Home | Journal Issues | Vol.55. Issue , No. : 4. , 2013
2013

Vol.55. Issue , No. : 4. , 2013

Published: 1/1/2014 – Start page -297  , End Page -394



articles...


  • Article title : Neonatal Polycythemia in Children Welfare Teaching Hospital, Medical city complex, Baghdad
    Description :

     Numan N. Hameed*       MAAP, MRCPCH, FIBMS, DCH

    Ashraf I. Jalil**              MBChB

    Summary:

    Backgroun1d: Polycythemia is defined as a central Hematocrit of at least 65%. Its` incidence is increased in babies who have intrauterine growth restriction (IUGR), are small for gestational age (SGA), and are born post term.  Many infants with polycythemia are asymptomatic. However, it may be associated with feeding problems and lethargy.   

    Objectives: This work aimed to study the polycythemic neonates admitted to neonatal care unit in children welfare teaching hospital, medical city complex, Baghdad, including demographic features, risk factors, management and early outcome.

    Patients and Methods: A descriptive study was carried out over 8 months period from 10th of April to the 10th of December 2012, on 50 neonates with polycythemia. The information collected including; age, sex, gestational age, birth weight, risk factors, clinical presentations, management and early outcome. All collected information were taken from patient's medical records, mothers, relatives of patients& residents in the neonatal care unit.

    Results: Males were more affected than females with male: female ratio of 1.6:1, irritability was present in 11(22%), Tachypnea 21(42%), Respiratory distress 14(28), Cyanosis 11(22%), Feeding disturbance 28(56%), Jaundice 5(10%), Hypoglycemia 15(30%), and thrombocytopenia in 4(8%). the risk factors include Hypertensive mother in 7(14%), diabetic mother 12(24%), twin pregnancy 7(14%). The gestational age:  18(36%) were term, 8(16%) were preterm, 24(48%) were post term. Regarding birth weight 9(18%) were Appropriate for gestational age, 32(64%) were Small for gestational age, 9(18%) were large for gestational age. The complications include seizure 4(8%), necrotizing enterocolitis 3(6%), renal failure in 2(4%). Partial exchange transfusion (PET) was done to 10 (20%). The early outcome include 36(72%) were discharged well, 5(10%) were discharged on family responsibility, 4(8%) were referred to other hospital, 3(6%) died.

    Conclusions: There is a male predominance in neonatal polycythemia. The most common and significant clinical finding was feeding problem. The most significant laboratory finding was hypoglycemia. The most significant risk factors are small for gestational age and Post term neonates. The outcome is generally good.

    Keywords: Neonatal polycythemia, plethora, risk factors, Partial exchange transfusion

    pages: 279-283

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  • Article title : Microalbuminuria in children and adolescent with type 1 Diabetes mellitus attending the diabetic center of children welfare teaching hospital.
    Description :

    Munib A. Alzubaidi*                  MBChB, DCH, FICMS.

    Ali A. jawad*                               MBChB, FICMS.

     Summary:

    Backgrounds: Despite advances in management of diabetes mellitus, it remains one of the major causes of morbidity and mortality, yet diabetic nephropathy is one of the main complications of diabetes mellitus. .Microalbuminuria is the beginning to the renal complications of diabetes mellitus; it is a significant index of early detection as well as monitoring the progression of diabetic nephropathy.      Aim of the study: to estimate the presence of microalbuminuria as predictor for nephropathy among children and adolescent with type1 diabetes mellitus and to study the effect of various factors on incidence of microalbuminuria in these patients.    

    Subjects and methods: this study was carried out in the Children Welfare Teaching Hospital/ Medical City over ten months period. Fifty patients with type 1 diabetes and fifty non-diabetic children matched for age and sex were included in the study as control group. History was taken, physical examination and investigations done for all subjects. Early urine samples were used to estimate albumin/creatinine ratio to detect microalbuminuria. Statistical analysis done using T test and chi square, P value < 0.05 regarded as statistically significant.  

    Results: out of 50 patients with type 1 diabetes, 35 (70%) had microalbuminuria. There was significant association between presence of microalbuminuria and increasing age (P value 0.04), increasing duration of diabetes (P value 0.03) and glycemic control level(P value =0.04).Seven (46.6% ) patients with duration of  <5 years had microalbuminuria, all of them had onset of diabetes before puberty. There was no significant difference between diabetic patients and controls and between microalbuminuria +ve and -ve diabetic patients in regards to systolic and diastolic blood pressure, body mass index and glomerular filtration rate.                                                     Conclusions: All patients with microalbuminuria had normal blood pressure, and normal glomerular filtration rate, so we can detect the patients early before they develop overt nephropathy, hypertension and impaired renal function. Some of our patients with duration of diabetes   < 5 years had microalbuminuria, all of them had prepubertal onset of diabetes.                                               

    Key words: Type 1 diabetes mellitus, microalbuminuria, diabetic nephropathy

    pages: 284- 289

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  • Article title : Experience with treatment of fifty eight Iraqi patients with Acute Myeloid Leukemia
    Description :

    Khudhair A. AL-Khalissi                    (MRCP) U.K.

    Summary:

    Background: Adults with Acute Myelogenous Leukemia (AML) have the lowest survival rate of all leukemias. Complete remission (CR) rate after induction therapy is about 55-85%, however 30% of patients fail to achieve remission and they remain alive only for about a year. Consolidation chemotherapy results in 5-year overall survival (OS) of about 30%.

    Objectives: To study characteristics of adult patients with AML who attended Baghdad Teaching Hospital, their response to induction therapy and then to consolidation therapy, and their 5-year (OS) and disease free survival (DFS).

    Patients and methods: Sixty seven patients with AML (excluding M3) were admitted to the haematology ward /seventh floor/Medical city teaching hospital during 2008 with follow up till the end of 2012. Fifty eight patients included in the study, 47 patients (≤ 60-year) received 3+7 induction regimen. Nine (> 60 year) received attenuated courses of subcutaneous cytosar, or 2+5 regimen (according to presence or absence of co-morbidities). Those who attained CR were consolidated mainly with Modified MiDAC.

    Results: Eleven patients who received attenuated induction therapy had a median survival of 6-8 months and none of them achieved CR. Twenty six (55.5%) out of 47 patients who received 3+7 induction regimen had CR with treatment related mortality( TRM) of 34%, while OS and DFS were 30% and 34% respectively.

    Conclusion and recommendation: Early referral to the hospital is essential to avoid high early mortality. OS and DFS in our study is comparable to other studies in spite of shortage of antibiotics and cytotoxic therapy.

    Key words: AML, induction, consolidation, OS, DFS.

    pages: 290- 295

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  • Article title : Laparoscopic Cholecystectomy; It’s Complications and Causes of Conversion to Open Cholecystectomy.  
    Description :

    Jawad K. Al-Dhahiry           CABS   (MD)

    Summary:

    Background: The laparoscopic cholecystectomy is the gold standard for treating the symptomatic cholelithiasis. Conversion is sometimes necessary due to finding unexpected pathology,intraoperative complications or unexpected technical errors .

    Objectives: The aims of this study were to determine the complications and the predictive factors of conversion in patients undergoing laparoscopic cholecystectomy for various indications in elective and acute settings in a general hospital in order to reduce the incidence rates of both , complications and  conversion of laparoscopic cholecystectomy to the open technique .

    Patients and Methods: This is a prospective study included 128 patients [their ages ranged from18 -65 years; the mean =39.60 ± 11.37 SD years].Female patients were 111 (86.7 ) ,male patients were 17 (13.3 % ) . These patients underwent a laparoscopic cholecystectomy in AL-Karama Teaching Hospital / College of Medicine / Wasit University-Iraq,from April 2011 till December 2012. Recorded data were sex, age, indications for laparoscopic cholecystectomy , complications, conversion to the open technique , reasons of conversion, co- morbidity , length of the hospital stay and 30- day mortality.

    Results: The intraoperative complications were; bleeding from the cystic artery in 9 patients (7.03 %), perforation of the gallbladders in17 patients (13.28% ) and spillage of the stones from cystic duct stump in12 patients( 9.37% ).All these complications were successfully treated laparoscopically.This study has no postoperative complications during follow-up period . Conversion from a laparoscopic cholecystectomy to an open cholecystectomy was performed for 7 patients ( 5.49 % ). The reasons for conversion were ; dense fibrosis of Calot’s triangle in two patients ( 1.56 % ) and one patient(0.78 % ) for each of the following pathologies : cholecystoduodental fistula ,postoperative adhesions , impacted stone in the cystic duct , Mirrizzi’s syndrome and incidental CBD stone.The intaoperative findings and postoperative histopathologic diagnoses were: 114 patients( 89.1 % ) with chronic calculous cholecystitis, 5 patients ( 3.9 % ) with acute calculous cholecystitis, 5 patients( 3,9 % )  with empyema of the gall bladder, 4 patients ( 3.1 % ) with mucocele of the gall bladder .There was no mortality in this study.                                                                                                                       

    Conclusions: In this study,there were simple complications being laparoscopically treated .Male gender, age older than 50 years that were associated with dense fibrosis of Calot’s triangle , postoperative upper abdominal adhesions,cholecystoduodenal fistula Mirrizi’syndrome ,impaced stones in the cystic duct and incidental CBD stone were the main factors of conversion .                 Key Words: Laparoscopic Cholecystectomy, Cholecystitis, Cholelithiasis .

    pages: 296- 301

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  • Article title : Laparoscopic subtotal cholecystectomy in patients with acute cholecystitis
    Description :

    Tariq I. Al-aubaidi*                                    FIBMS.

    Anwar A. Abid-AlKadhim**                     FIBMS.

    Khalid R. Sbahi***                                     MBCHB.

    Summary:

    Background: Using Laparoscopic approach, Cholecystectomy is made hazardous by distortion of the anatomy of Calot's triangle by acute or chronic inflammation and dense omental adhesions. Laparoscopic subtotal cholecystectomy (LSTC) without cystic duct ligation is an alternative to conversion to open surgery in difficult cases.

    Methods: This prospective study included 50 patients with different forms of clinical presentations subjected to LSTC at the 2nd floor in Baghdad Teaching Hospital and conducted during a period from Jan. 1st, 2010 to Dec. 31st, 2012.

    Results: Fifty cases of LSTC were performed, 32 of them were males and the remaining 18 patients were females. The age of study group was ranged (18 – 75) years with a median of (46) year. The median operating time was about 90 min. and the mean duration of hospital stay was 7.3±2.2 days. There were 8 patients (16%) with postoperative bile leak, most of them recover spontaneously and only 2 patients (4%) underwent postoperative ERCP and stent insertion for persistent bile leak. 4 patients (8%) with postoperative wound infection and 2 (4%) with postoperativechest infection due to bile leak and longer operating time.1 patient (2%) with subphrenic collection which mandates open drainage for cure. No mortality was recorded in our study.

    Conclusion: LSTC is an alternative to open conversion in cases with Calot's triangle difficult anatomy and dissection is hazardous. And is associated with avoidance of any injury to biliary passages in spite of longer operating time.

    Key words: Laparoscopic subtotal cholecystectomy (LSTC), No cystic duct ligation.  

    pages: 302- 307

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  • Article title : Single-layer seromuscular Continuous Versus Two-Layers Intestinal Anastomosis Of Small bowel in Baghdad Teaching Hospital (A prospective Study)
    Description :

    Mohammed M. Habash*                       FICMS

    Yahya K. Hammoudi**                         FICMS

    Tharwat I. Sulaiman***                        FRCS, CABS

      Summary:

    Background: Anastomosis may be done with the help of stapling devices, by using double layered suturing technique or by a single layer technique.

    Objective: The aim of the study is to prove that a single layer continuous technique can be constructed in a significantly less time with similar rate of complications compared with two layers technique.

    Patients and methods: A prospective study conducted in Baghdad Teaching Hospital, Iraq.  A total of sixty- four patients were included in this study. They were divided into two groups; group A, 28 patients, single layer seromuscular continuous anastomosis was done and group B, 36 patients underwent conventional double layered anastomosis.

    Results: There were, 15 male (53.6%) and 13 (46.4%) female within group A and 20 (55.6%) male and 16 (44.4%) female within the group B. There was no significant difference in gender distribution or mean age between or within groups. Bullet and sharp nail injuries to the abdomen were the most common causative agents followed by malignant disease of GIT. Wound infection was the most frequent complication in both groups as fourteen patient out of 64 (21.9%) developed wound infection; 8 of them were among group B.  There was no significant difference in the incidence of anastomotic leakage; in group A was 3.6%, while in group B was 4.7%. The average time for the construction of the single layer anastomosis was 20 min and in double layer it was 35 min. The difference in average time is statistically significant

    Conclusion: The single-layer continuous anastomosis requires less time to construct and has a similar risk of leakage compared with the two-layer technique. It also costs less than any other method and can be safely introduced into a surgical training program.

    Key Words: Anastomosis, Single  layer, Double layer, Seromuscular

    pages: 308-312

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  • Article title : Serum parathyroid hormone and total serum calcium levels in mild & severe preeclampsia versus normal pregnancy
    Description :

    Maad M. Shalal*                            FICOG.

    Najmah M. Miran*                        FICOG, CABGO, DOG.

    Inaam F.  Mohammad**               MBChB.

     Summary:

    Background: Preeclampsia (PE) is a major cause of maternal morbidity and mortality, complicating 3-14% of all pregnancies. Although the etiology remains unknown, placental hypoperfusion and diffuse endothelial cell injury are considered to be the central pathological process; many endocrinological changes have been linked to the etiology of preeclampsia including parathyroid hormone and calcium level.

    Objective: to compare serum parathyroid hormone and total serum calcium levels in mild and severe preeclampsia versus normal pregnancy.

    Patients and methods: Serum parathyroid hormone (PTH) level and total serum calcium level were measured in thirty normotensive pregnant women and thirty women with mild preeclampsia and thirty women with severe preeclampsia using Enzyme Linked Immuno- Sorbent Assay (ELISA) test for parathyroid hormone & colorimetric test for total serum calcium. All pregnant women enrolled in the study had similar demographic background. Patient and control groups were matched for age, and gestational age.

    Results: Total serum calcium level was decreased and parathyroid hormone level was elevated in preeclamptic women compared to normotensive women with significantly lower total serum calcium (7.43 ± 0.68) and higher level of parathyroid hormone (93.84 ±10.63) in severe preeclampsia compared to mild preeclampsia group where total serum calcium was(8.02±1.02) and parathyroid hormone was (79.34 ±6.04).With p value <0.005 between mild & severe preeclampsia groups.

    Conclusion: Total serum calcium is significantly decreased & parathyroid hormone is significantly increased in severe preeclampsia in comparison to normal pregnancy.

    Keyword: serum calcium, serum PTH, preeclampsia.

    Pages: 313- 317

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  • Article title : Surgery In Infective Endocarditis
    Description :

    Laith S. Abood*              FIBMS (ThCVS)

    Summary:  

    Background: Early surgery during the active phase of infective endocarditis was considered to carry high morbidity and mortality due to technical difficulties on an inflamed tissues.

    Objectives: Is to focus a light on the increasing indications for surgery during the active phase of infective endocarditis which lead to significant drop in the hospital mortality.  

    Patients and Methods: Eighteen patients with bacterial endocarditis and valvular dysfunction were admitted to Iraqi center for heart diseases during the period from January 2008 –April 2013. All of them were fully investigated and adequately prepared for open heart surgery.

    Result: Seven-teen patients were successfully treated surgically with uneventful post-operative course. One patient developed another attack of prosthetic valve endocarditis which mandates a redo surgery .Only one patients died two years later.

    Conclusion: The indications for surgery and its timing are difficult decisions to take . Close follow up , collaboration between cardiologist cardiac surgeon and laboratory personnels are mandatory.

    Key word: - Open heart surgery, mechanical valve Endocarditis, prosthetic valve.

    pages: 318-320

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  • Article title : Surgery in Varicose Veins
    Description :

    Hassanein A. Hussein*           MBChB, FIBMS (ThCVS)

    Waleed M. Hussen**             MRCS, FRCS, FACS, MS, FIBMS (ThCVS)

    Summary:

    Background: Varicose veins are common in Iraq. Increasing incidence is associated with available jobs of bodyguards, barbers and computer workers.

    Objectives: To highlight the frequency, presentation, methods of accurate diagnosis and surgical procedures which are commonly used by Vascular Surgeons in Medical City Teaching Complex, Al-Shaheed Ghazi Al-Hariri Subspecialties hospital and to compare this study with other international studies.

    Patients and methods:  This is a retrospective study of hundred patients with varicose veins, who were admitted and surgically treated at Al-Shaheed Ghazi Al-Hariri subspecialties hospital during one year period (1st of July 2010 to the 30th of June 2011). It illustrates the technique used and presents the surgical complications met within these cases.

    Results: Most of the patients were males (67%). Most of them were bodyguards or computer workers. In eight patients only surgical complications are met and dealt with.

    Conclusions: We are in utmost need for newer methods of treating varicose veins such as Endovenous laser treatment or radiofrequency ablation, and also in need for a well trained personnel and the essential equipments to implicate this.

    Key Words: Deep veins, venous valves, Stripping, Laser.

    Pages: 321- 326

    File size : 13 MB
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  • Article title : Lupus Nephritis, the therapy and the role of Rituximab in resistant cases
    Description :

    Hussein A. Nasir*                            CABM 

    Yasir F. Sharba**                            CABP FICMS neph

    Nadia A. Nasir***                            FABCM 

     Summary -

    Background Systemic lupus erythematosus (SLE) is a common autoimmune disease that affects mainly young females and nephritis is an important complication of the disease that may end with end stage renal disease (ESRD). Early diagnosis and proper treatment is important in decreasing the morbidity. Multiple immunesupressor agents used and according to the histopathology stage of the disease, still the proper drug used and the duration and dose required not settled. Rituximab which is monoclonal antibody that reacts against CD20 antigen on lymphocytes that cause B cells depletion is recently introduced in treatment of lupus nephritis .

    Objectives: to see the effect of different immunosuppressive agents in lupus nephritis and any response of resistant cases to Rituximab

    Methods sixty three systemic lupus erythematosus (SLE) patients’ age 3-45 years, 54 females and 9 males referred to the Nephrology Center in AL Sader Hospital in AL-Najaf governorate from April 2009- June 2013 enrolled in this study. All patients had renal biopsy and had categorized in different histopathological classes, the patients in stages I and II were treated with prednisolone while patients with other stages were treated with prednisolone and immunosuppressive therapy. The patients were followed up clinically and by laboratory results for response to the therapy, those who respond to the treatment tapering of the steroid was done and patients follow up were continued. Patients who showed no response to prednisolone or to the immunosuppressive agent were given Rituximab.

    Results –Mean age of patients was 22 years with a standard deviation+ 9 years. The association between sex and prednisolone was statistically not significant. The association between immunosuppressor therapy and sex was statistically not significant. The association between rituximab and sex was statically significant (p value 0.03(. The response to steroid therapy & age was statistically not significant. The association between response to immunosuppressor therapy and age was statistically not significant .The response to immunosuppressor therapy in different histopathological stages was statistically significant (P value 0.03). Response to Rituximab therapy was statistically significant (P value 0.048).

    Conclusion:  Immunosuppressor therapy may have an effect in treatment of lupus nephritis and Rituximab may be useful in treatment of resistant cases of lupus nephritis.

    Key words:  Lupus nephritis, Rituximab

    pages: 327-332

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  • Article title : The value of ultrasound to differentiate between benign and malignant duct ectasia
    Description :

    Enam A.AL -Tememy*                           MBChB , DMRD

    Laith Ahmad*                                          MBChB , DMRD ,  FGMC

    Zainab O.AL-Shaheen*                          MBChB , DMRD

    Jinan A. Jabbar*                                     MBChB ,  DMRD

     

    Summary:

    Background: Mammary duct ectasia is defined as dilated duct larger than 2 mm in diameter seen in fibrocystic changes, ductal epithelial hyperplasia, papiloma, DCIS. US has a significant role in diagnostic breast imaging. It is most commonly used as an adjunctive test in characterizing lesions detected by other imaging modalities or by clinical examination

    Objective: This study was designed to investigate differences in ultrasonographic findings between malignant and benign mammary duct ectasia.

    Patients and Methods: From November 2010 to July 2011, 100 womem with mammary duct ectasia lesions depicted on sonograms were included in this study. We evaluated the ultrasonographic (US) findings in terms of involved ductal location, size, margin, intraductal echogenicity, presence of an intraductal nodule, calcification, ductal wall thickening and echo changes of the surrounding breast parenchyma. The US findings were correlated with the pathological features.

    Results: Of the 100 lesions, 84 lesions were benign and 16 lesions were malignant. Benign lesions include: an inflammatory change (n=14), ductal epithelial hyperplasia (n=6), fibrocystic change (n=54), intraductal papilloma (n=10). Malignant lesions include: ductal carcinoma in situ (DCIS) (n=2), infiltrating ductal carcinoma (n=14). On US images, the peripheral ductal location, an ill-defined margin, ductal wall thickening and a hypoechoic change of the surrounding parenchyma were features significantly associated with malignant duct ectasia.

    Conclusion: For ill-defined peripheral duct ectasia with ductal wall thickening and surrounding hypoechogenicity as depicted on US, the possibility of malignancy should be considered and radiologists should not hesitate to recommend a prompt biopsy.

    Keywords: ductectasia , ductal carcinoma in situe, ultrasound.   

    pages: 333-338       

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  • Article title : Dysmenorrhea and its impact on daily activities among secondary school students in Basra, Iraq
    Description :

    Jasim N. Al-Asadi,*                     PhD

    Rasha A Abdul-Qadir**           FICMS

     Summary:

    Background: Most adolescent girls experience some degree of dysmenorrhea, which can impact on their daily activities. It is responsible for school absenteeism or interruption of social activities. Therefore, investigating dysmenorrhea among secondary school students is important to provide caregivers with data necessary for interventions

    Objectives: This study was conducted to estimate the prevalence of dysmenorrhea among secondary school students in Basra, Iraq and to study its impact on their daily activities.

    Materials & methods: A cross sectional study was conducted from Jan. 2011 to May 2011 among 350 secondary school students using a semi-structured questionnaire.

    Results: Out of 350 participants (aged 15-20 years), 313(89.4%) had dysmennorhea. Dysmenorrhea was mild in 12.8% of students, moderate in 54.3% and severe in 32.9%. Menstrual irregularity, and a family history of dysmenorrhea were important risk factors for dysmenorrhea (p<0.05). Of dysmenorrheic students, 79.9% reported that it limited their daily activities. Activities affected by dysmenorrhea included; class concentration (53.4%), homework (48.6%), school attendance (33.9%), socialization (24.3%). The most common associated symptoms were fatigue (55.9%), mood change (37.4%), dizziness (35.5%) and loss of appetite (34.8%). Of those who experienced dysmenorrhea, 13.7% consulted a physician, and 56.3% practiced self-medication.

    Conclusions: The prevalence of dysmenorrhea among secondary school students in Basra was high, and it may be severe enough to affect their daily activities. It is necessary to improve the therapeutic options to relieve pain and to reduce the impact of dysmenorrhea on social and school activities.

    Key words: Adolescents, Basra, daily activities, dysmenorrhea, prevalence, school absenteeism, students.

    pages: 339-344

    File size : 14 MB
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  • Article title : Cervical Spondylosis, Surgical Management and Outcome
    Description :

    Emad S. Abbas*                       FICMS (Neurosurgery), MRCPS (UK).

    Yuksel Y. Mohammad*        FICMS (Neurosurgery).

    Summary:

    Background: Cervical spondylosis is a degenerative disease of the cervical spine and can occur at any age but mostly after 5th decade.

    Objectives:  is to focus a light on the clinical features, radiological findings and the result of the surgical treatment with comparison to the global results in the same field.

    Patients and method: This is a prospective study of 50 patients with cervical spondylosis managed with surgery at surgical specialty hospital in the medical city, Baghdad, from the period from Jun. 2011 till Jan. 2012. The clinical, radiological, neurophysiological studies together with surgical outcome were all reviewed and included in the study.

    Results: Patients were divided into two age groups; those below 50 years had their disease mostly of traumatic cause and their presentations were mostly of motor dysfunctions. Older patients had the disease process of degenerative cause and much slower progress and they were mostly complaining of sensory problems.

    Conclusions: Early surgery was the most beneficial in both groups, and bearded less morbidity to the patients.

    Keywords: Cervical spondylosis. Dysphagia. Vertigo. Osteophytes. Myelopathy. Laminectomy and Corpectomy.

    pages: 345-348

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  • Article title : Seroprevalence of anti- C. trachomatis IgG and IgM antibodies Among Pregnant women in Diyala province
    Description :

    Asmaa H. Hwaid*                    MSc      

    Abul-Razak SH. Hasan**      PhD

    Abbas A. Al-Duliami*             PhD

    Summary:

    Background: Chlamydia trachomatis infections are the most prevalent bacterial sexually transmitted infections (STI) recognized throughout the world. Screening programs for C. trachomatis is of paramount importance in the prevention of long-term sequelae.

    Objectives: To investigate the anti-chlamydia IgG and IgM seropositivity of healthy pregnant women in Baquba-Diyala province.

    Subjects and methods: A total of 91 normal healthy women were included in this study, which was conducted for the period from 1st. November/ 2011 to 1st. March 2012. They were chosen by simple random selection from Al-Batool Teaching Hospital for maternity and children, and some health care centers in Baquba city. The age range was 17-42 years. 49 (53.8%) and 42 (46.1%) were from rural and urban areas respectively. 77 (84.6%) of women with no previous abortion, and 14 (15.3%) with one or more abortions. 15 (16.5%) with no previous deliveries, and 76 (83.5%) had a number of children ranging from 1 to 7. The anti-chlamydia IgG and anti-chlamydia IgM antibodies were detected using ELISA technique.  Statistical analysis was performed using SPSS version -15, and P - value of < 0.05 was considered significance.

    Results: The results revealed that the rate of anti-chlamydia IgG antibody among pregnant women was 5(5.5%), and 3 (3.3%) women were positive for anti-chlamydia IgM antibody. All anti-chlamydia IgM and the majority of anti-chlamydia IgG antibody positive women were belong to the age group 20-29 years. The anti-chlamydia IgM and IgG positivity rate has no association with residency, number of children, number of previous abortions, and the duration of pregnancy.

    Conclusion: The rate of C. trachomatis infection among healthy pregnant women in diyala province was low.

    Keywords: C. trachomatis, anti-chlamydial IgG, anti-chlamydial IgM.

    Pages: 349-352

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  • Article title : Evaluation of in vitro activity of Calvatia craniiformis extract against bacteria isolated from pregnant women with asymptomatic bacteriuria
    Description :

    Anfal Sh. Motib*                    BSc;MSc                

    Basim M. Ibrahim**              BSc;MSc                         

    Hiba H. Rahid*                       BSc    

    Summary:

    Background: Urinary tract infection (UTI) is the most common disease associated with pregnant women due to several anatomical and hormonal changes in pregnant women lead to ureteral dilatation and urinary infection, many of microorganisms such as fungi, viruses, and bacteria have numerous virulence factors that enhance their ability to colonize in pregnant women. Some bacteria have resistance toward many antimicrobial agents for treatment has led to therapeutic difficulties worldwide, in order that many investigators try to test fungal extract to reduce bacterial infection.

    Objectives: To assess the effectiveness of extract of Calvatia craniiformis on different types of bacteria which was isolated from pregnant women with asymptomatic bacteriuria.

    Materials and methods: One hundred five vaginal swabs were collected from pregnant women with asymptomatic bacteriuria attending to Al-Batool hospital for maternity and children in Diyala Governorate during the period from 1st /April /2012 till 1st/ July/2012.

    All specimens were streak on blood agar and MacConke ager, then identified according to standard bacteriology and biochemical criteria. The susceptibility patterns toward 6 antimicrobial agents were done by disc diffusion methods, 40% Calvatia craniiformis extract used for study the effect of this extract against different types of bacteria .

    Results: Fifty fife out of 105 samples (52.38%) were demonstrated negative bacteria growth while 50 out of 105 samples (47.61%) demonstrated positive bacteria culture. The isolated revealed that 22 Escherichia coli, 15 Klebsiella, 11 Proteus, and 2 Staphylococcus saprophetec. The majority of bacterial isolates were sensitive to 40% concentration of extract of Calvatia craniiformis.

    Conclusion: Extract of Calvatia craniiformis was effective as antibacterial against antibiotic resistant strain.

    Keywords: Urinary tract infection (UTI), pregnant women, antibiotic, Calvatia craniiformis.

    Pages: 353-357

    File size : 11 MB
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  • Article title : Epstein-Barr Virus Antibodies in Rheumatoid Arthritis Iraqi patients
    Description :

    Aida R. Al-Derzi*                    FICM/path.

    Muhammad M. Alani*            FICM/path

    Hayfaa S. AL-Hadithi*           FICM/path

     Summary:

    Background: Rheumatoid arthritis (RA) is an autoimmune disease that results in a chronic, systemic inflammatory disorder that may affect many tissues and organs, but principally attacks flexible (synovial) joints. Many cases are believed to result from an interaction between genetic factors and environmental exposures. Epstein-Barr virus (EBV) is associated with several autoimmune diseases, such as systemic lupus erythematosus, rheumatoid arthritis and multiple sclerosis.

    Objective: To study the association between EBV antibodies and RA.

    Patients and methods: This prospective study was carried out in the period between March 2013 and May 2013. The study involved 30 patients diagnosed with RA attending rheumatology outpatient's clinic Baghdad  medical city teaching hospital and 30 apparently healthy individuals as a control group. Serum samples were collected to investigate the level of EBV-IgG and IgM  by using ELISA technique.

    Results: This study showed that 70% of control group had positive EBV-IgG while only 6 out of 30 had positive EBV-IgM. The mean values of EBV-IgG were significantly higher among RA patients (0.542 IU/ml) in comparison  with that in control group(0.269 IU/ml). Also mean value of serum EBV-IgM (0.723 IU/ml) were significantly higher than that in healthy individuals(0.354 IU/ml)

    Conclusions: The serum levels of EBV-IgG and IgM were significantly higher in RA patients in contrast with those in healthy individuals.

    Keywords: Rheumatoid arthritis, Epstein-Barr virus, EBV-IgG, EBV-IgM, ELISA.

    pages: 358-361

    File size : 8 MB
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  • Article title : Cryptococcus neoformans Isolated from burn Patients in Burn Hospital in Baghdad
    Description :

    Inaam K. Jassem*                                       BSc

    Sudad J. Mohammed**                              BVM&S, MSc

    Tawfeq W. Tawfeq***                                MBCHB, FICMS

    Jassem M. Karhoot*                                   MSc., PhD

    Summary:

    Background: wound infections are associated with increased morbidity and mortality. Etiologic agents of wound infections vary with geographical location

    Objective: This study presents Cryptococcus neoformans and their Characteristics identified from burn patients at a major Iraqi Specialized Burn Hospital.

    Patients and Methods: All burn patients admitted to Specialized Burn Hospital from November 2011 to May 2012. Once fungal infection was suspected clinically, swabs were harvested for the culture of yeast. The sensitivities of the identified yeast were determined and the positive samples and cases were analyzed.

    Result: The most predominant yeast isolates was Candida species which represented (56.94%), followed by Cryptococcus species (27.77%) . Twenty fungal cultures were positive for Cryptococcus species. Cryptococcus neoformanus was recorded higher percentages 8 (11.11%) follows by Cryptococcus laurentii 6 (8.33%), Cryptococcus albidus 4 (5.55%) and Cryptococcus humicola 2 ( 2.77%).

    Conclusion:  Cryptococcus species isolated from burn patient in a Burn Hospital in Baghdad were identified.

    Keyword: Fungal infection, Cryptococcus, Burn wound.

    Pages: 362-364

    File size : 5 MB
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  • Article title : Effect of alpha-1antitrypsin,adiponectine,leptein in obesity
    Description :

    Halla G. Mahmood *                           PhD

    Summary:

    Background:- Obesity is associated to significant disturbances in endocrine function. Hyper insulinemia and insulin resistance are the best known changes in obesity, but their mechanisms and clinical significance are not clearly established.

    Objectives:- to investigate the relationship between alph-1 antitrypsin,leptein,adiponectein in  serum of an obese population to find new markers for treating obesity and related disease.

    Patients and methods:-This study had included thirty patients with obese (12 male and 18 female) with age ranged between 30-45 years and thirty apparently subjects matched for age and weight have been studied, attending the out patients consultation clinic of Baghdad teaching hospital in medical city. The levels of A1AT, adiponectin, leptin, within the centrifuged samples were tested using the ELISA kits purchased from the Millipore Corporation

    Results:- Result obtained in the present study showed that serum levels of alph-1antitrypsin  and  adiponectin were significantly lower in obese patients than in healthy control.while the serum level of leptin was significantly higher in obese patients than in healthy control.

    Conclusion:-levels of alpha-1antitrypsin in human serum

    correlate strongly with BMI and also with serum levels of adiponectin, and leptin. These results suggest that alpha-1antitrypsin might be useful as a biomarker and be a potential target for treating obesity.

    Kew words:- alpha-1antitrypsin, adiponectin, leptin, obesity.

    Pages: 365-368

    File size : 7 MB
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  • Article title : The Role of Brainstem Auditory Evoked Potential Study in Patients With Moderate Closed Head Injury
    Description :

    Maha K. AlsayadI*                 MBChB, MSc.

    Najeeb H. Mohammed**       MBChB, MSC, DM, PhD

    Anwer N. Hafdh*                    MBChB, FICMS, NS.

     Summary:

    Background: The high prevalence of head injury among civilian populations and the provision of the adequate hospitals services have become matters of worldwide concern. Brain-stem auditory evoked potentials (BAEPs) have been shown to be of highly resistant to systemic factors and toxic or metabolic derangements, making them particularly useful in differentiating reversible brain-stem dysfunction from that due to structural disruption.

    Objectives: The purpose of this study was to demonstrate the changes in   brainstem evoked response (BAER( in patient with moderate closed head injury and   assessing again these changes in BAER six months later as follow up indices.

    Material and methods: This is a prospective study conducted in the unit of Neurophysiology /Hospital of Neurosurgery/Baghdad from November 2010 to February 2012, using Esoata machine. Ninety three patients with moderate closed head injury (49 female and 44 male), with an age range from (5 -51) years, with a mean age of (26±11.95) years, were chosen according to Glasgow coma scale (GCS) (9-12 score) undergo BAER and only 86 patients will be followed up by BAER and both were compared to control group of 55 healthy subject.

    Results: Central wave latencies of wave III, IV and V of BAER of right and left sides at early measurements were found to be significantly prolonged in comparison to that of healthy subject, Moreover, 6 months later measurements of right and left sides were significantly prolonged as compared to healthy subject at an early measurement, which indicates significant improvement.  However 6 months later measurements have significant reduced toward normal when compared to that at early measurements and with control group.

    Conclusion:  This study revealed that head injury had serious effect on the brain functions reflected by changes in brainstem auditory evoked response which needs long time to return to normal levels.

    Key word: head injury, Brainstem auditory evoked Response.

    Pages: 369-372

    File size : 9 MB
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  • Article title : The Role of Antimullerian Hormone in the Diagnosis of Poly Cystic Ovarian Syndrom.
    Description :

    Hanan A. Al-Taee.                     MBChB, PhD.

     Summary:

    Background: Polycystic ovary syndrome (PCOS) is a common endocrine disorder, affecting up to 10% of women of reproductive age. The cardinal features of PCOS are hyperandrogenism (HA) and oligo-anovulation. Many work teams recently have relate the severity of PCOS with Anti mullerian hormone (AMH) or antral follicle count (AFC). Objective: 1) to confirm if there is an increase of serum AMH in this group of patients with PCOS, 2) to relate the AMH level to the follicle status at ultrasound (U/S) in this group, and 3) to search if AMH or AFC can serve as surrogate for the definition of PCOS. 

    Patients and methods: Twenty five (control) and another 45 participants (with PCOS) were selected for this study. The control women had a mean age of 32.5 year (yr) and the patients group women had a mean age of 28.4 yr. Blood samples were collected from all participants, anthropometric measurements were calculated, and transvaginal U/S was performed to measure the AFC during the early follicular phase. The blood samples were assayed for AMH, follicle-stimulating hormone (FSH), Luteinizing Hormone (LH) and estradiol (E2) and total testosterone (TT).

    Results: Basal serum hormonal levels of LH, AMH and TT as well as AFC were significantly higher in the study group than in controls. While basal serum levels of E2 and FSH show no significant difference between the two groups. Body mass index (BMI) is significantly higher in PCOS patients. Basal serum levels of AMH  show significant positive correlation with both AFC and basal serum TT levels.The area under the receiver operating characteristic curve (ROCAUC ) for AMH and AFC show significant sensitive and specificities

    Conclusion: serum AMH and AFC appear as a sensitive and specific parameter that would probably help in the diagnosis of PCOS. Both criteria need to be incorporated into the Rotterdam definition for PCOS, and it indicates PCOS only if associated with HA and/or oligo-anovulation.

    Key words: Antimullerian hormone(AMH) , antral follicle count(AFC) ,Poly Cystic Ovarian Syndrom(PCOS) .

    Pages: 373-378

    File size : 13 MB
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  • Article title : Morning blood pressure surge and dipping profile in non-hypertensive obese subjects
    Description :

    Hayder S. Hasan*                               MBCHB , MSc

    Zaid Almadfai**                                 MBCHB , PhD

    Faris Abdulkareem***                       MBCHB , CABM, FRCP

    Summary:

    Background: Obesity is an evolving major health problem in both developed and developing countries. Non-hypertensive obese may have an elevated Morning Blood pressure surge (MBPS), which is associated with increased risk for cardiac events (CE) independently of office and ambulatory blood pressure (BP). Non-hypertensive obese also may have a blunted nocturnal decrease in BP during the night, while healthy normotensive non-obese individuals have a 10%–20% nocturnal decrease in blood pressure (BP) during the night or dipping. Thus, 24-hour ambulatory blood pressure monitor (ABPM) is the gold standard to evaluate MBPS and dipping profile in non-hypertensive obese individuals.

    Objectives: to measure and evaluate morning blood pressure surge and dipping profile for normotensive obese subjects by using 24-hour Ambulatory blood pressure monitor (ABPM).

    Methods: A total of 86 asymptomatic obese individuals (54 males, 32 females) were recruited from Obesity Unit in Alkindy College of Medicine/ University of  Baghdad. Ambulatory blood pressure monitoring was done in addition to 42 healthy non-obese subjects of either sex served as controls. Fasting blood glucose level was considered for all study subjects in addition to anthropometric measurements.

    Results: Obese subjects had a significantly higher morning blood pressure surge (MBPS), BMI is positively correlated with MBPS with significance (P=0.0001) with Pearson's correlation coefficients (r= 0.92). Obese subjects had a significantly higher mean 24-hour, daytime and night systolic/diastolic blood pressure with P value less than 0.0001. The dipping profile of obese subjects  revealed a significantly less dipping percent as compared with normal weight control subjects in both systolic and diastolic BP with p = 0.02 and 0.04 for systolic and diastolic blood pressures respectively.

    Conclusion: BMI is positively correlated with MBPS. In regard to dipping profile, obese subjects had decreased or blunted nocturnal fall in blood pressure. In addition, obese subjects had increased ambulatory blood pressures (systolic, diastolic, daytime and nighttime pressures), emphasizing the strong association between obesity and pathogenesis of hypertension. 

    Keywords: morning blood pressure surge, dipping profile, obesity.

    Pages: 379-383

    File size : 12 MB
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  • Article title : Effect of doxorubicin on the histological structure of the kidneys in male albino rats
    Description :

    Wasan W. Al-Hassawi                MBChB

    Maha A. Al-Sammak                  MBChB , MSc ,PhD

    Summary:

    Background:  doxorubicin is one of the most active cytotoxic agents in current use, it has a very potent effect in the treatment of various malignancy either used alone or combined with other cytocidal agents, the antitumor activity of this drug associated with cytotoxic effect such as cardiotoxicity, hepatotoxicity,  nephrotoxicity, myelosuppression.

    Objectives: - this study was designed to investigate the effect of the doxorubicin on the histological structure of the rats' kidney.

    Patients and  Methods:- one of the most important cytotoxic effect of doxorubicin is nephrotoxicity. Therefor sixteen adult male Wister albino rats have been used in this study, Eight of them were given 1 ml of intraperitoneal injection of normal saline alone daily for six consecutive days and served as a control group (A), The other Eight rats were given intraperitoneal dose of (1mg/kg body weight) doxorubicin, daily for six consecutive days and served as treated group (B), tow animals from group B kept alive without treatment for another week (observation period) as follow up animals to see the reversibility of the renal injury that are caused by doxorubicin. the animals were sacrificed at the end of the experiment, The body weight of the animals were recorded before starting the injection and recorded again just before killing the animals to see the changes in the body weight and the kidney sections were prepared and stained with hematoxylin and eosin stain, Periodic acid Schiff ̓s reagent (PAS), Orcin VanGieson stain, and examined by light microscope.

    Results:   -  Doxorubicin cause reduction in the body weight and changes in the histological structure of the kidney which are atrophy of some  glomeruli with widening of the urinary space between the glomerular tuft and the bowman's capsule , other glomeruli show expansion of glomerular tuft with obliteration of the urinary space, degenerative changes in the tubular epithelium, increase rate of apoptosis, necrosis, cystic changes of the tubules and vacuolation of the tubular epithelial cells cytoplasm, protein cast formation in the tubular lumen, infiltration of inflammatory cells in the interstitium, proliferation of collagen fibers(fibrosis) in the interstitium and glomerulosclerosis, the follow up animals show persistence and more extensive lesion than group B.

    Conclusion:  doxorubicin causes marked changes in the normal histological architecture of the rats' kidney, and these changes are irreversible after cessation  of  doxorubicin injection (observation period).

    Key words: doxorubicin, rat kidney, histological changes.

    Pages: 384-389

    File size : 27 MB
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  • Article title : Large functioning Childhood adrenocortical carcinoma (Case report)
    Description :

    Jinan A.Jabbar*           MBChB ,DMRD

    Qusai A. Fahad**         MBChB ,DMRD,FICMS                                

     Summary:

    We describe a large functioning non metastasizing ACC in 8 years old boy who presented with a history of precocious puberty noticed by his parents since 3 months .Ultrasound of the abdomen showed a large well defined right suprarenal mass with calcification and necrosis . MRI  showed  the mass to be hypojntense to liver on T1 and   hyperintense  to liver on T2, a379-383nd  dynamic CT scan revealed a large hetrogenous  enhancing right suprarenal mass with calcification and necrosis , clear chest .Histopathology done after surgical removal reveal adrenocortical carcinoma,so we recommend to do an abdominal ultrasound to any child with precocious puberty because it is easy,cheap and non invasive , if any suprarenal mass found it should be further characterized by MRI and  dynamic conontrast enhanced CT to determine its respectability

    Keywords: paediatric adrenocortical tumor, functioning adrenocortical carcinoma.

    Pages: 390-392

    File size : 6 MB
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