Table of content

Iraqi Academic Scientific Journal

المجلة العراقية للاختصاصات الطبية

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

This journal is Open Access

About

publisher Every Three Months 2000

Loading...
Contact info

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

Table of content: 2019 volume:18 issue:3

Article
Surgically Treated Isolated Posterior Wall Fractures of Acetabulum: A Short Term Outcome Study

Loading...
Loading...
Abstract

BACKGROUND: Isolated posterior wall fractures are common injuries of the acetabulum, anatomical reduction and stable fixation are the goals of operative treatment when indicated, outcomes of surgical treatment depend on many patient`s and fracture`s factors. OBJECTIVE: To evaluate the functional and radiological outcomes of surgically treated isolated posterior wall fractures of acetabulum and the effect of patient`s and fracture`s variables on the outcomes in a short term follow up. MATERIALS AND METHODS: Prospective study on twenty patient who met the inclusion criteria treated surgically for isolated posterior wall fractures of acetabulum at Baghdad Medical City Directorate from July 2014 to December 2016 with at least one year follow up. All patients were evaluated clinically with Modified Merle d`Aubigne score and Harris hip score, and radiologically with Matta`s radiological outcome grading. The effect of gender, BMI, associated dislocation, timing of reduction of dislocation, timing of surgery, and quality of reduction on the outcomes were evaluated. RESULTS: The mean final Modified Merle d`Aubigne score was 15.65 (range, 8 to 18) with excellent and good results in 16 patient (80%), fair and poor results in 4 patients (20%). The mean final Harris hip score was 89.2 (range, 65 to 100), with excellent and good results in 16 patient (80%), fair and poor results in 4 patients (20%).The final radiological outcome results were excellent and good in 17 patient (85%), fair and poor in 3 patients (15%). The functional and radiological outcomes were significantly affected by the quality of fracture reduction ( p=<0.0001, p=0.0009) respectively. In addition, the functional outcome was significantly affected by the presence of dislocation (p=0.019), delay in reduction of dislocation (p=0.0026), and delay in surgery more than 2 weeks (p=<0.0001). However, gender, and BMI did not show clear effects on the functional outcome ( p=0.938, p=0.172) respectively. CONCLUSION: Satisfactory outcomes can be obtained with open reduction and internal fixation of isolated posterior wall fractures of acetabulum in short term follow up. Anatomical reduction strictly correlated to both functional and radiological outcomes with favorable results. Early reduction of hip dislocation within 12 hours and early surgery within two weeks had favorable functional outcome while the presence of hip dislocation adversely affects the functional outcome. However differences in gender and body mass index did not clearly affected the functional outcome.


Article
Value of Apparent Diffusion Coefficient (ADC) in the Assessment of Renal Insufficiency in Diabetic Patients

Loading...
Loading...
Abstract

BACKGROUND: diabetic nephropathy is being recognized as a worldwide public problem with high cost and poor outcomes, there is increase in the incidence and prevalence of renal failure all over the world. Functional renal imaging methods such as diffusion- weighted magnetic resonance imaging (DWMRI), has been shown to be a promising technique in the evaluation of renal function OBJECTIVE: To study the value of apparent diffusion coefficient (ADC) in the detection and evaluation of diabetic nephropathy, correlating these values with the clinical stage of diabetic nephropathy and to compare these findings with diabetic patient without nephropathy. PAT IENTS AND METHODS: A cross sectional analytic study was conducted in MRI unit of Radiology department at Al-Imamein Al-Kadhimyain medical city through period form 1st oct.2017 to 30 of July 2018, 80 diabetic patients were classified according to GFR into two groups; group I 40 patients (diabetic patient with no nephropathy) group II 40 patients (diabetic patients with nephropathy). DWI ( b value ,0 and 1000 s/mm2) was performed in two group of the study . The mean ADC value of renal cortex was calculated from three regions positioned in the upper, mid and lower third of the kidney. The Relationship between ADC value and stage of diabetic nephropathy were assessed. RESULTS: In comparing diabetic patients (with no nephropathy) with patient with diabetic nephropathy, there was significant decline in mean ADC value among patients with advanced stages of diabetic nephropathy(p< 0.001). The mean ADC value with diabetic nephropathy was significantly lower among patients with type I DM (P<0.001). CONCLUSION: The magnetic resonance imaging-apparent diffusion coefficient value is an appropriate method for assessment and evaluation of diabetic nephropathy and is a reliable diagnostic tool for


Article
Assessment of Exclusive Breastfeeding Effect against Urinary Tract Infection in Infancy

Authors: Zainab Saad Ali, Yousif AbdulRaheem
Pages: 204-210
Loading...
Loading...
Abstract

BACKGROUND: Urinary tract infection is the third most common pediatric bacterial infection in developing countries. Exclusive breastfeeding as World Health Organization recommendations in infants provides the simplest method that provides protection against infant’s infections including UTI. OBJECTIVE: To assess the possible protective effect of exclusive breastfeeding on infant UTI. PATIENTS AND METHODS: A case control study was carried out in Children Welfare Teaching Hospital from March to September 2018. The study group included 300 infants (100 cases and 200 controls). Cases were selected from Pediatric Nephrology Department when clinically suspected as UTI. Controls were selected from the patients of other diseases in the hospital. Both cases and controls were divided according to the type of feeding during first 6 months of life into three groups: Exclusive breastfeeding, bottle feeding and mixed feeding. RESULTS: Infants exclusively breastfed for 6 months, shown to have a lower risk of UTI 12% than partially breastfed 68% or bottle fed peers 20%. This protective effect after fixation of other variables (P value=0.0001). The study also showed that lack of circumcision in male infants, having a previous history of UTI and use of antibiotics inappropriately were significant risk factors for UTI in infants. CONCLUSION: This study showed a protective role of breastfeeding on UTI in infancy. Other risk factors for the UTI were uncircumcised male infants, positive history of UTI and improper use of antibiotics.


Article
Permanent Pacemaker Implantation in Ibn - Al Nafees Hospital; Indications and Early Complications

Loading...
Loading...
Abstract

BACKGROUND: A pacemakers is a small device that is placed in the chest to help control abnormal heart rhythms and prevent bradycardia. OBJECTIVE: To evaluate the practice of permanent pacemaker implantation including indications and early complications. PAT IENTS AND METHODS: This is a retrospective study in 90 patients over 2.5 years (from June 2013 to January 2016). The case sheets of patients were studied carefully including history, clinical examination, ECG findings, echocardiographic Study and cardiac catheterization. In addition, the reports of the first follow up visit around two weeks after implantation were studied. RESULTS: The females (61.2%) more than males, syncope (44.4%) and dizziness (33.3%) were the most common presentations, most of patients (87 patients) represented in class I indication for pacemaker implantation, CHB (72.2%) was the most common ECG finding, the most common causes of heart block were unspecified (55%) and post MI (27.7%), the most common pacing mode was VVI mode (43.3%). The complications of pacemaker implantation were 11.1% and the infections represent 3.1%, In older age group and in diabetic patients the infection incidence increased. The indication of temporary pacemaker prior to permanent pacemaker implantation was (22.2%), and post-acute MI and hemodynamically unstable patients were the most common causes (8 patients) and (7 patients) respectively . CONCLUSION: implantation of permanent pacemaker is a save and could be life saving in significant bradycardia, and complete heart block was the most common cause of pacemaker implantation


Article
Clinicopathological Consistency in the Diagnosis of Skin Disorders in Patients Attending Dermatology Centre Medical City Teaching Hospital

Loading...
Loading...
Abstract

BACKGROUND: Skin biopsy is often considered as confirmatory in case of diagnostic dilemma and is the most common investigation sought by a dermatologist. Hence, a high diagnostic accuracy of this investigation is pursued. OBJECTIVE: The study was planned to determine the consistency between the provisional clinical diagnosis of skin diseases and the final diagnosis after clinicopathological correlation. MATERIALS AND METHODS: The study was carried out from the 1st of April 2017 to the 1st of April 2018 at dermatology center Medical City Teaching Hospital. During this period, a total of 440 biopsies were performed, and 110 biopsies were reviewed at the clinicopatholgical meeting every Sunday. Interesting and difficult cases were presented at the meeting and discussed to reach a final diagnosis. A comparison was made between the provisional clinical diagnosis and the final diagnosis, and between the histopathological report and the final diagnosis. RESULTS: This study included 110 patients; of them, 65 patients were males (60%) and 45 patients (40%) were females with the mean of age was 41.6±18.6 yrs. The most frequent conditions were tumors in 51 cases (46.36 %), pupulosquamous diseases 20 cases (18.18 %), infections 11 cases (10 %), connective tissue diseases 7 cases(6.36 %), vescicobullous 7 cases (6.36 %), & miscellaneous diseases 14 cases (12.72 %). Concerning tumors, 35 cases (68.63%) were malignant, and 16 cases (31.37%) were benign. Of these tumours the most frequent tumour was mycosis fungoides; 9 cases (17.6%), followed by squamous cell carcinoma; 5 cases (9.8%). Regarding the consistency between provisional clinical diagnosis and the final diagnosis, the current study showed that 21 cases (19%) were consistent, 60 cases (55%) were corroborative, and 29 (26%) of the cases were inconsistent. This study showed that there was a consistency between provisional clinical diagnoses and histopathological report in 19 biopsies (17%), 75 biopsies (68%) were corroborative, and 16 biopsies (15%) were inconsistent.Concerning the consistency between histopathological report and final diagnosis, 68 biopsies (62%) were consistent, while 42 biopsies (38 %) were inconsistent. CONCLUSION: Clinicopathological


Article
One Year Follow Up of Newborn Babies with Undescended Testes

Loading...
Loading...
Abstract

BACKGROUND: Cryptorchidism is one of the most common congenital urological disease. The prevalence of cryptorchidism at birth varies from 2 to 5% and the testis mostly descend during the first 6 months of life. In large clinical series, the majority, 75-80% of undescended testes are palpable and 60-70% are unilateral involvement of the right side is more common. The recommended age of orchiopexy progressivley descreased from 10-15 years in the 1950 until the last decade, orchiopexy is recommended between 6-12 months. OBJECTIVE: The aim of this study was to determine the most of favorable age at which orchipexy should be performed PATIENTS AND METHODS: Fifty 50 newborn boys babys with undescended testes was followed up through two years from February 2015 to February 2017 in a private clinic in Baghdad. Follow up done every 3 months included examination of the inguinal and scrotal area to palpate the position of the testis, and history taken for the family history of undescended testis. RESULTS: Forty one (82%) babies with unilateral undescended testis, follow up of 1 year, 36.6% of babies, the testes were descended down to its normal position, and only one case (2.4%) had incomplete descent. Those with bilateral undescended testes (9 babies; 18%), only 11.1% of them had complete descent to normal position. CONCLUSION: Boys with retractile testes do not need medical or surgical treatment but require close follow up. Spontaneous descent of testes from inguinal to suprascrotal or scrotal position are observed in majority of infant boys during first year of life.

Keywords

Cryptochidism --- orchiopexy


Article
Acute Kidney Injury in Patients with Acute Stroke

Loading...
Loading...
Abstract

BACKGROUND: According to world health organization, about 15 million people suffer from stroke worldwide each year. Acute kidney injury complicates 5-7% of acute care hospital admissions and up to 30% of critical care patients. These in turn lead to increase disability, decreased quality of life and disproportionate burden on healthcare resources. Patients admitted for diagnosis and treatment of acute stroke are at high risk of developing acute kidney injury due to comorbid conditions, poor oral intake and exposure to nephrotoxic agents. OBJECTIVE: to determine the incidence of acute kidney injury in patients admitted with acute stroke and evaluates associated comorbidities and possible risk factors. PATIENTS AND METHODS: in a cross-sectional study, a cohort of 436 patients admitted with acute stroke, (327 with ischemic stroke and 109 with intracerebral hemorrhage) entailed in this study. Serum creatinine readings using Jaffe method was obtained at first day of insult, after 48 hours and 7 days after onset of stroke, KDIGO criteria was used to define patients who developed acute kidney injury which include elevation of serum creatinine of 0.3 mgdl or more within 48 hours or 1.5 fold or more increment of baseline serum creatinine within 7 days. RESULTS: Acute kidney injury was a common complication in acute stroke population with total incidence 13.5%, with significantly higher incidence in intracerebral hemorrhage group (22.9%) than in ischemic group (10.4%) p=0.000919. The study also show significant sex difference with higher incidence in males than females in ischemic group (13.4% vs 6.7%; p= 0.049) intracerebral hemorrhage group (31.5% vs 12.3%; p=0.0246). Study also shows significant relation between developing acute kidney injury and history of hypertension in both groups with p=0.00229, and significant relation with diabetes mellitus p=0.009096. Study shows that there is significant elevation of serum creatinine on consecutive measures between first day and day 7 with p=0.000. We found that there is significant direct relation between increasing age and incidence of acute kidney injury with p=0.040 in ischemic group and p= 0.015 in intracerebral hemorrhage group. CONCLUSION: The incidence of acute kidney injury in acute stroke patients was 13.5% with significantly higher incidence in intracerebral hemorrhage group with significant relation between development of acute kidney injury and being male, has hypertension, diabetes mellitus or advance age.


Article
Survey of Pap Smear in Women with Systemic Lupus Erythematosus

Loading...
Loading...
Abstract

BACKGROUND: Systemic lupus erythematosus (SLE) is a chronic multisystem autoimmune disorder affecting mainly young women during childbearing years. OBJECTIVE: To assess the prevalence of cervical dysplasia in a group of Iraqi women with SLE and study the relationship between results of Pap smear and HPV DNA test with disease activity, disease duration and use of immunosuppressant drugs. PATIENTS AND METHODS: A case controlled study was conducted on 55 women with SLE and 55 healthy controls. Full history was taken and complete physical examination including extensive gynecological evaluation was done for both groups. High vaginal swab and culture, Pap smears and HPV PCR test were done to them. RESULTS: Patients with SLE were more likely to have cervical dysplasia than control (P=0.022) with 2.1 folds increased risk. HPV infection was found to have no statistically significant difference between both studied groups (P>0.15). The C1N1 changes were significantly associated with high SLEDAI scores (P=0.030) and longer disease duration (P= 0.027). There was no significant correlation neither with the dose nor with the duration of use of immunosuppressant medications and Pap smear findings (P> 0.05). CONCLUSION: The prevalence of cervical dysplasia was higher in SLE patients than controls. Patients with SLE were more likely to have abnormal Pap smear findings which significantly and directly associated with disease duration and disease activity than controls.


Article
Effect of Magnesium Sulfate on Hemodynamic Response to CO2 Pneumoperitoneum in Patients Undergoing Laparoscopic Cholecystectomy

Loading...
Loading...
Abstract

BACKGROUND: Pneumoperitoneum with CO2 insufflation is used during laparoscopic cholecystectomy to facilitate surgical access as it is a minimally invasive procedure, and despite its benefits when compared to the open cholecystectomy, it is known that pneumoperitoneum has some adverse physiological effects including an abrupt increase in the arterial blood pressure and an increase in the heart rate due to increased catecholamines release. OBJECTIVE: To investigate the effect of magnesium sulfate on attenuating the hemodynamic response to carbon dioxide pneumoperitoneum in patients undergoing laparoscopic cholecystectomy. PATIENTS AND METHODS: This double blind prospective study was conducted in Rizgari Teaching Hospital in Erbil/Iraq on 60 patients whose ages ranges between (20-45) years to assess the effectiveness of magnesium sulfate in attenuating the hemodynamic response to cholecystectomy, after dividing the patients into two groups: group I (magnesium group) and group II control group. RESULTS: The increase in systolic blood pressure, diastolic blood pressure, mean arterial blood pressure and heart rate readings were less in group I (Magnesium group) when compared to group II (control group) with a statistically significant difference (p < 0.05). CONCLUSION: It can be concluded that magnesium sulfate attenuates the hemodynamic response to pneumoperitoneum in laparoscopic cholecystectomy. KEYWORDS: Magnesium sulfate, Laparoscopic cholecystectomy,


Article
Treatment of Plane Warts by Topical Trichloroacetic Acid with Two Concentration (35% & 70% ); A Comparative Therapeutic Study

Loading...
Loading...
Abstract

BACKGROUND: Plane warts represents a common dermatological problem and self-limiting viral infection of the skin caused by human papilloma viruses type (3,10,28,29) with no uniformly effective treatment modality. OBJECTIVE: To evaluate and compare the effectiveness and side effect of topical trichloroacetic acid solution in two concentration (35% & 70%) for treatment of plane warts. PATIENTS AND METHODS This is a comparative interventional therapeutic study conducted at the dermatology center of Baghdad Teaching Hospital / Medical City . Sixty consecutive patients with plane warts were randomly assigned into two groups of thirty patients each; group A received topical trichloroacetic acid 35% (9 patients defaulted for unknown reasons) and group B received topical trichloroacetic acid 70% (8 patients defaulted for unknown reasons) once weekly application by doctor at hospital with wood stick once weekly until complete responce of the lesions or for at least four weeks. Patients with complete response follow up monthly for 3 months for detecting recurrence. RESULTS: In group (A) 9 (42.85 %) patients from showed complete response, with 9 (42.85 %) patients showed partial response; the remaining 3 (14.28%) patients showed no response (p value ˂ 0.05) with complete response (7 from 9) need 4-8 weeks of treatment, while in group (B) 13 (59.09 %) patients showed complete response, with 8 (36.36 %) patients showed partial response; the remaining one (4.54 %) patients showed no response, (p value < 0.05) with complete response (8 from 13) need two to four weeks of treatment i.e TCA 70% faster response. Most of patient suffer from burning sensation & itching as a side effects and few patients with erythema & dyspigmentaion. There are 2 (9.52%) recurrent cases from group 35% with 1 (4.54%) recurrent case in group 70% . CONCLUSION: both concentrations

Keywords

plane wart --- TCA


Article
Primary Health Care Physicians' Knowledge and Attitude towards Elderly in Baghdad/Al-Karkh-2018

Loading...
Loading...
Abstract

BACKGROUND: It is important for primary health care (PHC) physicians to possess adequate knowledge and attitude towards geriatrics to cope with the increasing number of elderly patients care during their daily practice. OBJECTIVE: To assess the knowledge and attitude of PHC physicians towards elderly and to study the relation between some factors with physicians’ knowledge and attitude. PATIENTS AND METHODS: A cross sectional study was conducted in 31 PHC centers in Baghdad/Al-Karkh for a period of 3 months from 1st of March to the end of May 2018. A self-administered questionnaire was used for data collection which covered some physicians' characteristics. RESULTS: Out of 225 PHC physicians working at the chosen PHC centers, 200 physicians enrolled in the study, with a response rate of 88.88%. The results showed that only 27.5% of physicians had good knowledge levels and 117 (58.5%) had positive attitude. Better levels of knowledge and attitude were achieved by family physicians, females in addition to those who work for less than 5 years in PHC centers. CONCLUSION: Despite positive attitude of physicians towards elderly, better training and continuing medical education are important to improve the knowledge of physicians to ensure better services.

Keywords

Knowledge --- Attitude --- Aging --- PHC physicians


Article
Uncommon Presentation of a Rare Cases- Incidental Finding in a Tonsillectomy Specimen in Mosul City: Histopathological Study

Loading...
Loading...
Abstract

BACKGROUND: Histopathological examination in a patient who did tonsillectomy due to various indications reveals some of a rare but important incidental pathological finding as choriostomatic tissue (cartilage and fat) and an unusual bacterial colonization (actinomycosis) in tonsillar specimen. OBJECTIVE: The aim of this study is to represent of an unusual finding of choriostomatic tissue in resected tonsils, and to evaluate the incidence of Actinomyces colonization with disclose their relation to tonsillar diseases. PATIENTS AND METHODS: A case series study design is adopted. The sample of the present study included 100 patients who have done tonsillectomy are carried out in the ENT Department of Al-jamhori Teaching Hospital in Mosul city during the period from February 2018 to February 2019. RESULTS: In the current study, the most frequent indication for tonsillеctomy is recurrent tonsilitis. Also shows that there is highly significant relation between incidence of actinomycosis with chronic, recurrent tonsillitis and hypertrophied tonsils (p=0.000, 0.000, 0.003) respectively, there was a statistically insignificant relationship between the presence of actinomycosis and age furthermore there is predominance of actinomycosis in tonsillar obstructive hypertrophy 4 (18.2%), moreover their occurrence in adult patient is more common than in children. The mesenchyme cartilage is seen only in two adult cases (male 2.3%, female, 2.9%) has recurrent and chronic tonsillitis, respectively. CONCLUSION: A histopathological analysis of the tonsillar specimen aids in the diagnosis of actinomycosis organisms which are difficult defined in culture. Although choristoma in tonsillectomy specimen is uncommon entity. However, any patient with recurrent or chronic tonsillitis, suspicion for this condition should be considered.

Table of content: volume:18 issue:3