Table of content

Zanco Journal of Medical Sciences

مجلة زانكو للعلوم الطبية

ISSN: 19955588/19955596
Publisher: Hawler Medical Univeristy
Faculty:
Language: English

This journal is Open Access

About

Zanco Journal of Medical Sciences (Zanco J Med Sci) is the scientific journal of Hawler Medical University. Zanco J Med Sci is a peer-reviewed, open access journal. Zanco J Med Sci aims to publish peer-reviewed and original scientific research of Iraqi, regional and international interest. Submissions of manuscripts in the clinical and basic medical sciences come within the scope of its publication. Original articles, review articles, case reports, brief communications, insights, and letters to the editor are all considered.

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Email: zanco.journal@hmu.edu.krd

Table of content: 2013 volume:17 issue:3

Article
The effect of two finishing and polishing systems on the surface roughness of two composite resins
تأثير نظامي التشطيب والتلميع على خشونة السطح لريتين من الراتنجات المركبة

Authors: Razawa K. Saeed --- Intesar S. Toma --- Media A. Saeed
Pages: 484-489
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Background and objective: The purpose of this study was to evaluate the effect of two finishing and polishing systems on the surface roughness of two different types of composite resins. Methods: Fourty samples of 6 mm in diameter and 2 mm in depth were prepared, 2 types of composite resins were used (nanocomposite and hybrid composite resin). Twenty samples of each type of material were prepared and divided into two main groups and then each main group subdivided randomly into two subgroups of 10 samples each. Ten samples of each material were submitted to finishing by finishing disc. While the other 10 samples of each material were submitted to finishing by finishing bur. Both finishing systems were used with a slow-speed hand piece in a dry field and with a light intermittent pressure for about 15 seconds for each disc and bur. After storage of the samples for 48 hours; the analysis of the surface roughness was carried out, three readings were made on each surface using a stylus tip, and the extension of each reading was 2 mm stroke. Results: There was non significant difference between the groups except there was a significant difference between the two finishing systems when used with hybrid composite. Conclusion: Finishing discs gave best results on nano composite and hybrid composite when compared with finishing diamond bur, with highly significant effect on nano composite.


Article
The influence of tobacco smoking on the enzyme activity of serum gamma glutamyl transferase (GGT)
تأثير تدخين التبغ على نشاط إنزيم gamma glutamyl transferase

Authors: Salim Khalid Mohammad
Pages: 490-494
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Background and objective: The gamma glutamyl transferase GGT is a cell-surface protein contributing to the extracellular catabolism of glutathione. The enzyme is produced in many tissues, but most GGT in serum is derived from the liver so that it is currently the most sensitive enzymatic indicator of liver disease. To evaluate the effect of smoking on liver diseases through assessing the enzyme activity of serum GGT. Methods: A cross-sectional study was carried out from January to June 2012 by clinical analysis department in College of Pharmacy at Hawler Medical University on (30) individuals of smokers, and (30) non-smokers. Serum GGT activity was measured using enzymatic colorimetric method. Results: The mean value of serum GGT activity was significantly higher in smokers (20.89 ± 6.79 IU/L) (Mean ± SD) than that of non-smokers (14.51 ± 6.46 IU/L) (Mean ± SD) (p<0.01). Conclusion: Significant increased activity of GGT in smokers seems to support the harmful effects of cigarette smoking.


Article
A comparison of in-Hospital complications with ST segment elevation resolution after thrombolytic therapy in acute myocardial infarction
مقارنة بين المضاعفات داخل المستشفى ودقة ارتفاع شريحة ST بعد العلاج الخثاري في احتشاء عضلة القلب الحاد

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Background and objective: The primary goal of thrombolytic therapy in ST-segment elevation myocardial infarction is to restore the complete coronary reperfusion. The aim of the study was to assess the association of in- Hospital complications with ST-segment resolution after thrombolytic therapy in acute myocardial infarction. Methods: The ECG s of 100 patients with first ST-segment elevation myocardial infarction were recorded on admission, 90 and 180 minutes after Alteplase at Hawler Teaching Hospital (Coronary Care Unit) from January 2011 to October 2011. The mean age (±SD)was 59.8±8.4years,ranging from 37-80 years, 63% were males and 37% were females, male to female ratio equal 1.7:1. Patients were divided into three groups: Group (A): complete resolution of ST segment, group (B) : partial resolution and group (C) no resolution of ST-segment, those patients were followed for the detection of in-Hospital complications. Results: Heart failure cardiogenic shock,left ventricular systolic dysfunction and ischemic mitral regurgitation were higher in group (B) and (C) than (A) when ECGs were recorded at 90 and 180 minutes after thrombolysis (P < 0.001). Conclusion: Failure or partial resolution of ST segment can predict the early development of heart failure, shock, left ventricular systolic dysfunction and ischemic mitral regurgitation.


Article
Assessment of three methods of curetting orientation for women with excessive uterine bleeding
تقييم ثلاث طرق لcuretting orientation للنساء مع نزيف الرحم المفرط

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Background and objective: Dilation and curettage (D&C) is commonly performed for the diagnosis of gynecological conditions leading to excessive uterine bleeding. The aim of this study was to evaluate different methods of curetting orientation to optimise the diagnosis of common pathological lesions associated with excessive uterine bleeding. Methods: Data and cases retrieved from women presented with excessive uterine bleeding and underwent D&C, at a private histopathology laboratory in Erbil city, Kurdistan region, from December 2010 to January 2012. Three methods of curetting orientation were carried out on 275 patients. Light microscopical study was done to asses the cause of excessive uterine bleeding. Results: A total of 274 out of 275 cases were found to have optimal tissue processing, embedding and histological examination. When the tissue specimens attached to filter paper and gauze, two out of 275 cases were found to have endometrial adenocarcinoma. Moreover, out of 275 cases, 198 were found to have dysfunctional uterine bleeding (hormonal imbalance) and 25 cases were found to have endometrial hyperplasia. Conclusion: Optimal tissue processing, embedding and histological orientation can be attained by using filter paper and/or gauze. Dilation and curettage is an adequate diagnostic tool for endometrial hyperplasia and carcinoma.


Article
A double blind comparative study of the effect of nimesulide and naproxen on postoperative pain and swelling following periradicular surgery
دراسة مقارنة عمياء مزدوجة لتأثير نيميسوليد ونابروكسين على آلام ما بعد الجراحة وتورم بعد جراحة محيطة بالجذر

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Background and objective: Pain and swelling are common postoperative complications that occur after periradicular surgery. A double blind comparative study was, therefore, designed to evaluate the effect of nimesulide and naproxen on the postoperative pain and swelling following periradicular surgery on one of the upper anterior teeth. Methods: Sixty patients with a periapical lesion that required periradicular surgery were included in the study. They were divided into three groups according to the type of the postoperative analgesia they are going to administered. Group I: Nimesulide administered group. Group II: Naproxen administered group. Group III: Placebo administered group. Patients of each group were informed about the nature of the study and given the same shape of capsules. They are asked to assess their postoperative pain and swelling for 5 days by using the visual analogue scale (VAS). Results: The results showed that both nimesulide and naproxen are effective in reducing the postoperative pain and swelling following periradicular surgery, and the nimesulide is found better than naproxen in this regard. Conclusion: In this study both nimesulide and naproxen were significantly more effective than their corresponding placebo for reducing postoperative pain and swelling following periradicular surgery, but nimesulide administered group expressed significantly little pain in comparison to naproxen administered group, and the nimesulide administered group showed lesser swelling in the 2nd and 3rd postoperative day than those administered with naproxen.


Article
Dual effects of aspirin and Garcinia Cambogia on human blood viscosity
الآثار المزدوجة للأسبرين وغارسينيا كامبوغيا على لزوجة دم الإنسان

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Background and objective: Prevention of bacterial adhesion is an attractive target for the development of new therapies in the prevention of bacterial infection. The aim of this study is to investigate the effects of pomegranate peel extract, vitamin C, combination of pomegranate peel extract and vitamin C & gemifloxacin on adhesion of E.coli to uroepithelial cells. Methods: This study was conducted in the Department of Pharmacology, college of Medicine, AL-Mustansirya University in 2009. Twenty patients with peripheral vascular diseases enrolled in this study. Those patients randomly allocated equally into two groups; group (A) received aspirin oral tablets 300 mg/day and group (B) received aspirin oral tablets 300 mg/day plus Garcinia cambogia oral tablets 500mg/day. The duration of therapy was two weeks. In this study, measurements were done for total blood viscosity, packed cell volume, serum fibrinogen, and serum cholesterol, before treatment as control and after one and two weeks of treatment. Results: After 2 weeks treatment with aspirin there was significant reduction in plasma fibrinogen (p < 0.05). Combined aspirin and Garcinia Cambogica treatment for 2 weeks produce significant reduction in all blood viscosity parameters (p<0.05) except the packed cell volume which was not affected (p >0.05). Conclusion: Aspirin and Garcinia cambogia produced significant and better effects than aspirin alone on blood viscosity.


Article
Management of fingertip injury in Erbil, an evaluation study
معالجة إصابة الإصبع في أربيل ، دراسة تقييمية

Authors: Rasul Hamed Awla --- Jalal Hamasalih Fattah
Pages: 518-525
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Background and objective: Fingertip injuries are common. Out of the various available reconstructive options, one needs to select an option which achieves a painless fingertip with durable and sensate skin cover. The objective of this study was to find out the characteristics of patients, and to describe the methods of management and the proportions of complications. Methods: A prospective study of 130 cases of fingertip injuries of patients managed from March 2009 to March 2011. The data were collected through using a questionnaire. Standardized photographs and radiographs were taken. Various reconstructive options were considered for the fingertip injuries .Statistical package for social sciences (SPSS version 17) was used for data entry and analysis. Results: Crush injury (76 cases) was found to be the commonest mechanism of fingertip injury. Various reconstructive options were considered based on the preoperative evaluation. Ninety percent of reconstructions healed uneventfully. Few minor complications occurred which responded to conservative management. Conclusion: A proper evaluation of fingertip defects is necessary to choose the best possible reconstructive option to achieve best result.


Article
Digital rectal examination and urethral catheterization by medical students: comparative study
فحص الاصبعي للمستقيم وقسطرة الاحليل من قبل طلاب الطب: دراسة مقارنة

Authors: Ismaeel Hama Ameen Aghaways
Pages: 526-532
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Background and objective: To determine the difference of acquired skills of how to perform Digital Rectal Examination and Urethral Catheterization, by medical students of two groups. Group (A) large group (traditional teaching group) and Group (B) small teaching group Methods: A questionnaire containing information related to digital rectal examination (DRE) and urethral catheterization was given to all year six medical students at College of Medicine, University of Sulaimanyia , in June 2004 and 2007, just before their fina examination. The questionnaire focused on the important points in relation to ways of teaching. Results: Responses to all given questions in the questionnaire from the two groups were different, 54% of students from traditional teaching group responded as oppose to 53% from small group . Up to 93% of traditional teaching group student were taught how to perform Digital Rectal Examination, while approximately 80% of students from small teaching group have been taught to do DRE. Only 23% of those among traditional teaching group have done more than 3 DRE, while that of small teaching group was only 8%. In both groups, their findings were uncommonly checked by senior doctor. In both groups nearly 80% of the students had never felt a clinically malignant prostate and nearly the same for rectal tumor. Students from traditional teaching group, who did Digital Rectal Examination, 22% of them were not sure about their ability to give an opinion based on their clinical findings, while 33% of the small teaching groups were unable to give opinion. Nearly 73% in traditional reaching group have been taught how to perform male urethral catheterization, while that of small teaching group was 78%. In traditional teaching group, only 23% have performed 2 and less male urethral catheterization on qualification while 44% in small teaching group. 39% of small teaching group were not confident at all to do male urethral catheterization, while that of traditional teaching group was 27% only. Conclusion: There was obvious similarity between the two groups regarding the lack of basic skill in conducting DRE, urethral catheterization. This was probably due lack of objectives in the teaching curriculum.


Article
Effect of thrombolytic therapy on ventricular function of patients with acute myocardial infarction: a single institutional experience in Iraq
تأثير العلاج بالتخثر على وظيفة البطين لمرضى احتشاء عضلة القلب الحاد: تجربة مؤسسية واحدة في العراق

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Background and objective: Early reperfusion has been shown to improve left ventricular function (LVF) and survival after acute myocardial infarction (AMI). We aimed to evaluate the influence of thrombolytic therapy (TT) on LVF in patients with AMI. Methods: This study involved 100 patients who were diagnosed with acute ST-segment elevation myocardial infarction (STEMI). Patients were allocated into 2 groups; group I (n=50 patients) who received intravenous TT, and this was further subdivided equally into groups Ia and Ib; and group II (n=50), who did not receive TT. An echocardiographic-derived measurement of LVF at the end of the first and 6th weeks of the event was assessed. A left ventricular ejection fraction of ≥ 55% was considered a normal systolic function. Results: After adjusting for age and gender, approximately 85% of group Ia patients and 50% of group Ib patients demonstrated an EF of ≥ 55% while only 16% of patients in group II had an EF of ≥55%, regardless of the infarcted area/site. Conclusion: Thrombolytic therapy significantly improved LVF in patients with STEMI when it was administered within 12 hours of symptoms onset, than in those who did not receive this form of therapy.


Article
The impact of body mass index on serum androgen and leptin association in reproductive age women
تأثير مؤشر كتلة الجسم على ارتباط أندروجين المصل ولبتين في النساء في سن الإنجاب

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Background and objective: Obesity has been associated with increased androgenicity in women. There are, however, major inconsistencies in available data concerning the possible association between androgenicity and leptin in humans.The objectives of this study were to evaluate the impact of body mass index on androgens and the potential contribution of leptin in determination of androgen levels in women. Methods: The study included 80 healthy females with an established Body Mass Index (BMI). They were divided into 4 groups. First group, 30 normal weight subjects (BMI<25 Kg/m2), second group, 25 overweight subjects (BMI=25–29.9 Kg/m2) , third group,15 obese grade-I subjects (BMI=30–34.9 Kg/m2) and forth group, 10 obese grade-II subjects (BMI>35 Kg/m2). Serum, leptin, free testosterone, androstenedione, glucose, lipid profile and body mass index were measured. Results: There was no statistically significant difference in median serum androstenedione, while free testosterone was significantly lower (14.5 pg/ml) in obese grade II and higher in normal weight (60 pg/ml) and statistically significant increase in serum leptin with increase in body mass index. Serum free testosterone was lower (23.5 pg/ml) in subjects with highest quartile serum leptin and higher (43pg/ml), in subjects with lowest quartile serum leptin, the difference was not significant statistically. Conclusion: high body mass index negatively influence the circulating free testosterone in reproductive age women. An inverse association between circulating leptin and free testosterone was observed


Article
The effect of hyoscine N– butyl bromide on the duration of active phase of labor
تأثير هيوسين بروميد البوتاسيوم على مدة المرحلة النشطة من المخاض

Authors: Runak Tariq Salim --- Hanaa Alani -------
Pages: 549-555
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Background and objective: Hyoscine N-butyl bromide acts by inhibiting cholinergic transmission in pelvic parasympathetic ganglia and antagonizing muscarinic receptors of smooth muscles in the abdomen and pelvic organs, thus relieving spasm aiding to cervical dilation. This study is to assess the efficacy of Hyoscine butyl bromide on cervical dilation in multigravid pregnant women during the active phase of labor. Methods: A randomized clinical prospective trial was conducted in maternity hospital in Sulaimaniyah, from 1st of January to the 1st of July 2010. Women were consecutively randomized into: the study group (A) who received 40 mg Hyoscine N-butyl bromide by slow intravenous injection in the active phase of first stage of labor and the control group (B) who received 2ml of normal saline. Each group consists of 130 patients after excluding high risk pregnancy. Results: Mean duration of active phase of labor was 142.69 min, 258.00 min in group A and B, respectively (p-value < 0 .001). Mode of delivery and neonatal outcome were comparable. No adverse maternal or fetal effects were noted. Conclusion: Intravenous Hyoscine N-Butyl Bromide shortens the duration of active phase of labor without any unwanted fetal or maternal effects, also it effectively shortens the 2nd and 3rd stages of labor.


Article
Effect of cigarette smoking on liver function test and some other related parameters
تأثير تدخين السجائر على اختبار وظائف الكبد وبعض العوامل الأخرى ذات الصلة

Authors: Bakhtiar M. Ahmed --- Sangar Najat Abdul-Razaq
Pages: 556-562
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Background and objective: Cigarette smoking is one of the 10 greatest contributors to global death and disease. Cigarette smoke consists of many chemicals, including cytotoxic, carcinogenic and free radicals, therefore it affects many organs if not all.This work is directed to evaluate the effects of dose response patterns of tobacco exposure on liver tissue, through assessing some serum biochemical parameters related with liver efficiency. Methods: This study was done in Kirkuk province. It was conducted on (110) healthy male subjects, their ages ranged from 20 to 40 years. They were divided into three groups; 40 heavy smokers, 30 moderate smokers and 40 non-smokers. Blood was withdrawn for estimation of serum liver function test, lipid profile, protein electrophoresis, and lipid peroxidation test (Serum Malondialdehyde; MAD level). Results: There were statistically significant elevations in serum alkaline phosphatase (ALP), alanine transaminase(GPT) and aspartate aminotransferase(GOT) activities in heavy smokers while serum total bilirubin significantly was lower comparing to non smokers. Serum total protein and albumin were significantly lower in heavy smokers comparing to non smokers. The results of serum protein agarose gel-electrohporesis showed significant changes in serum protein fractions in smoker groups. The mean level of serum total cholesterol, triglyceride, LDL, VLDL and malondialdehyde was significantly higher in heavy smoker group, while serum HDL level had a significantly lower value. Conclusion: Cigarette smoking can affect liver efficiency and functions. These effects are dose exposure depenent.


Article
Evaluation of salivary α-L-Fucose and its related parameters in periodontitis
تقييم اللعاب α-L-Fucose والمعلمات ذات الصلة في التهاب اللثة

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Background and objective: Periodontitis is one of the most widespread oral diseases in Kurdistan. Saliva can be used as a noninvasive diagnostic fluid to measure chemical biomarkers released during oral disease, so this work is directed to focus on the study of salivary fucose (a glycoprotein component) and its related parameters in periodontitis, to assess the possibility of using them as indicators for the disease and its progress. Methods: The present work included 79 individuals. They were grouped into healthy (32), advanced periodontitis (20) and moderate periodontitis(27) subjects. Their age was ranged between (20-60) years. Unstimulated whole saliva samples were collected from all the groups. The samples were used for the estimation of salivary; total fucose (TF), protein bound fucose (PBF), protein bound hexose (PBH), lipid associated fucose (LAF), total protein (TP), total calcium (TCa), zinc (Zn), and salivary magnesium (Mg). Results: Salivary TF, LAF, FF, PBF, TP and TCa were significantly increased in both advanced and moderate periodontic groups comparing to healthy individuals, while there were no significant differences in salivary PBH, Mg and Mg/Ca levels in periodontic groups when compared to normal. Salivary TF/TP, PBF/TP, PBH/TP and FF/TP ratios and salivary zinc were significantly reduced in periodontic males. Conclusion: On the basis of the above results, it can be concluded that these biochemical parameters, may be used as indicators for the extent of periodontal tissue damage, thus they can be used in the identification of periodontitis progresses and treatment follow up.


Article
Dental students’ knowledge for prescribing antibiotics used for treatment of periodontitis
معرفة طلاب الأسنان لوصف المضادات الحيوية المستخدمة لعلاج التهاب اللثة

Authors: Shima Ghazi Thanoon
Pages: 570-576
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Background and objective: Although antibiotics along with analgesics are commonly prescribed medications by the dentists, little is known about the knowledge and understanding of dental practitioners concerning its use in every day clinical practice. Prescription errors are very common and this may be due to medical students are not adequately instructed. This study was done to investigate dental students’ knowledge of prescribing antibiotics to see if they are competent to prescribe rationally at the point of graduation. Methods: A questionnaire was devised to investigate the dental students’ knowledge for prescribing antibiotics. Students at their final year of graduation (2010) included in this study. A structured questionnaire was filled at the College of Dentistry/HMU. Results: Most of the antibiotics prescribed were at the correct doses and dosage form but there was variability in the frequency of dosing and duration of therapy. Four different antibiotics were prescribed in this study, these were amoxicillin (74.63%), metronidazole (5.97%), tetracycline (2.99%) and erythromycin (1.49%). Conclusion: A continuous education on the rationale use of antibiotics in dental infections is required and this would be better when integrated with its application in the clinical practice. Prescribing guidelines are required to improve the prescribing patterns of antibiotics by dental students so they will be competent to prescribe correctly and responsibly at the point of graduation.


Article
The early results of surgical treatment of congenital clubfoot by a modified soft tissue release
النتائج المبكرة للعلاج الجراحي للقدم المشقوقة بواسطة تحرير الأنسجة الرخوة

Authors: Mustafa Adnan Mustsfa --- Omar Ameen Saeed
Pages: 577-581
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Background and objective: Talipes Equinovarus (TEV) or Congenital Clubfoot is the most common congenital anomaly of the foot. The incidence of TEV is 1-2 per 1000 life births, about 30% of these cases is bilateral with a higher incidence in males than in females (2:1). Congenital Clubfoot is a complex deformity which has four components: Heel in equinus, hind foot in varus, mid foot in cavus, forefoot in adduction and supination. The presented study aimed to evaluate the surgical treatment outcome of congenital club foot by a modified soft tissue release (i.e. division of tendons of tibialis posterior and flexor hallucis longus). Methods: This is a prospective study done on the Result of treatment of congenital Clubfoot by soft tissue release. Numbers of patients are thirty three patients, forty eight feet, fifteen patients (45.46%) had bilateral, and eighteen patients (54.55%) had unilateral deformities. Twenty one patients (63.64) were male and twelve patients (36.37) were female, male to female ratio was 1.75:1, their ages range between 4-35 months (mean ages in months = 15.43 months). The patients whom included in this study had no previous treatment because of delay in presentation. Results: All patients were assessed clinically and radiologically. The result of our study was as follow: Excellent result for 28 feet (58.3%), Good result for 16 feet (33.3%), Poor result for 4 feet (8.3%). The over all result can be sub divided to two categories; a) satisfactory which involve both the excellent result and the good result (91.67%) and b) unsatisfactory result which involve only the poor result (8.33%). Conclusion: The study revealed that the use of this surgical method is of good result and lower rate of complication.


Article
Influence of feeding pattern on risk factors of lower respiratory tract infections in infants
تأثير نمط التغذية على عوامل خطر انخفاض التهابات الجهاز التنفسي عند الرضع

Authors: Dhahir Tahir Gardi --- Kawes O. H. Zangana
Pages: 582-589
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Background and objective: Human milk is recommended as the exclusive nutrient source for feeding infants for the first six months of life and should be continued with the addition of solid foods after six months of age. This study is designed to study the socio-demographical risk factors on lower respiratory tract infections and influence of feeding on these factors. Methods: A well matched case control study performed on 200 children admitted with acute lower respiratory tract infections to Raparin Pediatric Teaching Hospital – Erbil city in the period of 1st September 2010 to 1st May 2012. Children between 2 months and 2 years of age presenting with an acute history of cough and rapid respiration or difficulty in breathing were included in the study, according to WHO criteria for ALRI. The study sample was divided into two groups: group 1 (cases) and group 2 (control) . After that the cases were subdivided to two groups; bottle fed or mixed fed group and a excusive breast fed group. Results: This study showed that 69% of bottle-fed infants developed lower respiratory tract infections compared with 31% infants of breast-fed. This was significant statistically (p value 0.013). Mean age was 9.8 ±2.6 months; male: female ratio was 1.5:1. Concerning vaccination status; cases were had lower level of vaccination, history of respiratory infection in the family was highly recognized as a risk factor. Conclusion: infants who are more prone to develop respiratory infections are those of bottle fed, low level of vaccination, less than one year of age, family history of respiratory infections, low socio economical status and overcrowd families.


Article
Promyelocytic blast crisis of chronic myeloid leukemia after one year of Imatinib treatment
أزمة ارومة البروميلوسيتيك لابيضاض الدم النخاعي المزمن بعد سنة واحدة من علاج بإيماتينيب

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A 60 year-old man in the chronic phase of chronic myeloid leukemia (CML-CP) was treated with imatinib mesylate for 1 year. After one year of the initial diagnosis of CML chronic phase, the patient progressed to a promyelocytic blast crisis, karyotyping showed 46,XY,t(9;22)(q34;q11.2), t(15;17)(q22;q21) in all cells examined. The patient was diagnosed with promyelocytic blast crisis of CML. With administration of all-trans retinoic acid (ATRA) and high-dose imatinib mesylate (800 mg/day), the patient has died of disseminated intravascular coagulation within 2 weeks. As karyotyping showed 46,XY,t(9;22)(q34;q11.2), t(15;17)(q22;q21) in all cells examined, this is suggesting that the clonal evolution of PML/RARa translocation occurred early in the CML-CP.

Table of content: volume:17 issue:3