Table of content

Al-Kindy College Medical Journal

مجلة كلية الطب الكندي

ISSN: 18109543
Publisher: Baghdad University
Faculty: Al-Kindy Medicine
Language: English

This journal is Open Access


Al-Kindy College Medical Journal ((Al-Kindy Col.Med.J)), a periodic peer reviewed scientific journal published biannually by Al-Kindy College of Medicine –University of Baghdad. specialised
in research of medical and related subject ISNN 1810-9543
The articles and research studies published in the journal are carefully selected and reviewed by a high standard advisory board from doctors who are most seniors and experts in their medical fields according to the subjects submitted to the journal.
Al-Kindy Col.Med.J is well recognized by Baghdad ,Mustansiriya and Nahrain universities for promotion of their teaching staff.
Three hundred articles ,research papers, case reports and studies have been published ourn medical journal since 2003 till now and the journal has been distributed to all medical collages of Iraq and most counties in the Middle East.

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Table of content: 2006 volume:3 issue:1

The Use of Spiral Computerized Tomography in theDiagnosis of Middle –Third Facial Fractures asCompared to Plain Radiography


Background: Trauma is one of the most common
clinical problems that confront the maxillofacial
surgeon and radiologist alike. Middle third facial
fractures are diagnosed primarily on the bases of
clinical examination and plain radiographs than can
result in much preoperative speculation.
Objective: To assess the advantages of spiral
computerized tomography over conventional
radiography in the pre-surgical evaluation of middle
third facial fractures.
Methods: Thirty patients with thirty-eight facial
fractures were studied, all patients were examined
clinically, by plain radiography and then by spiral CT.
Results: Of the 38 middle-third fractures, 16
(42.1%) were zygomatic fractures, 8 (21.1%) were
LeFort fractures, 6 (15.8%) were residual deformities,
4 (10.5%) were orbital blow-out fractures and 4
(10.5%) were naso-ethmoidal injuries.
Conclusion: Improved diagnosis of fracture lines,
specific patterns of comminution in mid-face
fractures, direction of displacement of fracture
fragments and the associated soft tissue changes made
possible with spiral CT.
Keywords: Trauma, middle third facial fractures,
spiral CT.

Congenital (Infantile) HypertrophicPyloric Stenosis (IHPS)


Background: Infantile hypertrophic pyloric stenosis affects 0.5 – 3.0 per 1000 live birth and it is the most common surgical cause of vomiting in infancy.
Objective: To analyze variable peri-natal factors that may be involved in the etiology of infantile hypertrophic pyloric stenosis.
Methods: Over a two year's period, from January 2000 – December 2001, 31 cases of infantile hypertrophic pyloric stenosis were evaluated for variable peri-natal risk factors in AL-Eskan central child teaching hospital for children.
Results: The 31 cases studied were 77.4% males and 48.4% at three weeks of age. And of all cases, 51.6% were breast fed with a blood group (O) being the predominant in 54.8%.
Normal vaginal delivery was in 80.6% of cases. All infants 100% had vomiting, and 48.4% of them presented with Jaundice and only 16.1% had constipation. There were no significant correlations between age and pyloric mass size, age and presence of jaundice or between pyloric mass size and the presence of jaundice.
Conclusion: Infantile hypertrophic pyloric stenosis is a common condition affecting young infants and its etiology remains unknown, more genetic and environmental factors should be investigated in the future.
Key Words: Infantile hypertrophic pyloric stenosis, congenital pyloric stenosis, pyloric stenosis.

Oral Carriage Rate of Candida Speciesin Diabetic Patients


Background: It is well known that oral carriage
of Candida species increase in many situations, like
obesity, debility, leukemia, viral infection, use of
certain drugs in addition to diabetes mellitus.
Objective: find the relation between diabetes and
its control on oral carriage of Candida.
Methods: Thirty four hundred oral swabs from
diabetic patients 67% are females and 33% are
males, 41.7% are type 1 diabetes and 58.3% are type
2.different culture media are used.
Results: we found that 37.9% of diabetics had oral
carriage, older age group had more but the
difference is not significant statistically P>0.05, in
addition females carry more Candida than males
P<0.05, while type of diabetes had no effect on oral
carriage we found that control of diabetes had
significant effect P<0.01.
Conclusion: There is high carriage rate of
Candida species in oral cavity of diabetic patients
37.9%, the rate of carriage increase in females and
those with poor control. Candida albicans is the most
common type with all the associated factors.
Key Words: Diabetes, oral carriage, Candida


diabetes --- oral carriag --- canada

Serum Zinc Level in Patients with Heart Failure


Background: Zinc is involved in a variety of
metabolic processes and it has a well known
antioxidant activity, so the measurement of its serum
level can have a special value in several diseases.
Objectives: The study is designed to determine the
serum zinc level in heart failure patients and to
compare it with that of healthy individuals and to
study the significance of the results obtained.
Methods: Atomic absorption spectrometer
technique was used to determine serum zinc level in
fifty heart failure patients and fifty healthy individuals
who were age and sex matched.
Results: The mean serum zinc level in healthy
individuals was about 45.5% greater than that of heart
failure patients. This difference was statistically
Conclusion: The reduced serum zinc level in heart
failure patients could be an acceptable risk factor for
the development and/or deterioration of heart failure
and therefore its correction might have a positive
effect on management and prognosis of such patients.
Key words: Zinc, antioxidants, heart failure.

Per Cutaneous Ultrasonic Guided Fine NeedleAspiration in the Diagnosis and Managementof Intraabdominal Abscesses


Background: Ultrasonic guided per-cutaneous
fine needle aspiration drainage technique of intraabdominal
fluid collection and/or abscess has
become the treatment of choice for the majority of
the cases, regardless of etiology.
Objective: To evaluate the role of fine needle
aspiration drainage technique with intra-cavitory
broad spectrum antibiotic instillation as a diagnostic
and therapeutic procedure for intra-abdominal
abscesses and/or fluid collection.
Methods: From September 1999 to April 2000
thirty two patients presented with intra-abdominal
abscesses and fluid collection was treated by
ultrasonic guided per-cutaneous fine needle
aspiration drainage.
Results: Complete recovery and resolution was
achieved in (93.7%) of the cases with two failure
cases which needed another surgical intervention.
Gram etiological microorganism, and (56.3%) of
cases gave a history of previous intra-abdominal
surgical intervention before symptoms started.
Conclusion: This technique was proved to be
negative bacilli were found to be the most common
cause of intra-abdominal abscesses cases as an a
desirable approach to diagnose and treat patients
with intra-abdominal abscesses and/or fluid
Key words: Fine needle aspiration, ultrasonography,
intra-abdominal abscess

Culture of Bone Sinus Track

Authors: Ali Hafid Khudair
Pages: 35-39

Background: Sinus track represents the site of
drainage of chronic osteomyelitis, and is caused by
improper treatment of acute hematogenous
osteomyelitis ended with sequestrum formation,
trauma results in compound fracture, post operative
complications of the bone operation, and / or
tuberculous osteomyelitis. Sinus track culture of
chronic osteomyelitis is a very important & difficult
subject to deal with, because collection and
cultivation of material need patience and skillful to
reach best results
Mthods: Culture comparison of sinus track and
operative specimens was performed on 20 patients
with chronic osteomyelitis. This was conducted to
isolate the causative microorganisms of the chronic
sinuses discharge.
The investigation included a prospective study
during the period from October 1999- August 2000
in Tikrit Teaching Hospital.
The aim of the study was to culture compare
between the reliability of sinus track with bone
specimen obtained by operative method to know
actual causative agent of chronic bone infection.
Results: Eighteen patients (90%) had a single
isolated pathogen from their operative and sinus
specimens, while 2 (10%) patients have more than
one organism.
Sinus track cultures show the specificity of 100%
and predictive value of 91.6%, while sensitivity
shows 94.5%, was more dependent in the study.
Sinus track cultures were proved to be unreliable
source for the isolation of Staph. epidermidis while
it is proved to be a reliable source for isolation of
other type of bacteria caused chronic osteomyelitis.
Isolation of Staph. aureus from sinus track correlated
with the presence of Staph. aureus in the operative
Conclusion: Syringe aspiration of material is
proved to be more reliable than cotton swab.
A cotton swab can miss most of the causative
organisms especially the anaerobes and specific
bacteria as Mycobacterium tuberculosis, or it may
contain some contaminants. Mycobacterial isolation
was limited to only 2 patients in the present study.
Keywords:Chronic,osteomyelitis, sinus


Chronic --- osteomyelitis --- sinus

Cervical CytologyContinuous Nine Months Oral Danazol

Authors: Waffaa N Saieed --- Inas T Al-Hamdani
Pages: 40-43

Background: Danazol is a synthetic steroid primarily used to treat endometriosis. Its effectiveness
is due to reversible hypo-oestrogenic and hyper-androgenic state which leads to atrophy of
endometrial tissue. Its effect on cervical tissue has not yet been studied. Pap smear is a well known
method for cytomorphological evaluation of exfoliated or mechanically dislodged cervical cells. It can
detect pathologic abnormalities as well as hormonal effects. An attempt to link prolonged danazol
therapy (leading to relief of symptoms of endometriosis) to changes in cervical cytology during this
therapy and trying to find a possible relationship between them was the main goal of this study.
Objective: To study cervical cytological changes with continuous oral danazol use
Design: Prospective Study.
Setting: Al-Elwiya Maternity Teaching Hospital and Central Health Laboratory/ Baghdad, Iraq.
Methods: sixty eight cases of pelvic endometriosis with primary infertility, started oral danazol
between Jan. 2002 and Nov. 2002, in doses of 200-800mg/day. Their ages were between 20-38y.
The forty cases included in this study had the following criteria collectively:
1-Cases with primary infertility and endometriosis irrespective to their age or stage of the disease.
2-Normal cervical cytology prior to commencement of treatment.
3-Amenorrheic and symptom free, during the period of treatment.
4-Use of barrier method of contraception (condom).
5-Monthly performed high vaginal swab, revealed normal flora.
6-No biochemical evidence of impaired glucose metabolism.
According to the American Fertility Society Score (AFSS), sixteen cases had stage II, twenty cases
had stage III, and four cases had stage IV. Non had stage I. Cervical cytology was repeated after nine
months continuous oral danazol treatment.
Results: The forty cases that fit the criteria of inclusion were divided into two groups; A & B; group
B included the 12 cases requiring equal to or less than 400mg/day oral danazol, while group A
included the twenty eight cases that required more than 400mg/day danazol. After the completion of
nine months treatment, group B showed cervical cytological changes of "squamous metaplasia", while
group A showed "androgenic" picture of cervical cytology i.e. proliferation of glycogen rich
intermediate cells with vesicular nuclei.
Conclusion: Cervical cytology changes can be caused by continuous nine month oral danazol
therapy if we want to reach a symptom free state in patients with primary infertility and endometriosis.
These changes were dose related, when the dose exceeded 400mg/day, the changes were mainly
androgenic, while doses equal to or less than 400mg/day showed sqamous metaplasia. The changes
were irrespective to age and stage of the disease.
Key Words: Danazol, cervical cytology ,endometriosis.

Pattern of Congenital Heart Disease a Hospital-Based Study

Authors: Sadiq Mohammed Al-Hamash
Pages: 44-48

Background: The congenital heart disease occurs
in 0,8% of live births and they have a wide spectrum
of severity and about 30-40% of patients with
congenital heart disease are symptomatic during the
1st year of life, and these disease still one of the
frequent cause of morbidity and hospital admission
among the pediatric age group.
Objective: This study was carried out to identify
the specific types of CHD, sex and age distribution
and the most common pattern of presentation among
hospitalized patients.
Methods: This is a retrospective study of 89
patients with congenital heart disease admitted to the
fifth unit in Child Welfare Hospital in Baghdad from
January 2003 to January 2004. The diagnosis was
established by two dimensional and Doppler
echocardiography examination. The pattern of
congenital heart disease, mode of presentation, male
to female incidence, and the effect of different
lesions on the growth parameters had been studied.
Results: Out of 1023 patients, 89 patients 8.6%
had congenital heart disease. The most common
congenital heart disease were ventricular septal
defect 51.8%, Tetralogy of Fallot 17.9%, Patent
ductus arteriosus (13.5%), Transposition of great
arteries 8.9%, Pulmonary stenosis 4.4%, and Atrial
septal defect 3.4%. The most common presentation
was respiratory infection and heart failure in a
cyanotic patients and cyanosis in cyanotic groups.
Conclusion: Patent ductus arteriosus and atrial
septal defect defects were more common in female
while all other lesions had equal male to female
incidence or slightly more common in male.
Key Words: Congenital heart disease; hospital

Antibiotics Prophylaxis In Non-Perforated AppendicitisA Prospective Study

Authors: Khaleel A Al-Mefreji
Pages: 49-51

Background: The haphazard use of antibiotics in some centers is increasing and causing more harmful complications than its benefit.
Objective: To study the role of antibiotics prophylaxis in low-risk non-perforated acute appendicitis.
Methods: This study was done at Al-Kindy Teaching hospital in the period between Jan. 1999-Feb. 2000. 100 cases of acute appendicitis selected prospectively to be involved in a study including the use of prophylactic antibiotic therapy versus none. Criteria for selection were; age range between 13-30 years, no additional preoperative risk factors (diabetic, pregnant ladies, patients on steroid or anti-cancer therapy were all excluded), proper aseptic operative technique performed. Patients were divided into two groups, group A (n =53) were given antibiotic prophylaxis per-operatively (1gm of cefizox I.V), while group B (n = 47) were given no antibiotics.

Intraperitoneal cultures were taken prior to antibiotic therapy. All excised appendices were sent for histopathological examination. Follow up was up to 4 weeks.
Results: The study showed no statistically demonstrable difference among patients in group A (antibiotic group) and group B (control) regarding duration of hospital stay, incidence of wound infection, incidence of delayed postoperative complications.
Conclusions: Antibiotic prophylaxis can be safely omitted in low-risk patients with non-perforated acute appendicitis, careful aseptic technique is mandatory. Cultures of peritoneal cavity are not necessary, saving efforts and financial resources.
Key words: Acute appendicitis, non-perforated appendicitis, antibiotic prophylaxis

Evaluation of Staging of Carcinoma of Breast as anIndicator for Presentation of Patients

Authors: Mahdi Jasim Moosa --- Najeeb Sleiwah Jabbo
Pages: 52-55

Background: The type of treatment of carcinoma
of the breast depends on its stage at presentation. Its
early detection is important.
Objective: Analysis of treated patients for
carcinoma of breast in regards to their stages,
considering it as an indicator for patient's presentation
and discusses the results in this collection.
Methods: A review study of cases treated surgically
for the last 10 years by the authors. Their stages were
recorded in addition to their age, gender and type of
Results: A collection of 110 patients was studied.
Those in the 5th decade were affected more. Females
were 107 and males were only 3. The right breast was
affected more than the left one. Infiltrative ductal
carcinoma was the commonest type of pathology
followed by the lobular carcinoma. Stage 2 was the
commonest stage at time of diagnosis and treatment.
Conclusion: In our collection, more than half of
our patients present during stage 2. This is a late
presentation. Earlier detection is necessary. An
important Program for early detection directed by the
authorities, using the periodic physical examination
and self breast examination and considering the start
of mammography screening program for those with
age range of (40-60). Programs for educating women
in regards to the risk factors and other information
about this disease through the internet should be
Keywords: Breast carcinoma, stage, presentation.

Diagnostic Value of Cytology and Colposcopy in Patients withAbnormal Cervical Pap Smears


Background: An optimal cancer detection system
for preclinical cervical lesions should combine a
cytological examination with a colposcopic follow-up
examination. Detection at early pre-invasive stage
provides an opportunity for treatment to prevent
progression to invasive cancer.
Objective: The present study aimed at evaluation
of cytology, colposcopy, and combined cytology and
colposcopy in predicting histopathological diagnosis
of cervical intraepithelial neoplasia/squamous
intraepithelial lesion (CIN/SIL) or other neoplastic
changes in patients with abnormal cervical
cytological findings.
Methods: This prospective study was conducted in
the Cyto-colposcopy Unit of Teaching Laboratories
and Outpatient Department of Medical City Teaching
Hospital over a period of one year (Sep. 2001- Sep.
2002). Eighty-one married females were included in
the study. A cervical smear was taken followed by a
colposcopic examination of the cervix and then a
punch biopsy was taken from the suspected lesions
for histopathological study. Estimation and evaluation
of the validity parameters of cytology, colposcopy,
and combined cytology and colposcopy were
performed using different cutoff points by special
statistical analysis.
Results: Sensitivity, specificity and accuracy of
cytology in the diagnosis of CIN/SIL were 73%,
93.2% and 84.0% respectively.
The False–negative rate was 27%. Sensitivity,
specificity and accuracy of colposcopy in the
diagnosis of CIN were 83.3%, 58.5% and 70.1%
respectively choosing doubtful findings as a cut-off
point. The combination of cytology and colposcopy
gave the following results: sensitivity, specificity and
accuracy were 94.6%, 61.4% and 76.5% respectively;
the negative predictive value (NPV) was 93.1%.
When suspicious colposcopic findings were chosen as
the cut-off point, the specificity and the positive
predictive value (PPV) were higher at the expense of
sensitivity and NPV
Conclusion: The conventional Pap smear, a
valuable tool in the evaluation of patients with
abnormal cervical cytology, was found to be of
relatively low sensitivity in predicting CIN/SIL.
Colposcopy is a valuable tool too. However, the
validity parameters showed variable figures
depending on the different cut-off points applied for
the diagnosis of CIN/SIL. The ideal cut-off point was
when doubtful and higher-grade colposcopic lesions
are considered positive. The combination of cytology
and colposcopy resulted in an increased sensitivity
and NPV. The specificity could be further increased
or improved when the threshold was set to distinguish
higher-grade lesions (suspicious lesions) from lesser
Key words: Colposcopy, Abnormal Pap smears,

Recurrence after SurgeryIn Lumbar Disc Protrusions

Authors: Abdullah Y Al-Mihyawi
Pages: 67-74

Background: Persistent symptoms after operation
for lumbar disc protrusions may be due to: (1) disc
prolapse at another level; (2) residual disc material in
the spinal canal; (3) nerve root pressure by a
hypertrophic facet joint or a narrow lateral recess
(‘root canal stenosis’). After careful investigation, any
of these may call for re-operation; but second
procedures don’t have a high success rate.
Objective: This study is designed to verify the
possible causes of recurrence after surgery for lumbar
disc prolapse and their appropriate treatment
regarding re-exploration.
Methods: A follow-up and result of treatment in
100 cases operated upon for lumbar disc prolapse is
presented. Clinical & radiological assessments
including myelography and magnetic resonance
imaging were done post-operatively in persistent
symptoms including backache or sciatica.
Results: In this series, twelve patients required reexploration,
9 patients had only one re-exploration
and 3 patients had two explorations each. One patient
had one re-exploration was subjected to sacro-iliac
fusion, which improved his symptoms.
Conclusion: In the majority of patients the causes
of persistence of symptoms are beyond the control of
the surgeon. Removal of disc prolapse is effective in
most instances in relieving the pain in lower extremity
but a large number of patients continue to suffer from
further backache and a few from further leg pain of
varying intensity. Re-exploration carries a bad
prognosis but if a disc prolapse is found at reexploration
then the result is much more favorable
Keywords: Sciatica, recurrent lumbar disc, reexploration.

Essential Hypertension in a 17 Years Old Girl: APossible Correlate withLow Birth Weight and Growth Parameters

Pages: 75-77

We enclose a case of essential hypertension in a 17
years old girl presented for the first time with
hypertensive encephalopathy. Various hematological,
biochemicals, hormonal and imaging studies failed to
explore underlying etiology. A possible correlate of
low birth weight and growth parameters with early
onset of essential hypertension was postulated.
Keywords: Hypertension, birth weight, growth


hypertention --- birth weight --- growth

Table of content: volume:3 issue:1