Background: Although Electroconvulsive Therapy (ECT) is still regarded as a controversial treatment by some people, it is an important and effective treatment. The practice of ECT is different across the world. Objectives: to obtain an overview of the electroconvulsive therapy practice in Iraq. Method: Forty item self administered questionnaire about the attitude and practice of ECT, was sent (by mail or delivered by the researcher) to 73 Iraqi psychiatrists during the period from March to September, 2007. Results: Half of participants had asked for the patient's consent, and all asked the family for the consent, 72% had asked for written consent and 28% for oral consent only. Majority ( 81%) gave oral information to patient's family before ECT while 36% gave oral information to patients . Average number of ECTs administered per patient were six, 61% perform ECT thrice weekly while 39% twice weekly. Maintenance ECT was used by 16% of participants. Bilateral ECT is exclusively used in Iraq and 74% perform unmodified ECT. Vast majority of the participants (85%) believed in application of ECT as a strongly effective treatment. The majority 79% never stop medications before ECT. Forty eight percent did routine investigations before ECT performance, The main complications associated with ECT were; amnesia (57%) headache (54%), and nine deaths were reported during the practice of the 65 psychiatrists. The main indications for ECT were depression (31%), schizophrenia (26%) , mania (21%) and schizoaffective(16%). Many absolute contraindication mentioned by Iraqi psychiatrists , increased intracranial pressure(79%) , space occupying lesions(74%), Myocardial infarction (64%), aortic aneurysm (56%) and below 15 years of age (41%) Conclusion: Iraqi psychiatrists practice of ECT is a mixture of different international experiences .A legislation and a code of practice for the use of ECT is mandatory .
DOI : 10.32007/jfacmedbagdad.v146-52% Anahtar Kelimeler :
Iraq, Electroconvulsive therapy, *Assistant professor and consultant psychiatrist
Cilt: 55 Sayı: 1
Background: - Aspergillus fumigatus is a ubiquitous and opportunistic fungal pathogen causing sever invasive aspergillosis, an important source of morbidity and mortality in immunocompromised hosts (human and animals) .The present study was conducted to obtain more clarification about the toxicity and histopathological effects of this pathogen in albino mice Material and Methods :- fourteen male mice( 6-10) weeks old ,( 20 – 28) gm weight , divided into two groups , test group ( n= 8) , intranasally infected with 25μl (710 conidia / ml normal saline ) of A. fumigatus for 7 successive days , compared with uninfected group ( n=6) . the weight of all animals were measured at the beginning and at the end of the experiment , in addition to histological study for lung , liver and kidney were performed , with estimation of enzyme activity of GOT ( Glutomic Oxaloacetic Transaminase),GPT (Glutamic Pyruvic Transaminase) , ALP (Alkaline Phosphatase ) and Creatinine Kinase in homogenized liver and kidney tissues were studied by colorimetric method . Results :- increased ( p< 0.05) in body weight , and organs weight ( lung , liver , kidney ) in infected mice with different histological changes were found in organs tissues of infected mice especially in lung and liver , these changes were supported by variation in enzyme activities of GOT, GPT, ALP and Creatinin kinase in homogenized organs tissues Conclusion: - normal host can suffer from systematic diseases after inhalation of infective forms of A. Fumigatus (conidia), and further work is needed to study the active components, which are responsible for pathogenesis of this opportunistic fungi
Background:Pediatric acute myeloid leukemia (AML) has a poor prognosis, and novel therapies are needed. The FLT3 tyrosine kinase inhibitorsrepresents a promising target in pediatric AML. Objectives:This study was done to estimate the frequency of FLT3- ITD mutation in childhood acute myeloid leukemia using conventional PCR & correlate this mutation with the clinical presentation and response to induction therapy. Patients, Materials &Methods: Twenty children with AML, and 16 children with reactive bone marrow as negative control were enrolled in this study. Those patients were attending Child Welfare Teaching Hospital in Baghdad from March 2010 to July 2011 .For each patient hematological investigations including complete blood picture, and bone marrow aspiration were done.FLT3-ITD mutation was detected by conventional PCR technology using specific primers. Complete hematological remission achievement after induction chemotherapy was assessed by clinical examinations and full laboratory investigations. Results: Out of 20 AML children who participated in this study, 2 (10%) had FLT3-ITD mutation. The mean age of patients who had the mutation was higher than those without the mutation; and the mutated patientswere males, (P> 0.05).The FLT3-ITD mutation showed no correlation to clinical presentation.The peripheral blood & bone marrow blast cell percent werenon significantly higherin mutated patients as compared to non mutated patients. Regardingits relation to FAB classification, the FLT3-ITD mutation was only detected in M3(1/20) and M3v(1/20), and no mutation was found in other subtypes(M1,M2,M5). Furthermore, mutated patients showed lower response to inductiontherapy as compared to non mutated patients. Conclusions: This is a noval study in one Iraqi teaching hospital to detect FLT3-ITD mutation by using conventional PCR in children with AML. This mutation was detected in 10% of thosechildren , and since they were male,older age group,and presented with higher peripheral blood &bone marrow blast cell percent thus we may propose that it may be used as a marker for the aggressiveness of the disease and can be used to modulate the treatment strategy for those patients.
Background: Hydrocephalus is an imbalance of cerebro-spinal fluid (CSF) formation & absorption of sufficient magnitude to produce a net accumulation of fluid within to cerebral ventricles. Aim of study: the main objective of this study is to compare frontal with post parietal shunt regarding the surgery complications , end results & then to compare it with other studies abroad. Patient & Methods: this study included 920 patients admitted to the Neurosurgical department in the Hospital of surgical specialty,Medical city. The patients had full radiological study including MRI and CT . All patients were surgically managed & followed up for at least one year. Results: results were & compared regarding the type of surgery we did (VP&VA)shunt. frontal or parieted with other studies. Conclusion: frontal shunts can be as successful as post parieted shunts, & it carries less complications & lower mortalty although more difficult procedure & needs more experience
DOI : 10.32007/167323-27 Anahtar Kelimeler :
VP & VA
Cilt: 47 Sayı: 1
Background: revascularization therapy for patients with left main (LM) and/or three vessel coronary disease is a matter of argument for long a time whether bypercutaneous coronary angiography orcoronary artery bypass grafting. SYNTAX trial was designed to assess the optimal revascularization strategy between percutaneous coronary intervention and coronary artery bypass grafting, for patients with left main stem coronary artery disease and/or 3-vessel coronary disease. Aim: To estimate the complexity of coronary artery disease in patients referred to a tertiary Iraqi cardiac center and its effect on mode of revascularization. Patients and Method: Ninety nine patients who were referred to Iraqi center for heart disease from July to December 2010 withthe diagnosis of CAD were included. Full history, clinical examination, biochemical tests ( blood sugar ,total cholesterol , blood urea and serum creatinine) were checked, electrocardiographic and echocardiographic characteristics were analyzed .All patients underwent diagnostic angiography andSYNTAX score calculator was applied and the SYNTAX score was recorded.Patients were divided into two groups : group A , thosewho were planned for PCI and group B who were planned for CABG . Results: Mean age of the patients was 57.6±10.6, ranging 19-80 year, male were more than female (75.8% vs. 24.6%). Risk factors prevalencewas DM (42.6%), high blood pressure (52.8 %), smoking (42.4%), hypercholesterolemia (43.4%) and prior MI (32.3%). Mean age of group A was 54.22±11.27 while group B was 62.37±7.47 (P value 0.0001) . There was no significant difference in risk factors prevalence between group A and B ( DM 36.2% vs.51.2% p=0.31), hypertension(53.4% vs.53.3% p=0.98), smoking (41.3% vs.43.9% p=0.8), hypercholestoemia (31% vs. 60.9%),ejection fraction<50% ( 20.6% vs. 24.3% ) (p=0.66). All patient with left main steam disease 13 (31.7%) passed to CABG group. Mean total SYNTAX score for all patients was 16.7±6.5. Mean SYNTAX score were (10.24±6, 26.01±7.7) for group A and B respectively (P value 0.00001). Conclusion: Patients with lower SYNTAX score were managed by PCI. Iraqi patients treated with PCI have lower syntax score than that in SYNTAX study, while those who were treated by CABG, were comparable to that in SYNTAX study.
Background: Urine cytology has an acceptable sensitivity, & specificity that justifies its use in the current diagnostic protocol. In Iraq transitional cell carcinoma (TCC) constitute about 62.1 % of bladder cancer (which ranks the third according to the results of Iraqi Cancer Registry 1995-1997). Urine cytology used in the primary diagnosis, follow up, and in the screening programs of asymptomatic but high-risk patients. Patients and methods: This study was conducted on 93 patients, diagnosed or clinically suspected to have TCC of the urinary bladder attending to the Urological department in ALKadhimiya Teaching Hospital, AL-Yarmouk Teaching Hospital, and Baghdad Medical City. During the period from July 2004to July 2005. 76 were males & 17 were females. Urine cytological examination was done to those patients using two types of stain (hematoxylin and eosin, and papanicoloau stain) to detect malignant cells with the identification of the degree of differentiation, if possible, the cytological findings were correlated with the histopathological findings. And the cytological findings compared regarding each type of stain. Results:. Mean age of the patients was 59 year. Male:female ratio was 4.4:1. Main clinical presentation was hematuria (45.8%) of the total. Urine cytological examination has a sensitivity of 87.7%, specificity of 100% with an overall accuracy of 78% in the detection of TCC of urinary bladder. The main chief complaint of patients with TCC was haematuriawitch constitute 45.8% of the total. The percentage of highgrade cases in urine cytology was higher than that in histopathology.the percentage of cases of TCC diagnosed by papanicoloau stain was more than that diagnosed by H & E (73.24% by pap stain versus 70.42% by H&E). Conclusion: Urine cytology has an acceptable sensitivity, specificity and an overall accuracy in the diagnosis of TCC of urinary bladder, and it offers a good chance for determination of the grade of the tumor especially in high grade tumor. Pap stain was better in the diagnosis of TCC.
Anahtar Kelimeler :
An appraisal of urine cytology
Cilt: 49 Sayı: 2
Background: Many variables determine the destructive capacity of a weapon; missile velocity is an important consideration. Wounding capability of a missile depends on the amount of kinetic energy dissipated in the tissues. A penetrating high velocity missile (usually bullets) transfers a destructive energy called shock wave to the surrounding tissues. Objective: To detect and estimate tissues damage away from the main track of high velocity missiles in firearm rifled weapons injuries. Methods: This cross-sectional study is performed in medico-legal institute in Baghdad for (8) month’s duration from (1-1-2010) to (1-9-2010). Full proper autopsy including external and internal examination of the body for all cases was performed, and complete medico-legal history was obtained to determine the type of the weapon used so as to include only the cases of high velocity missile injures. Results: The study included (30) cases; (21) men and (9) women with their ages ranged between (15 –70) years. The total body injures in all cases were (69) in the main track and (43) away from the main track of the missiles. Head and neck region was affected more than other body regions by primary injury, while the chest region was the most affected by distant injuries due to shock wave. Conclusion: The shock wave damage had happened in all cases of high velocity missile firearm injures in this study. Most of them were in the chest; the lower limbs were the least frequently affected. This should be put in consideration of forensic pathologist.
DOI : 10.32007/jfacmedbagdad.v4401-405% Anahtar Kelimeler :
Firearm injuries, Rifled weapon, High velocity missile, Shock wave.
Cilt: 53 Sayı: 4
Background: Idiopathic autoimmune thrombocytopenia purpura (ITP) is an isolated thrombocytopenia in a patient with no clinically apparent associated conditions or factors that can cause thrombocytopenia. The syndrome of ITP is caused by platelet-specific auto-antibodies that bind to autologous platelets. The diagnosis of ITP is usually a diagnosis of exclusion based on a demonstration of peripheral thrombocytopenia. Steroids are the conventional first-line therapy for adult ITP. Most patients demonstrate a response to steroids within 2 to 4 weeks, but a late response is possible. Patients and Methods: A prospective study on 50 patients with diagnosis consistent with ITP, initially treated by steroid, patients who were non responders to steroids or relapsed following its withdrawal offered splenectomy Results: Ten patients (20 %) had permanent satisfactory remission following steroid therapy, while other 40 patients (80 %) were either non responders (20 patients, 40 %) or relapsed (20 patients, 40%). Twenty patients (40%) underwent splenectomy, all of them initially responded, after 3-6 months, 17 patients of them (85%) were still in complete remission, while 3 patients (15%) were refractory ITP and required further treatment. Conclusion: Steroid therapy is less effective in achieving satisfactory remission in adult patient with ITP; on the other hand, splenectomy had more sustained response after steroid failure.
Background: High oncogenic-risk genotypes of human Papillomavirus (HPV) infect a wide range of human cells, including prostate tissue that give rise to benign prostatic hyperplasia and prostatic adenocarcinomas. Objectives: This study aimed to detect DNA of HPV genotype-16 &18 using in situ hybridization technique in prostatic tissues from benign prostatic hyperplasia and prostatic adenocarcinomas, and elucidate the association between these HPV genotypes and prostatic carcinogenesis. Patients and methods: Forty-eight (48) formalin-fixed, paraffin embedded prostatic tissue blocks were obtained ,among them (28) tissue biopsies from prostatic carcinoma with different grades and (20) benign prostate hyperplastic tissue blocks as well as (10) apparently normal prostate tissue autopsies which were collected from the archives of Forensic Medicine Institute / Baghdad and used as prostate healthy control groups. Detection and genotyping of HPV was done by highly sensitive in situ hybridization technique. Results: The signals of in situ hybridization reactions of both HPV-16 and HPV-18 in prostate cancer cases in the present study was 25% (7 / 28) whereas in BPH, HPV-16 was detected in 45 %( 9 /20) and HPV-18 was presented in 35 %( 7/ 20). Neither HPV-16 nor HPV-18 was detected in the apparently healthy control group.The percentages of HPV 16 and HPV18 were increasing with advancing of grade of prostate cancer. Conclusion: Our results indicate that the oncogenic HPV-16 might contribute to the development of subset of prostate tumors. In addition, HPV16&18 might have a crucial role in progression of the prostate cancer and benign prostatic hyperplasia
DOI : 10.32007/jfacmedbagdad.v2201-206% Anahtar Kelimeler :
HPV-16, HPV-18, prostate cancer, benign prostatic hyperplasia, in situ hybridization.
Cilt: 53 Sayı: 2
Background: Cognitive dysfunctions in epileptic patients may develop due to the neurophysiologic changes related to seizures or antiepileptic drugs. Objectives: The aim of this longitudinal study was to evaluate the cognitive dysfunction in epileptic patients under antiepileptic drug therapy by the aid of event related potentials. Patients & Method: P300 latencies were obtained from Fz, Cz and Pz electrodes positions from both epileptic patients (n = 224) and age and sex matched control group (n = 91). Epileptic patients were classified either having partial epilepsy, generalized epilepsy or both partial and generalized epilepsy (combined epilepsy). EEG and p300 test repeated for each patient every three months for one year. The effect of epilepsy type and duration, treatment types (monotherapy/ polytherapy), daily dosages and EEG abnormalities on P300 latencies were studied. Results: P300 latencies were longer in the epileptics when compared to controls (P < 0.05). Besides, our results pointed out that P300 latencies were longer in patients with generalized and combined epilepsy as compared to those with partial epilepsy (P < 0.05). Conclusion: We believe that P300 latencies may have an important role in the evaluation of cognitive dysfunction in epileptic patients treated with antiepileptic drugs.
Summary: Background: Alcohol is the most important causes of liver cirrhosis. Many of the factors underlying the development of alcoholic liver diseases remain unknown. Recently, some epidemiological studies showed beneficial effects of coffee against the occurrence of alcoholic liver cirrhosis and upon serum liver enzymes level. These observations have been examined in this work. Patients and Methods: The relation of coffee drinking to serum GGT, AST and ALT activities were examined in 59 alcoholic male patients with or without habit of coffee consumption. 35 (59.3%) out of 59 patients were alcoholic drinkers without coffee consumption habit, and 24(40.7%) were alcohol drinkers with coffee consumption. In addition to 24 healthy persons as a control group. Results: Highly significant decrease in GGT (p<0.001), AST (p<0.001) and ALT (p<0.001) activities were found in alcoholic patients with coffee consumption habit as compared with alcoholic patients or with healthy control group. Conclusion: The result of this research suggested that coffee consumption may inhibit the induction of GGT in the liver by alcohol consumption, and may possibly protect against liver cell damage due to alcohol.
Pleuropulmonary blastoma is a rare and aggressive neoplasm typically presents in young children, younger than 5 years, as a pulmonary and/or pleural-based tumor. We reported a case of type-II pleuropulmonary blastoma (PPB) in an 8 month old infant who presented to Al-Khansa'a Maternity Hospital in Western Mosul with a history of repeated attacks of shortness of breath and signs of pulmonary infection unresponsive to treatment. A bronchoscopic examination showed a mass involved and obstructed the orifice of the main bronchial tree of the right upper lung lobe. A thoracotomy was performed; tumor involved the right upper lung lobe, the covering pleural surface and invading the mediastinal structures. Right upper lobectomy was performed. Tumor had cystic and solid components. It characterized histologically by a mixture of primitive blastematous and sarcomatous elements.
Background: Mesh infection after hernia repair is a devastating complication. Preoperative prediction of high risk patients may be useful to avoid infections. This study aims at evaluating risk factors for mesh related wound infection in our setting. Patients and methods: This prospective cohort analysis study included 120 patients underwent ventral hernioplasty with polypropylene mesh from October 2009 to February 2013 at Baghdad Teaching Hospital. Clinical data analyzed to determine risk factors of mesh related wound infection. Results: After one year follow up for each of 120; 21 patients (17.5%) developed mesh related wound infection. Predictors of infection were: age ≥ 45 years, BMI≥35 kg/m2, diabetes mellitus, past history of previous surgical repair, presence of more than one sac or defect, defect size larger than 5 cm, type of hernia sac content (small bowel), small bowel anastomoses, and increased duration of surgery. Conclusion: Clinical history and examination preoperatively can predict high risk patients to develop postoperative infection.
Background: Histamine is one of the biogenic amines that belong among the naturally occurring substances. It can be formed in food as a result of metabolic processes of microorganisms .If the concentration of histamine is above a normal level (5mg/100g) this could possibly due to bacterial contamination of food harmful affect may occur. Objective: The purpose of this study was to detect histamine forming bacteria and quantification of histamine in fresh meat product available in local meat markets in Baghdad. Methods: Histamine level determination in some red meats product was performed by known colorimetric methods. This method enables a rapid and precise determination of histamine in many samples, in this study, total number of ten red meat were collected from Baghdad local market. Meats were analyzed for histamine. Extraction and determination of histamine in all meat samples were made by colorimetric method. One gram of red meat samples were added to 99ml of sterile peptone water to make dilution 10-1, further dilution was made. 0.1 ml was put to inoculate selective culture media, incubated at 37C for 24 hours. Microbes which have been diagnosed were a Staphylococcus spp. and Pseudomonas spp. by conventional methods. Results: In this study histamine was detected in all red meat samples at concentration ranging from 0.87 to 17.30 mg/100g.Relatively, the histamine level was higher in amber, followed by Al-Hana and Al-murad. Histamine contents were established according to (WHO) regulation. Tested samples contain Pseudomonas spp. and Staphylococcus spp. Conclusions: Regarding the presence of biogenic amines in meat, it also would be useful the study of their role in formation of certain compound in meat and meat products. Contamination of red meat samples with Pseudomonas spp. May be attributed to cross –contamination.
DOI : 10.32007/med.1936/jfacmedbagdad.v59i2.15 Anahtar Kelimeler :
Histamine, red meat, colorimetric methods.
Cilt: 59 Sayı: 2
Seventy- four cases of clinically diagnosed Rheumatoid Arthritis (RA), fifty cases of systemic lupus erythematosus (SLE), and thirty healthy normal controls were investigated for detection of rheumatoid factor (RF), total serum immunoglobulins (Igs), antinuclear antibody (ANA), and ANA subtype anti-double stranded DNA (anti-ds DNA). Patients with RA showed 58.1% positive for RF comparable with 14% positivity in SLE patients and 6.6% in normal individuals. Serum Igs (IgA,IgG) were found to be elevated in RA and SLE patients (62.2% , 36.5%) (54% , 38%) respectively. This study revealed that ANA is found in 88% of SLE patients sera and 78% of these ANA is ds DNA in comparison with only 6.8% of RA sera were found positive for ANA.
Background: Arm span is the closest physiologic measurement to standing height. Increased arm span to standing height ratio, which indicates a possible loss of height, due to aging, often results from osteoporosis-related vertebral collapse or other causes. This has possible consequences on lung functions. Objective: To evaluate the effects of aging related loss of height to severity of dyspnea. Method: Patients visited pulmonary function test laboratoryat Baghdad teaching hospital outpatient clinic department from first of November 2009 to thirty first of December 2010 for preoperative assessment were recruited to participate in our study. All recruited subjects were evaluated with a clinical history and physical examination followed by measurements of arm span, standing height, weight, forced expiratory volume in one second (FEV1) and forced vital capacity (FVC). Patients 40 years old of age and older were included .Patients with chronic disabilities (cardiac, respiratory or systemic diseases) were excluded. Patients were classified according to their gender and Medical Research Council severity of dyspnea. Results: one hundred thirty one subjects aged 40 years and older were recruited for this study. Arm span to height ratio was significantly negatively correlated with FEV1/FVC ratio, FVC, and positively correlated with severity of dyspnea. Conclusion:There is a significant association between increased arm span to height ratio with increased severity of dyspnea. The role of arm span measurements in assessment of pulmonary function tests in older patients and the association between loss of height and dyspnea deserves further evaluation.
DOI : 10.32007/jfacmedbagdad.v2131-133% Anahtar Kelimeler :
Arm Span, height ratio, dyspnea.
Cilt: 54 Sayı: 2
Background: Patients who undergo craniectomy or removal of part of the skull bone following trauma to give a release to the brain are later managed by auto graft, or synthetic acrylic graft. Patients and method: 20 patients transferred to specialized surgical hospital from U.S mellitary Ibn Sinna hospital with removal the skull bone implanted in the abdomenol wall or thigh and managed by returning of the bone to the scalp compared with 20 patients managed in our hospital to start by craniectomy and implantation of a synthetic bone graft acrylic, the comparism included the surgery, time of delay, out come, complication. Results: We divided the patients to group A and B, A were the ones treated by Autograft & B by synthetic graft (Acrylic). In both groups half of the patients were between 20 and 40 years of age, with male predominance, the delay of surgery were more group B, but the complications were more in group A, & 25% required surgical intervention & removal of the graft. Conclusion: we think that Acrylic cranioplasty is better than Auto graft cranioplasty in traumatic cases as it carries better cosmetic results & final out come.
DOI : 10.32007/jfacmedbagdad.v130-31% Anahtar Kelimeler :
(Acrylic) bone graft, Autogenic, synthetic bone, head injury.
Cilt: 52 Sayı: 1
Background: There is a need for a periodic review of acute bacterial meningitis (ABM) since the pathogens responsible for infection vary with time, geography and patient's age. This study was carried out to describe the epidemiology of different types of meningitis and variables affecting the outcome (improvement, complication and death). Patients and Methods: All the cases of meningitis diagnosed and treated at Ibn- Al-Khateeb Teaching Hospital for the period Jan. 1993 to Dec. 1998 were included in this study. The collected data were age, sex, occupation, date of admission, date of discharge, type of meningitis and outcome of the disease. Results: Out of the total cases, 73.3% were ABM. High rate of ABM was among children < 5 years of age and a significant (p = 0.01) high rate was observed among male (60%) (p = 0.01). Predictors of outcome of meningitis were age, sex, residence, duration of hospitalization and type of meningitis. Conclusion: ABM was predominantly observed in children. The high case fatality rate reported in this study was attributed to the deterioration of health services due to wars and sanctions in 1990s.
DOI : 10.32007/1202%g159-161 Anahtar Kelimeler :
Acute bacterial meningitis, outcome, case fatality rate, Iraq
Cilt: 51 Sayı: 2
Background: Infection with Hepatitis C virus (HCV) is a major cause of chronic liver disease, WHO estimated that about 170 million people are infected with Hepatitic C virus, Silymarin (Legalon) have been recently shown to be effective in treatment of Hepatitic C virus infection. Objectives: The effectiveness of Legalon (Silymarin) on viral load in patients with Hepatitic C virus infection. Patients and methods: A prospective case – control study included 400 patients with Hepatitis C virus infection. 200 patients (group A) were treated with (peg-interferon, ribavirin, silymarin) the other 200 patients (group B) were treated with (peg-interferon, ribavirin) . only G1 & G4 genotypes were included , viral load were assessed initially and after 3 months in patients with positive viral load. Results: Viral load follow in group A, Hepatitis C Viral load was reported in 150 cases giving a response rate of 75% while in the 200 cases of group B the response was reported in 110 giving an overall response rate 55% , this indicate that cases in group A had a significant higher response rate than those in group B. Conclusion: Patients taking Silymarin (420 mg/day) for 3 months showed a decrease in viral load, effectiveness of silymarin was more in Genotype 1 than in the Genotype 4, the response was better in low viral load patients ( less than 600000 IU/ml).
DOI : 10.32007/med.1936/jfacmedbagdad.v59i1.4 Anahtar Kelimeler :
Hepatitis C, Treatment, Silymarin effects on treatment.
Cilt: 59 Sayı: 1
Background: Laparoscopic sleeve gastrectomy has gained more popularity as an independent bariatric procedure because laparoscopic sleeve gastrectomy was reported to be an effective, safe, and time-savingprocedure, leading to adequate weight loss for morbidly obese patients and becoming one of the most common procedures performed for the treatment of morbidly obese patients in the last few years until now. Objectives: The aim of this study is to compare two different techniques of the reinforcement of staple line during LSG in the reduction of major complications (bleeding and leak). Patients and methods: prospective randomized study of a consecutive series of 126 patients that underwent LSG between April 2014 till August 2015. Patients were randomly enrolled in two different techniques of reinforcing the staple line during LSG, Group A consisted of 63 patients that underwent sleeve gastrectomy using Ethicon Endo GIA stapleTM with staple line oversewn using 2.0 prolene continuous suture, group B also 63 patients who had the staple-line oversewn with a continuous suture using V-locTM and Covidien Endo GIA tristapleTM. Results: 126 patients who underwent LSG, 82(65%) were women and 44(35%) were men. Median age was 36 years (range, 19–58 years) and median preoperative BMI was 45.4 kg/m2 (range, 37–62 kg/m2), Three patients (4.76%)from group (A) and 2 patients (3.17%)from group (B)developed primary hemorrhage (within the first 24 hours post operatively), overall bleeding rate in both groups was (3.96%), no leak in both groups and no mortality. Conclusion: laparoscopic sleeve gastrectomy is a safe procedure as a sole weight reduction operation. The combination of meticulous surgical technique, reinforcement of the gastric staple line, lead to decrease the incidence of staple line leak whatever the suture material or stapler type used, but there is no significant decrease in the incidence of bleeding with staple line reinforcement.
DOI : 10.32007/med.1936/jfacmedbagdad.v58i2.1 Anahtar Kelimeler :
sleeve gastrectomy, staple line reinforcement, leak, bleeding.
Cilt: 58 Sayı: 2
Background: Traditionally, evaluation of the results of immunohistochemistry was done by visual quantification. Materials and methods: for reliable evaluation, more time-efficient and user friendly method we used simple computer program with image analysis options as independent parameters for reading positive results. To test the validity of visually scored results, we compare and correlate the results of Digital image analysis (DIA) variables with the visual scores of 280 pictures taken from entire stained glioma tumor sections for Bcl-2 and P53 oncoproteins in different glioma tumor grades. Results: In this study, rates expression of both oncoproteins was evaluated visually in glioma tumor samples (Bcl-2=72.41% and P53=82.76%), no statistical significant differences were observed according to pathologic grades. Similarly, these results were also explained by data obtained by DIA variables that has been closely correlated with visual scores. More importantly, the DIA variables explained little discrepancy in the visual scores of both oncoproteins. Conclusions: the quantitative DIA measurements of the immunohistochemically stained sections made the results more objective and supported pathomorphological diagnosis.
DOI : 10.32007/jfacmedbagdad.v2198-202% Anahtar Kelimeler :
Digital image analysis, immunohistochemistry staining.
Cilt: 52 Sayı: 2
Background: The annual incidence of stroke in children after the newborn period is approximately 2.3 per 100000. Half are ischemic, and half are non-traumaticintracerebral and subarchnoidal hemorrhages. Objectives: To study the etiologic factors, clinical presentation andoutcome of stroke among children admitted to children welfare teaching hospital/Baghdad. Patient and methods: A prospective study was carried out in Children Welfare Teaching Hospital;Children age ranged between 1 month -13 years and was admitted to pediatric neurology ward between 1st of November 2013 and 1st of November 2014. After carful clinical history, physical and neurological examinations, the diagnosis of brain stroke was confirmed in all patients by computerized tomography (CT) and/or magnetic resonance imaging (MRI). Patients included in this study were those diagnosed as having ischemic stroke, hemorrhagic stroke. Results: The total number of cases were 61, 36 were male (59%). The age at onset ranged from 1-156 months. Ischemic stroke constituted 39 patients (63.9%). The most common etiologic factors for the ischemic stroke were protein C deficiency (9, 23.1%). The most common etiologic factor for hemorrhage was bleeding disorders in about 50% of patients. The most common presenting features were hemiplegia, seizure, alteration of consciousness; Cranial nerves palsy is mostly present in the ischemic stroke (14,35.9%) and only in one patient (4.5%) of hemorrhagic stroke. Conclusions: Ischemic stroke is more common than hemorrhagic stroke in pediatric age group. The significant risk factors for ischemic stroke are protein C deficiency, Congenital heart disease(CHD) and positive family history, while vitamin K deficiency, prolong Partial thromboplastin time (PTT) and trauma are significant for hemorrhagic stroke. The most common clinical features of both types of stroke are hemiparesis, siezure and alteration of consciousness.
DOI : 10.32007/med.1936/jfacmedbagdad.v59i1.9 Anahtar Kelimeler :
Ischemic stroke, Hemorrhagic stroke, Children Welfare Teaching Hospital.
Cilt: 59 Sayı: 1
Background: Toll-like receptor -2 (TLR-2)play important roles in tumor biology; by activation and promotion of tumor cell proliferation, resistance to apoptosis andalso, enhancement of tumor cell invasion and metastasis by regulating metalloproteinase and integrin’s.As toll-like receptors are widely expressed on tumor cells and participatein the initiation and progression of cancer, they may thus serve an important target and have an effective perspective on breast cancer treatment. Objectives:The aims of the present study was to determine the levels of TLR-2 in the sera of healthy people and patients with benign and malignant breast tumors and also to investigate the validity of using TLR-2 as specific diagnostic markers of breast cancer. It`sdetection at early stage of disease could identify those patients with a high risk of progression to aggressive cancers. Patients and methods:Thirty breast cancer femaleswith age range from 27-76 years were included in this study and they were among patients who attending the National Center For Early Detection Of Cancer - medical city complex / Ministry of Health,during the period from October 2011 to February 2012.Thirty clinically diagnosed patients with benign fibro adenoma and twenty apparently healthy women were chosen as a case control and healthy control groups respectively. For all these study groups, serum level of TLR-2 using sandwich ELISA technique was carried out. Results:There was a statically significant difference in the serum level of TLR-2in blood of breast cancer patients and case control group in comparison to healthy controls (p >0.001),however there was no significant differences in such a level between the first two groups (p=0.44); therefore we were dealing with breast tumor cases in general regarding serum TLR-2.By using Receiver operating characteristic curve (ROC) area, in order to study the validity value of serum Toll like receptor-2 in differentiated breast tumor patients from healthy controls, serum TLR-2has the highest area under the curve (0.930) with cut off value associated with highest (perfect) sensitivity (100%) was equal to or above 0.14ng/ml. Conclusion:The current study showed that serum levels of TLR-2were significantly higher in patients with benign and malignant breast tumors which may confirm a possible role of this marker in the pathogenesis of the disease, furthermore the best sensitivity and highest accuracy obtained from serum toll-like receptor-2 was by using a cut off values equal to or above 0.14ng/ml; Therefore, TLR-2 may be promising new diagnostic tools especially at early stages and among patients at high risk.
DOI : 10.32007/jfacmedbagdad.v2152-157% Anahtar Kelimeler :
Toll like receptor-2, Breast cancer, Validity.
Cilt: 55 Sayı: 2
Objective To detect the changes in serum Lipids among Iraqi patients with active Rheumatoid Arthritis (RA) and the effects of drug therapy. Patients and methods Fifty Iraqi patients with untreated active Rheumatoid Arthritis and 50 matched healthy control were studied with concentration on estimation of fasting serum Lipid profile which is repeated after 3month treatment with different disease modifying anti Rheumatic drugs (DMARDs) regimens. Results Fifty Iraqi patients were included in this prospective study 47 females (94%) and 3 males (6%). The mean age of patients was (45±3.20). fifty healthy individuals were included in this study as a control group 45 females (90%) and 5 males (10%) the mean age of the control group was (44.9±2.9). Our results showed a significant reduction of VLDL, LDL, HDL, serum cholesterol and serum triglyceride in-patients with active RA (p=<0.05, 0.001. 0.001, 0.001 and 0.018 respectively). There was a significant relationship found between ESR and VLDL (P<0.05), serum triglyceride (P<0.04) and serum cholesterol (P<0.01). And there was a significant relationship between serum lipids and articular index VLDL (P<0.05), serum cholesterol (P<0.01) and TG (P=0.01). After 3-months treatment with Methotrexate or Methotrexate + Chloroquine ± large dose steroid or Chloroquine alone. There was a significant reduction of inflammatory activity and serum lipids return to levels similar to that of control group. Conclusions: The dyslipidemia associated with active RA characterized by low serum lipids and can be normalized by controlling disease activity with antirheumatic drugs including steroids.
Background: Breast cancer is the most frequent cancer in women worldwide and in Iraq. Proliferation rates of neoplastic process can be useful in predicting prognosis, aggressiveness of cancers and to guide treatment protocols in clinical practice. Objectives: To evaluate the role of Ki67 as a proliferative marker through analysing the associations between Ki67 with the clinic-pathological parameters, hormone receptors and Her2/neu expression. Patients and methods: Forty paraffin blocks belonging to patient with breast carcinoma and ten blocks with benign diseases were included in this retrospective cross-sectional study and used for the immunohistochemical assessment of hormone receptors, Her2/neu and Ki67. Results: Mean age of the malignant cases was (50.30±9) years; invasive ductal carcinoma was the main histopathological type (87.5%). Three quarters of the cases were with (Grade II) and (T2). Positive lymph node reported in (72.5%) of cases. Malignant cases positively expressed ER, PR, Her2/neu (score 3+) and Ki67 in (75%), (72.5%), (17.5%) and (75%) respectively. Luminal B subtype was the commonest among studied cases. Conclusions: Ki67 proliferative index represented a valuable tool and provided information about aggressiveness and prognosis of breast carcinoma, significant correlations found between Ki67 and tumor grade, lymph node involvement and Her2/neu score.
DOI : 10.32007/med.1936/jfacmedbagdad.v57i2.13 Anahtar Kelimeler :
Ki67, Breast carcinoma, prognostic factor.
Cilt: 57 Sayı: 2
Background:To evaluate the accuracy of serum uric acid to predict maternal and fetal complications in women with pre- eclampsia. Design: Prospective study. Setting: Tikrit Teaching Hospital. Subject and Methods: Fifty normotensive and forty-three pre-eclamptic pregnant women at (20-24) weeks of gestation were the study subject, serum concentrations of uric acid were measured and examine the correlations between serum uric acid level with fetal and maternal complications. Result: Serum concentration of uric acid in pre-eclamptic women were significantly higher than in gestational age match normotensive pregnant women, and women with pre-eclampsia and elevated uric acid concentration at increased risk of low birth weight , preterm delivery and cesarean , delivery compared with each condition in absence of hyperuricemia. Conclusion: Hypervricemia consider a good predictor to select group of per-eclamptic women with high risk for fetal and maternal complications.
Background: Patients with an Implantable Cardiovertor Defibrillation (ICD) describe psychological problems such as depression, anxiety, and stress. To achieve the full benefits of the device, patient must maintain their psychological status within good levels. Objectives: The major objectives of this study were to determine the main psychological problems in adult patients with an ICD and to find out the relationship between Psychological problems in patients with ICD and some demographic characteristics of patients with ICD. Patients and Methods: A Descriptive analytical study was carried out from January 25, 2011 to March 20, 2012 in order to determine Psychological problems of patients with ICD. The sample was selected by A purposive (non-probability) sampling of (100) patients raising ICD during routine checking or programming the device in outpatient at Ibn Abitar Hospital. Data was collected through the use of the Depression Anxiety Stress Scales (DASS) after doing some modifications and the process of the self- administrative report for each patient as a mean of data collection. The questionnaire was constructed by the researcher to achieve the objectives of the study, which consisted of two parts; the first part is concerned with the demographic characteristics of the patients; the second part consists of three domain describe the psychological problems and contain42- item measure of depression, anxiety and stress. Results: Results of the study indicate that (80%) of the sample are male at age group (40-49) years old, (53.3%) were married, (62 %) are at Bachelor Degree, (39. %) experience with ICD since 6-12 months, (42 %) employee, (7o%) take about (1-5) discharge per last 6 months. Psychological problems (depression, anxiety, and stress) among ICD patients at high levels, and the highest one was stress at MS (3.00) and SD (0.48), and there were significant relationships between depression and gender, educational level, and since ICD implantation at p-value (0.030, 0.011, and 0.037). There were significant relationships between anxiety and age, marital status, educational level, since ICD implantation at p-value (0.008, 0.025,0 .000, 0.007). There were significant relationships between Stress and age, gender, occupations, since ICD implantation at p-value (0.001, 0.000,0 .002, 0.053). Conclusions: An Implantable Cardioverter Defibrillator patients experience high levels of psychological problems, patients worry about the devices malfunctioning, a afraid from the ICD shocks, They should be granted psychological support from health professionals who are familiar with the specific problems of ICD recipients. As well as psychological interventions is important role of nurse for those patients with ICD.