1) as well as the incidence after 6 hours. The same is applied to the incidence of recurrent vomiting (˃ 1 attack) in the first 6 hours, while recurrent vomiting after 6 hours were comparable in both groups. The overall incidence of recurrent vomiting was 35% in group (2) and 0% in group (1). CONCLUSION: Despite a comparable recovery, propofol has a lower incidence of vomiting after tonsillectomy with or without adenoidectomy in healthy children than thiopentone induced halothane maintained anesthesia and is more suitable for outpatient pediatric surgery. .


Article
Experience Of Gastric Cancer In Al- Sadder City in Baghdad

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ABSTRACT: BACKGROUND: The aim of the study is to assess the following points among the patients with gastric cancer admitted to the surgical wards in Imam Ali Hospital- Al- Sadder City- Baghdad. • Sex and age distribution. • Mode of presentation. • Results of endoscopic findings and histopathology. • Risk factors and tumour staging. • Treatment options. PATIENTS AND METHODS: A prospective study was done in Imam Ali Hospital for a period of six years from (January 2009 to December 2014) where fifty cases with biopsy proved gastric cancer had been assessed. The age and sex distribution, mode of presentation, site of the tumour, macrosopical appearances histopathological findings, risk factors and treatment options were analysed. RESULTS: The male to Female ratio was 1.4:1, peak age incidence was 60-70 years, non-specific symptoms such as vague epigastric pain, dyspepsia, anorexia, weight loss were the most common symptoms; esophagogastric junction was the commonest site, polypoid type was the commonest endoscopic finding (44%); upper gastrointestinal endoscopy with biopsy was the most accurate method of diagnosing gastric cancer; Adencarcinoma was the most frequent histopathological type (96%); cigarette smoking is the predominant risk factor (64%) (32, 33, 34, 35); In the majority of those patients the disease was advanced and the curative measures were not possible. CONCLUSION: Gastric cancer remains a significant problem in Iraq, it's one of the most popular malignancies (ninth most common in Iraq) (37). No age group of both sexes can be excluded. Late presentation is a stigmata of the disease and the gloomy prognosis can only be improved by early detection based on a more vigorous diagnostic approach following a high risk index of suspicion in individuals at risk.


Article
Association of Serum Levels of 25 Hydroxyvitamin D and Type 2 Diabetes Mellitus: Age and Gender Dependent Study

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ABSTRACT: BACKGROUND: Vitamin D deficiency has been found to have an inverse relationship with the occurrence of diabetes mellitus (DM). The aims of this study were to investigate the serum levels of vitamin D in type 2 DM and to correlates the obtained values with their age and gender. SUBJECTS AND METHODS: This case-control study was carried out at Al-Ramadi General Teaching Hospital, and the National Diabetes Center for Treatment and Research at Al- Mustansiriya University, Iraq, during the period from December 2014 to November 2015. It involved, 80 patients with type 2 DM, and 60 healthy subjects. Investigations included serum measurement of 25 Hydroxyvitamin D (25OHD), fasting glucose, Insulin, glycated hemoglobin (HbA1c) in all patients and controls using ELISA technique. RESULT: The median concentration of serum 25 OHD of patients with type 2 DM (15.70 ng/ ml) were significantly lower than that of healthy controls (20.27 ng/ ml, P= 0.001). The rate of vitamin D deficiency (VDD) was significantly higher in type 2(82.5%) diabetic patients than in healthy controls (48.3%, P=0.001). Type 2 diabetic patients with age of 60 years and above and female had the highest VDD compared to others, type 2 diabetic patients with age of ≥ 60 years increased the risk of having VDD by 9.8 times compared to those with age group <18 years, but still insignificant (P =0.07). CONCLUSION: The results revealed significant deficiency of serum vitamin D in diabetic patients type 2. Supplementation of vitamin D may improve the control of this syndrome or even delay its incidence and complication. .


Article
Study of Thirty Two Patients with Infantile Spasms Admitted to Baghdad Medical City

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ABSTRACT: BACKGROUND: Infantile spasms is rare epileptic syndrome affect most often infants in first year of life, occur in paroxysmal attacks in clusters especially in periods of sleep transition range in number from few spasms to many up to one hundred, and associated with crying and abnormal behavior . OBJECTIVES: Study various aspects of conditioncauses, clinical features, electroencephalograms, radiological imaging, therapeutics choices, identification the variations in our patients and outcome. PATIENTS AND METHODS: the study enrolled thirty two infants referred to child welfare hospital and epilepsy clinic of Baghdad teaching hospital in medical city of Baghdad and were followed up in outpatient clinic of these hospitals for a period extend From beginning of January 2015 to end of January 2016. All data are encoded in patient file and discharging card. Study design was hospital based description of data from patients'records. RESULTS: Male-female ratio is 1:1 , age of presentation range from four to ten month,lag period between early seizures and diagnosis was range from two weeks to four months . two weeks in two cases four week in 20 cases ( 62 % ) , 10 cases present with more than four weeks delay (31.25%)seizure types were flexor spasms in 14 (43.75%) , extensor in 6 (18.75%) , and mixed in 12 patients (37.5%) , symptomatic cases were 24 (75 %) , idiopathic in 8 (25 %). Mode of delivery (18 patients delivered by caesarean section 56.25 %, 14 patients 43.75 % delivered by normal vaginal mode). Causes and gender relation, was that Symptomatic was more than idiopathic in both genders. The relation of gender to etiologic types, Tuberous sclerosis was the most common etiology in female, but neonatal and other disorders was the most common etiology in male. In Response to treatment and outcome ,16 patient (50%) had Complete remission of spasms, and 15 patient (50%) end with Severe developmental delay . CONCLUSION: Flexor type is commonest clinical types. Symptomatic group is predominant etiological types, neurocutaneous syndrome is commonest cause in symptomatic group .Hypsarrthmia is documented in majority of patients Brain atrophy is the commonest in radiological films .Steroids is main treatment. Infantile spasms had poor prognosis, in terms of neurobehavioral development. .


Article
The Prevalence of Papillary Thyroid Microcarcinoma in 489 Cases of Thyroidectomy in Iraqi Patients

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ABSTRACT: BACKGROUND: Thyroid cancer (TC) is considered the most common malignancy of the endocrine system. Papillary Thyroid Microcarcinoma (PTMC) is defined as tumors of less than or equal to 10mm in diameter, it could be non-incidental or incidental. OBJECTIVE: To evaluate the prevalence rate of thyroid papillary microcarcinoma, and to correlate the prevalence rate with different parameters including: age, gender, clinical diagnosis and type of surgery. PATIENTS AND METHODS: The present study, which is a retrospective study, was conducted on 489 cases of thyroidectomy specimens; the study was conducted at the Teaching laboratories of Medical City over a period of one year from February 2015 to Feb. 2016. The incidence of thyroid papillary microcarcinoma was correlated with different parameters including age, sex, clinical presentation, and type of surgery. RESULTS: In this study , cases were divided into: 53(10.83%) cases male, and 436 (89.171%) cases females, with age range 15-68 years and age mean 41.5 years ,regarding histopathological diagnosis ,cases were analyzed as followed: Nodular hyperplasia 354(72.41%) cases. Autoimmune thyroiditis 34(7.0%) cases, thyroid adenoma 28(5.7%) cases, follicular tumors 2 (0.4%) cases, papillary microcarcinoma 28(5.7%) cases, papillary carcinoma 16(3.3%) cases, follicular carcinoma 3(0.6%) cases, medullary carcinoma 1(0.2%) cases, hyperplastic nodule 6(1.2%) cases, toxic goiter 10(2.0%) cases, infections thyroiditis 1(0.2%) case, papillary carcinoma with lymph node involvement 4(0.8%) cases, thyroglossal cyst 1(0.2%) case, parathyroid adenoma 1(0.2%) case. Eight cases of PTMC(3.3%) were below 40 years of age. 20(8.1%) cases were above 40 years. There was a statistical correlation between age and prevalence of TPMC. CONCLUSION: The possibility of thyroid microcarcinoma should always be kept in mind while diagnosing a benign thyroid disease. There was a significant statistical correlation between age and prevalence of thyroid papillary microcarcinoma. .


Article
A Comparative Study Between Single Session Versus Six Sessions Mitomycin C instillation in Patients With Low Risk Non-Muscle Invasive Bladder Cancer

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ABSTRACT: BACKGROUND: Intra vesicle instillation following trans uretheral resection of low grade and low stage bladder cancer proved its efficacy in reducing recurrence and progression of bladder cancer. OBJECTIVE: To compare the efficacy of a single session of mitomycine C versus six sessions mitomycine C following TURBT on recurrence and progression rates in patients with low risk non-muscle invasive bladder cancer. PATIENTS AND METHODS: A total of 50 patients with low risk non-invasive bladder cancer were included in a prospective randomized controlled trial. Inclusion criteria include all patients who had a 3cm or less, single, papillary tumor. The tumor was completely resected before were randomized patients into 2 arms; Group one; those who receiving one session mitomycin C instillation of 40 mg (usually within 6 hours) into the urinary bladder. And Group B; Receiving six sessions mitomycin C instillation into the urinary bladder, Median follow up was 24 months. The events studied where the recurrence free rate, the recurrence rate/ year, the number of new tumors developing/year, and progression. RESULTS: At 24 months follow up, the recurrence free rate in a single session of mitomycin C instillation (group A) was (70.2%) while in six sessions mitomycin C instillation group was (84.7%) (Group B). Recurrence rate was ; Group A VS Group B : (10% VS 4 %) and recurrence per year rate (5% VS 2%), were decreased in the six sessions mitomycin C instillation (Group B) compared to the single session mitomycin C instillation (Group A). The number of new tumors per year rate (18% VS 11%), were decreased in the six sessions mitomycin C instillation (Group B) compared to the one session mitomycin C instillation, (Group A). A shorter hospital stay, catheterization period, and low level of local symptoms were noted in one session mitomycin C instillation (Group A) compared to six sessions mitomycin C instillation, (Group B). CONCLUSION: Single session mitomycin C given immediately after surgery or within 6 hours after resection may be as effective as six session protocol. This regimen may be cost effective and avoid prolonged hospitalization and catheterization with sex sessions regimen.


Article
Levels of Interleukin-6 and Certain Antioxidants in Patients with Colorectal Cancer

Authors: Abdulnasser M. AL-Gebori
Pages: 164-168
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ABSTRACT: BACKGROUND: Colorectal cancer (CRC) is one of the most aggressive common tumors in humans. It is known that development and progression of tumors is associated with deviations in the human immune system.Interleukin-6 (IL-6) is a pro-inflammatory and anti-inflammatory cytokine that it is secreted by T cells and macrophages to stimulate immune response, during infection and after trauma. Antioxidants catalase (CAT), Glutathion (GSH), Ceruloplasmin (CP) and Malondialdehyde (MDA) are substances that when present at low concentrations compared to those of an oxidizable substrate significantly delays or inhibits oxidation of that substrate. OBJECTIVE: The main objective of this study is to determine the frequency of IL-6, CAT, GSH, CP and MDA in patients with CRC. PATIENTS & METHODS: This study included 40 healthy control donors (20 male and 20 female) and 60 patients with CRC (20 smokers male, 20 non smokers male and 20 non smokers female). They were obtained from the people attending the out Patient Clinic/ Baghdad Teaching Hospital in Medical City. Ages ranges were 40-60 years and matched by age and sex to healthy control donors with mean age 53.24 ± 2.32 years RESULTS: The mean values of IL-6 and CP in sera of patients (smoker and nonsmoker groups) with CRC were significantly increased as compared to healthy control donors (P<0.01) and the mean values of CAT, GSH and MDA in sera of patients (smoker and nonsmoker groups) with CRC were significantly decreased as compared to healthy control donors (P<0.01) and results analysis shows that the IL-6, CAT, GSH, CP and MDA of female with CRC are less than of a male. CONCLUSION: It is clear from this study that there is a relationship between the levels of IL-6, GSH, CAT, CP, and MDA concentrations and CRC patients and may be a good indicator to evaluate this disease. r


Article
The Effect of Age on Clinical Presentations of Patients with Atrial Fibrillation

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ABSTRACT: BACKGROUND: Atrial fibrillation(AF) is a supraventricular tachyarrhythmia characterized by uncoordinated atrial activation with consequent deterioration of atrial mechanical function. OBJECTIVE: To demonstrate the effect of the age on clinical presentations of patients with atrial fibrillation. METHODS: This is a descriptive cross sectional study carried out in a tertiary cardiac center for 191 patients with atrial fibrillation who attended the selected hospital for any complaint.Their age was ranging from 18 years and above of both sexes. RESULTS: The more frequent age group for both sexes was between (40-65years). Palpitation was significant presentation in patient above 65 years and dyspnea and hypotention were more in patients below 40 years.The age is also had a significant effect on cardiomegaly on CXR, and on the echocardiographic findings of dilated LA, dilated LV, diastolic dysfunction and segmental wall abnormalities. CONCLUSION: The incidence of atrial fibrillation is age and gender related and age has an important effect on certain clinical presentations.


Article
Efficacy of Intranasal Beclomethasone in the Treatment of Children with Otitis Media with Effusion and/or Adenoid Hypertrophy

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ABSTRACT: BACKGROUND: Adenoid hypertrophy and otitis media with effusion are very frequent indications for surgery in children. Otitis media with effusion is the commonest cause of their hearing difficulty. A potential role of corticosteroids in the treatment of both diseases has emerged "6". Short-term use of systemic steroids provides a temporary improvement but long-term use of systemic steroids is not appropriate in children due to severe side-effects. On the other hand, topical nasal steroids without systemic side-effects might be used"7" . OBJECTIVE: To prove that intranasal steroid treatment can be a useful alternative to surgery in the treatment of children with otitis media with effusion and/or adenoid hypertrophy PATIENTS AND METHODS: A total of 68 children (4–14-year-old) on the waiting list for an adenoidectomy and/or myringotomy with or without ventilation tube placement were enrolled into the study and control groups. The study group (38 patients with adenoid hypertrophy, 19 of them with otitis media with effusion) received intranasal beclomethasone dipropionate (aqueous suspension) 168 mcg daily, and the control group (30 patients with adenoid hypertrophy, 16 of them with otitis media with effusion) was followed up without any treatment. All patients were evaluated at 0 and 8 weeks. The assessment of each patient included history, a symptom questionnaire, a tympanogram, a pure tone audiogram, and otoscopic examination and a plain radiograph (lateral soft tissue X-ray of postnasal space). The size of adenoid tissue was graded as a percentage according to obliteration of the airway of the postnasal space. The adenoid/postnasal (A/P) airway ratio was recorded for each patient. Symptoms were scored as 0 (absent), 1 (intermittent/periodic), or 2 (continuous). The data were analyzed with the “Statistical Package for the Social Sciences” (SPSS 9.0). RESULTS: Resolution of otitis media with effusion in the study group (41.6%) was significantly higher than that in the control group (13.3%) (p < 0.001). Twenty -six patients (68.4%) with adenoid hypertrophy in the study group showed a significant decrease in adenoid size according to the plain radiograph evaluation compared to the control group (p < 0.001). A significant improvement in obstructive symptoms was seen in the study group (p < 0.001). The radiographically measured adenoid/postnasal airway ratio and degree of obstructive symptoms showed a significant correlation (r = 0.838 p < 0.001, r = 0.879 p < 0.001, r = 0.838 p < 0.001, r = 0.879 p < 0.001). CONCLUSION: Nasal beclomethasone dipropionate treatment can significantly reduce adenoid hypertrophy and eliminate obstructive symptoms. It is a useful alternative to surgery (in good percentage of cases), at least in the short term (8weeks ), for otitis media with effusion.


Article
The Yield of Genexpert in Pulmonary Tuberculosis & Rifampicin Resistance.

Authors: Mohammed Waheeb AL.Obaidy
Pages: 184-190
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ABSTRACT: BACKGROUND : Earlier and improved tuberculosis (TB) case detection, including smear-negative disease & expanded capacity to diagnose multidrug-resistant tuberculosis (MDR-TB) are global priorities for TB control. The development of the Genexpert of mycobacterium tuberculosis and rifampicin resistance (MTB/RIF) assay for the Genexpert platform was completed in 2009 and is considered an important breakthrough in the fight against tuberculosis (TB). For the first time, a molecular test is simple and robust enough to be introduced outside conventional laboratory settings. Genexpert MTB/RIF detects M. tuberculosis as well as rifampicin resistance-conferring mutations using three specific primers and five unique molecular probes to ensure a high degree of specificity. The assay provides results directly from sputum in less than 2 hours. It is commercial real-time polymerase chain reaction (PCR) assay (Xpert™ MTB/RIF). OBJECTIVE: To assess the accuracy of the Cepheid Xpert™ MTB/RIF in the detection of M. tuberculosis from respiratory samples in the setting of data collected from TB center in Medical city complex. MATERIALS& METHODS: This is primarily laboratory -based study, used stored data from a previously reported retrospective evaluation of 56 patients suspected of having TB from clinical point of view. 9 patients subjected to the examination of sputum & broncoalevoaler lavage (BAL) at the same time rendering the total specimen number about 65 specimens. The results of Genexpert & RIF sensitivity for each patient were discussed &compared with that of direct AFB smear & culture of sputum and broncoalevoaler lavage (BAL). RESULTS: The result s of Gene xpert was compared with direct smear microscopically examination which considered as a primary diagnostic test although the highly sensitivity of Genexpert in diagnosing viable tubercle bacilli ,additionally it diagnose the the non-viable one with the same efficiency, such a feature considered an Achilles tendon of this test.The study revealed high sensitivity& extraordinary specificity in diagnosing TB making this technology the most rapid,simple&accurate diagnostic test of TB . CONCLUSION: The results demonstrate that rifampin-resistant M. tuberculosis can be detected in DNA isolated from sputum samples in a single-tube assay that takes less than 3 h to perform; the assay is extremely specific and extraordinarily sensitive. More over the assay is simple to perform and readily automatable for high-throughput screening.


Article
Clinical Profiles and Outcome of Children Admitted with Measles During 2009 Outbreak

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ABSTRACT: BACKGROUND: Measles is a highly contagious acute viral infection. It is a common cause of morbidity and mortality constituting half of vaccine preventable diseases. OBJECTIVE: The study was designed to describe the demographic, vaccination status, clinical profiles, and outcome of children admitted with measles during outbreak. PATIENTS AND METHODS: A cross sectional hospital based study was conducted on 137 children admitted with measles in Children Welfare Teaching Hospital/Medical City /Baghdad during the outbreak of measles in the period from 1st January- 31st May 2009. Patients below the age of 14 years who were clinically diagnosed as cases of measles were treated and followed. RESULTS: The median age was 17 months with a range of 3 months-14 years. Male /female ratio of 1.14:1. 86.86 % patients were admitted in March. Sixty eight (49.63%) children were not vaccinated. Twenty four (55.81%) children of vaccinated group had one dose of measles vaccine only and 19(44.19%) children had two doses. Complications of measles were detected in 120(87.59%) of patients. The most frequent complication of measles was pneumonia which was encountered in 72(52.55%) cases. Gastroenteritis was recorded in 44(32.12%) of patients. Six patients (4.38%) died after developing complications in the form of pneumonia in five and encephalitis in one. Forty four (32.12%) cases were malnourished and majority of them 26 (59 %) cases were in the >15 months age group. Two thirds of deaths were among malnourished children. The case fatality was 4.38%. CONCLUSION: One third of measles infections occurred before the age of 9 months. Half of measles cases were not vaccinated. The majority of the complicated cases had occurred in the unvaccinated children. Pneumonia was found to be the most frequent complication of measles that necessitated admission. Young age, pneumonia, malnutrition, immune deficiency and non-vaccination status were significant factors related to mortality. .


Article
Lupus Nephritis in Children Hospital Based Multicentre Study

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ABSTRACT: BACK GROUND: Lupus nephritis is a common and serious feature of a chronic autoimmune disease characterized by multisystem inflammation (systemic lupus erythematosus). OBJECTIVE: Study he demographic, renal manifestations, laboratory findings and histopathological findings of patients with lupus nephritis. PATIENTS AND METHOD: This study was descriptive cross sectional study, conducted on 71 patients with lupus nephritis who were diagnosed and treated in four major pediatrics nephrology units in Baghdad, Children Welfare Teaching hospital, Central Teaching hospital, Al-karama Teaching Hospital and Ibn Albalady hospital. The collected data included: gender, age at diagnosis, renal and extra renal manifestations, laboratory findings, renal biopsy findings. RESULTS: Seventy one patients enrolled in this study with a mean age of 11.9 ± 2.7 years, the mean age at diagnosis was 9.6 ± 2.3years. Female to male ratio was 4:1.Nephrotic syndrome was the most common renal manifestation, it was found in 51 (71.8%), and reduced renal function was found in only in 17patients (23.9%). Antinuclear antibody was positive in majority of patients 66 (92.9%), followed by low C3, C4 in 58 (81.6%), positive Anti double stranded DNA in 58 (81.6%).Renal biopsy was done for 58(81.6%) patients and class II lupus nephritis was the most common histopathological class which was found in 25 patients (35.2%), the least common was Class V which was found in only 4 patient (5.6%).On the other hand, none of the patients had class VI. CONCLUSION: Nephrotic syndrome is the most common renal manifestation in lupus nephritis in children; class II lupus nephritis was the most common histopathological class and Positive ANA was found in majority of patients. early referral of the diagnosed patients to the nephrologist is important to ensure better management of those patients.


Article
A Comparative Estimation of Metabolic and Hormonal Parameters Among Iraqi Hypothyroid Patients

Authors: Hind Shakir Ahmed
Pages: 204-209
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ABSTRACT: BACKGROUND: Thyroid hormones have a crucial physiological role to maintain balance of metabolism of body. Deficiency of iron can produce hypothyroidism. Hypothyroidism causes several lipid metabolism disorders. Visfatin and leptin are adipocytokines and have been suggested as important regulators in patients with thyroid dysfunction. OBJECTIVE: The aim of the present study was to estimate the circulating levels of lipids, iron, visfatin, and leptin in newly diagnosed hypothyroid patients. PATIENTS AND METHODS: The current study was conducted in medical city teaching hospital on 45 newly diagnosed cases of hypothyroidism aged 35-50 years and compared with 45 healthy in¬dividuals as control group during the period from June 2016 to January 2017. This study investigated the serum concentrations of lipid profile, some iron status parameters and hematological parameters, total- and free-, triiodothyronine, tetraiodothyronine, thyroid stimulating hormone, visfatin, and leptin in hypothyroid patients and compared them with the controls. RESULTS: There was a significant increased in serum total cholesterol and triacylglycerol in hypothyroid patients compared to the control, (P=0.001). There was a significant decreased in hemoglobin, serum iron, and ferritin while a significant increased in total iron binding capacity in hypothyroid patients compared to the control, (P≤0.05). Means value of thyroid stimulating hormone levels were significantly increased in hypothyroid patients compared to the control group. On the other hand, the levels of total- and free-, tetraiodothyronine, free triiodothyronine were significantly decreased in hypothyroid patients as compared to the control group. There was a significant increased in visfatin and leptin concentrations in hypothyroid patients compared to the control group, (P≤0.05). CONCLUSION: These data suggest that thyroid hormone insufficiency may lead to deficiency of iron and lipids abnormalities. Thus, estimation of iron and related parameters with lipids may be quite useful during the diagnosis and treatment of hypothyroid patients. Also, alterations in thyroid status change serum visfatin and leptin in hypothyroid patients. It is advisable to routinely investigate them for early detection allowing its early management.


Article
The Value of the Trans-Abdominal Ultrasound in Evaluation of Neonatal Respiratory Distress Syndrome

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ABSTRACT: BACKGROUND: Chest x-ray has been the traditional method of diagnostic evaluation of patients of neonatal respiratory distress syndrome of prematurity. Lung sonography has been lately explored as an alternative modality. OBJECTIVE: To evaluate diagnostic ability of trans-abdominal lung ultrasonography in detection of pulmonary manifestations of neonatal respiratory distress syndrome and compared the findings with Chest x-ray. PATIENTS AND METHODS: A cross section analytical study was performed at the NICU ward of Al-Yarmouk teaching Hospital; from January to august 2016, the study was done on 65 infants neonates included two groups one with neonatal respiratory distress syndrome group and other control group . Case were 50 premature newborns with neonatal respiratory distress syndrome ( gestational age from 24-35wks) and a control group of 15 premature newborns (gestational age30-35wks). The diagnosis of neonatal respiratory distress syndrome was made by clinical data and chest x-ray. The trans-abdominal lung ultrasonography was performed in all patients within the first 12 h of life. RESULTS: We seen that neonate are born by cesarean section 32(64%) and those neonates born by normal vaginal delivery 18(36%), while the male gender born with neonatal respiratory distress syndrome 33(66%) and female neonate with RDS 17( 34%), The trans-abdominal lung ultrasound showed 100% sensitivity,81 % specificity, The good correlation between stages of neonatal respiratory distress syndrome by lung ultrasound and chest x-ray findings CONCLUSION: This study show that using of an ultrasound for the diagnosis of neonatal respiratory distress syndrome is accurate and reliable tool with many advantages over other techniques as it is non-ionizing, low-cost and be performed at bedside, making this technique ideal for use in neonatal intensive care unit. ..


Article
Amyand's Hernia in a 9-Month-Old Infant: Case Report & Review of the Literature

Authors: Ali Egab Joda* ,Nawzat Hussein
Pages: 218-223
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ABSTRACT: Amyand’s hernia is defined as the presence of an appendix inside the sac of inguinal hernia whether inflamed or not, it is very rare occurring in less than 1% of patients of inguinal hernia surgery. Although it was first described three centuries ago in an 11-year-old boy by Claudius Amyand, it still continues to possess some fuzziness regarding its diagnosis & treatment because of the scarcity of its occurrence. It has variable clinical presentation according to the extent of appendix inflammation & related complications. The diagnosis of an Amyand's hernia is difficult to settled clinically. However, imaging studies are beneficial for both diagnosis and recognition of the associated complications. Here, we report a case of Amyand's hernia in a 9-month-old male infant discovered incidentally during surgery for right sided inguinal hernia in the department of pediatric surgery in the Central Child Teaching Hospital in Baghdad in which we did reduction of a normal appendix into abdominal cavity & herniotomy with high up transfixation of hernia sac. The purpose of presenting this case report is the rare occurrence of Amyand's hernia & the possibility of encountering an unusual content of hernia sac during the repair of inguinal hernia, that is why Amyand's hernia should be taken in consideration while operating on obstructed or strangulated inguinal hernia. The surgeon need to be aware of all clinical presentations with which the Amyand's hernia may present and the suitable, individualized option of surgical treatment applied. In this paper we review the literature on presentation of Amyand's hernia and discuss the diagnostic modalities with the current options of its surgical treatment.

Table of content: volume:16 issue:2