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Article
Bartholin Gland Cyst Treatment using Carbon Dioxide Laser (10600 nm)
معالجة كبس غدة البارثولين بأستخدام ليزر ثنائي اوكسيد الكاربون (10600 نانومتر)

Authors: Manal I. Mzaiel منال ابراهيم مزيعل --- Ali S. Mahmood علي شكر محمود --- Ahmed W. Ibrahim احمد وليد ابراهيم
Journal: Iraqi Journal of Laser المجلة العراقية لليزر ISSN: 18121195 Year: 2017 Volume: 16 Issue: B Pages: 27-33
Publisher: Baghdad University جامعة بغداد

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Abstract

Abstract: Background: The Bartholin gland cyst is a condition that occurs in approximately 2% of women, most of whom are of reproductive age. Although benign pathology, it is associated with significant patient discomfort. This disorder is caused by the obstruction and consequent dilation of the cyst duct. Definitive treatment involves the surgical removal of the entire cyst. Other alternative treatments include Marsupialization, Word catheter, and the use of CO2 laser. CO2 laser can be used either to vaporize or to excise the Bartholin gland cyst. The Objectives: The purpose of the study was to evaluate the efficacy and safety of (10600nm) CO2 laser in the treatment of Bartholin gland cyst. Patients, Materials & Methods: This study was done in laser medicine research clinics from July 2015 to the end of December 2015; 10 female patients whose ages ranged from 25 years to 50 years and who have Bartholin cyst. The details of the procedure were explained verbally to the patients and consent was written. Patients were examined and evaluated clinically and prepared for surgery. A CO2 continuous wave 1-40W laser emitted at 10600 nm. The laser is delivered via an articulated arm and laser is used to incise the cyst wall and vaporize the inner surface of the cyst. Results: The preliminary clinical findings included sufficient hemostasis, vaporization properties and precise incision margin with all of the surgical procedure. The postoperative advantages, i.e., lack of pain, bleeding, infection, good wound healing and overall satisfaction were observed. Conclusion: The clinical application of the CO2 (10600 nm) laser in surgical procedures can be considered practical, effective, easy to use and offers a safe, acceptable, and impressive alternative for conventional techniques of surgical treatment Bartholin gland cyst.

الخلاصة :الخلفيه :كيس غدة البارثولين حاله تحدث لحوالي 2%من النساء اغلبهم في عمر الانجاب .بالرغم من كون الحاله حميده الا انها مصحوبه بعدم ارتياح شديد .سبب هذه الحاله هو انسداد ومن ثم توسع في قناة الغده.والعلاج النهائي لهذه الحاله المرضية يشمل رفع الكيس كليا والخيارات الاخرى للعلاج تشمل فتح الكيس مع خياطة الجوانب قسطرة وورد واستعمال الليزر من نوع ثنائي اوكسيد الكاربون لتبخير او رفع الكيس. اهداف الدراسه: تقييم كفاءه وسلامه ليزر ثنائي اوكسيد الكاربون (10600) في علاج كيس غدة البارثولين. طريقة الدراسه: اجريت هذه الدراسة في عيادات الليزر الطبيه والبحثيه بمعهد الليزر للدراسات العليا من بدايه شهر تموز 2015 ولغايه نهايه شهر كانون الاول 2015 شملت الدراسه عشرة نساء لديهن اعراض كيس غدة البارثولين تتراوح اعمارهم ما بين 25 سنه الى 40 سنه,تفاصيل العمليه شرحت شفهيا للمرضى وتم فحصهم وتقييمهم سريرياواخذ الموافقه ورقيا ومن ثم تحضيرهم للتداخل الجراحي باستخدام ليزر ثناثي اوكسيد الكاربون وبقوه 15 واط وطول موجي 10600 نانو ميتر ,الليزر استخدم لفتح كيس غده البارثولين ومن ثم تبخير السطح الداخلي للكيس. النتائج :اثبتت النتائج السريريه القدره العاليه لليزر ثنائي اوكسيد الكاربون على ايقاف النزيف والقطع الدقيق خلال التداخل الجراحي كما من مميزاته عدم وجود نزف والم ومنع رجوع الكيس مع التأم جيد للجرح ,سجل معظم المرضى رضى عالي في استخدام الليزر في هذه العمليه . الأستنتاج:التطبيق السريري لليزر ثنائي اوكسيد الكاربون في العمليات الجراحيه يمكن اعتباره عملي وفعال وسهل الاستعمال وسليم ومقبول وبديل للعمليات التقليديه لعلاج كيس غدة البارثولين .


Article
Validation of Mitral Annular Plane Systolic Excursion & end Point Septal Separation for Rapid Assessment of Left Venticular Systolic Function

Author: Arshad Fuad Ridha
Journal: Iraqi Academic Scientific Journal المجلة العراقية للاختصاصات الطبية ISSN: 16088360 Year: 2017 Volume: 16 Issue: 4 Pages: 349-356
Publisher: The Iraqi Borad for Medical Specialization المجلس العراقي للاختصاصات الطبية

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Abstract

LEFT VENTICULAR SYSTOLIC FUNCTIONTHE IRAQI POSTGRADUATE MEDICAL JOURNAL VOL. 16,NO,4. 2017Validation of Mitral Annular Plane Systolic Excursion & end Point Septal Separation for Rapid Assessment of Left Venticular Systolic FunctionArshad Fuad RidhaINTRODUCTION:Mitral annular plane systolic excursion (MAPSE) also known as mitral ring displacement & mitral annulus excursion (MAE), is obtained from M mode & it assesses LV longitudinal function (1,2,3). It can be get easily (5,6,7) even for the junior doctor (7) and in patients with poor acoustic windows (3). It has been suggested as a surrogate measurement for LVEF in cardiac patients (6,8). MAPSE may be reduced with increasing age & in patients with atrial fibrillation, myocardial infarction & heart failure(9,10,11) and to be more sensitive thanAl Mustansiriyha Medical College.conventional echocardiographic markers in detecting abnormalities in LV systolic function at an early stage (2,12). MAPSE is known to be prognostic for major cardiac events and mortality in patients with cardiovascular disease (9,13,14,15). Measurement of MAPSE MAPSE can be measured using the M mode from the lateral & septal walls of the apical 4 chambers views & from the anterior & inferior walls of the apical 2 chambers views. The best is to obtain it from the lateral & septal walls. Generally, the lateral MAPSE values are higher than that of septal walls. (16)ABSTRACT:BACKGROUND:Assessment of LV systolic function is sometimes difficult because of obesity, chest wall deformities or in critically ill patients. We try to evaluate alternative methods for rapid assessment of LV systolic function.OBJECTIVE:In this study we try to evaluate mitral annular plane systolic excursion (MAPSE) ( Since LV longitudinal shortening reflected by MAPSE is a sensitive marker of LV systolic function.) & E-point septal separation (EPSS) for rapid assessment of LV systolic function & as alternative way to assess ejection fraction (EF).METHODS:This is an observational case-control study enrolling 143 patients, 73 patients with LV dysfunction & 70 persons with normal LV function served as a control group.LV EF (Left ventricle ejection fraction), MAPSE & EPSS all are measured for patients & the control groups. P-value ≤0.05 is considered as a statistically significant.RESULTS:A 73 patients with LV dysfunction & 70 patients with normal LV function (taken as a control) were enrolled in this study. There are significant LV dilatation, a decrease in LVEF, decrease in MAPSE & increase in EPSS in patients group in comparison with control groups, & all are statistically significant (P-value=0.0001).MAPSE less than 7 mm & EPSS more than 7 mm had a sensitivity of 34.24 % & 97.26% respectively & a specificity of 100% & 85.71% respectively.CONCLUSION:Both MAPSE & EPSS parameters are simple, easy to obtained & require no time especially in patients with poor acoustic window.An average MAPSE of less than 7 mm & EPSS of more than 7 mm can be used as a surrogate of LV systolic dysfunction with acceptable sensitivity & specificity.KEY WORD: MAPSE, EPSS, LV function.THE IRAQI POSTGRADUATE MEDICAL JOURNAL VOL. 16,NO,4. 2017349LEFT VENTICULAR SYSTOLIC FUNCTIONTHE IRAQI POSTGRADUATE MEDICAL JOURNAL VOL. 16,NO,4. 2017& during measurement always make the cursor parallel to the LV walls. The excursion in M mode should be measured from the lowest point to the highest point i.e. from end diastole to end systole. (Fig. 1). The post-systolic motion towards the apex during the isovolumetric relaxation period, which is sometimes linked with ischaemia, fibrosis, or pressure overload,(17) should not be included in the measurement.Figure 1 The average normal value of MAPSE derived from previous studies for the four annular regions (septal, anterior, lateral, and posterior) ranged between 12 and 15 mm (18, 9) and a value of MAPSE <8 mm was associated with a depressed LV EF (<50%)(18) . A mean value for MAPSE of ≥10 mm was linked with preserved EF (≥55%) (1, 20). In addition, a mean value for MAPSE of <7 mm could be used to detect an EF <30% in dilated cardiomyopathy patients with severe congestive heart failure (9). One important thing is that the association between MAPSE & EF is only true in case of a normal or dilated LV (20, 21), but this association is not applicable in case of left ventricular hypertrophy (LVH) (22). This is because the LV longitudinal function represented by MAPSE is impaired in case of LVH while radial function represented by EF will remain normal or even increased (23). The same is also true with increasing age in which MAPSE is impaired while the EF remain normal or even increased.(24,25) EPPS, Surrogate markers of LV systolic function: EPSS refers to the distance between the anterior leaflet of the mitral valve and the interventricular septum during early diastole. This is easiest to measure using M-mode echocardiogram, and the measurement is taken when the anterior mitral leaflet is at its closest to the septum (Figure 2).Figure 2During diastole, the tip of the anterior MV leaflet move toward the septum & during M mode this is represented by E point as seen in fig. 2. The distance between E point & the septum is called E point septal separation (EPSS) & it does not onlyassess LV dilatation & function but it has a strong negative correlation with EF i.e. the higher the distance the lower the EF (26,27). Normally, the EPSS is no more than 6mm. The distance increases with worsening left ventricular350LEFT VENTICULAR SYSTOLIC FUNCTIONTHE IRAQI POSTGRADUATE MEDICAL JOURNAL VOL. 16,NO,4. 2017systolic function, and an EPSS >7mm is a sensitive marker for severely impaired systolic function.METHODS:Study design:This was an observational case-control study evaluating the relationship of MAPSE & EPSS to LVEF in patients with LV dysfunction & in healthy population who attended the Echocardiogram department in Al-Yarmouk hospital for any indication.Subjects:73 patients with LV dysfunction as documented by an LVEF < 54 % in females or LVEF < 52% in males were enrolled during the period from 21ST of April 2016 to 25th of March 2017.A 70 healthy individuals as documented by an LVEF ≥ 54 % in females & LVEF ≥ 52% in males were enrolled as a control during the period of 21st of April 2017 to 20th of April 2017.Exclusion:1. Patients with valvular cardiomyopathy (valve leading to LV dysfunction).2. Patients with left ventricular hypertrophy.Measures:All echocardiographic examination were completed using S4 probe 2.5 Mhz phased-array. Comprehensive transthoracic echocardiogram was performed with Vivid E9 echocardiography system (GE).After taking a consent, we asked about past medical history, current or past occupation, smoking status & presence or absence of ischemic heart disease.By echocardiogram, we measure LV size (left ventricular internal diameter diastolic) (LVIDD), LVEF, EPSS & MAPSE.Two-dimensional imaging examination was performed in the standard fashion in parasternal long- & short-axis views & apical 4-& 2- chamber views.LVEF were calculated using cubed formula i.e. Teichholz methods.Excursion of mitral annulus was measured using M mode from the apical 4 chambers view with beam positioned to the lateral walls. The amount of excursion was measured in mm.In M mode the longitudinal motion of MV annulus was recorded against time giving the appearance of a sine wave. The depth of the sine wave occurred in end diastole while the height occurred in end systole. Measurement of depth to height represent MAPSERegarding measurement of EPSS, an M-mode from parasternal long axis view was taken at the level of mitral valve leaflet tips.Measurement was taken in early diastole (in mm), & EPSS was defined as the shortest distance from the E-point of mitral valve (the tip of the anterior mitral valve leaflet) to the ventricular septum.Statistical analysis:Data were coded & analyzed using the SPSS package program, version 24.0 (SPSS Inc, Chicago, IL, USA) & excel 2013 programs. Qualitative data were presented using the frequency & its related percentage, while quantitative data were presented using the mean & standard deviation. Continuous variables were compared between the two groups using student’s t-test, while categorical variables were compared using Pearson Chi-square test. One-way analysis of variance (ANOVA) was used to compare three or more groups.A P-value of < 0.05 was chosen as the level of significance.RESULTS:A 73 patients with LV dysfunction classified according to their EF (EF ≤ 54 % in females & ≤ 52 % in males ) & 70 patients with normal LV function (EF > 54 in females & > 52 in males ) (taken as a control) were enrolled in this study.There were 47 (64.38 %) males & 26 (35.62%) females in patients group, & 31 (44.28%) males & 39 (55.72 %) females in the control groups. The mean age was 58.9 ±12.4 year of the patients group, the range was 6-77 years & the mean age of the control group was 45.8 ± 13.5 year, range 19-75 year. The rest of clinical data is demonstrated in table 1.351LEFT VENTICULAR SYSTOLIC FUNCTIONTHE IRAQI POSTGRADUATE MEDICAL JOURNAL VOL. 16,NO,4. 2017Table 1: Demographic & clinical data of patients with LV dysfunction & control groups.Patients Controls P-value Number7370Age “Mean±SD (Range)” 58.9±12.4 (6-77) 45.8±13.5 (19-75) 0.0001* Males47310.016# Females 26 39 Hypertension36260.142 Diabetes 33 12 0.0001# IHD3380.0001# Smoking 11 16 0.053*Significant using Students-t-test for two independent means at 0.05 level# Significant using Pearson Chi-square test at 0.05 level.Table 2 shows the echocardiographic parameters of patients & control groups, there are significant LV dilatation, a decrease in LVEF, decrease in MAPSE & increase in EPSS in patients group in comparison with control groups, & all are statistically significant (P-value=0.0001).Table 2: Echocardiographic findings in patients with LV dysfunction & control groups.Mean Patients Control P-value LV size (mm)62.5±9.5 (41-90)50.3±5.4 (40-68)0.0001* EF (%) 36.3±8.5 (17-53) 70.9±6.3 (57-83) 0.0001* MAPSE (mm)8.4±3.1 (4.2-17)15.1±2.5 (11.3-22.1)0.0001* EPSS (mm) 16.3±5.9 (6-35)) 4.0±2.5 (0-11.3) 0.0001**Significant using Students-t-test for two independent means at 0.05 levelTable 3 shows the echocardiographic parameters between males & females patients, there are significant LV dilatation, decrease in LVEF & decrease in MAPSE in male patients in comparison to the females (P-values: 0.001, 0.002, 0.001 respectively.While there is no statistically significant deference between males & females regarding EPSS.Table 3: Comparison of echocardiographic findings between males & females patients.Mean Male patients Female patients P-value LV size (mm)65.3±9.7 (41-90)57.6±6.9 (44-70)0.001* EF (%) 34.1±7.9 (17-52) 40.4±8.2 (25-53) 0.002* MAPSE (mm)7.9±2.8 (4.2-17)9.3±3.3 (5-16)0.001* EPSS (mm) 17.9±5.9 (6-35) 13.3±4.8 (6.8-22.7) 0.070*Significant using Students-t-test for two independent means at 0.05 levelTable 4: Comparison of echocardiographic findings between ischemic & non-ischemic LV systolic dysfunction.Table 4 shows the echocardiographic parameters between ischemic & non-ischemic LV dysfunction patients. LV dilatation, LVEF & MAPSE all showed a non-statistically significant difference, while EPSS is significantly increased in non-ischemic patients in comparison to the ischemic ones (P-value: 0.045)Ischemic Non-ischemic P-value LV size (mm)61.6±8.4 (41-49)67.0±12.9 (51-90)0.061 EF (%) 36.6±8.2 (17-52) 35.2±10.3 (21-53) 0.587 MAPSE (mm)8.4±2.9 (4.2-17)8.5±3.7 (4.2-14.2)0.919 EPSS (mm) 15.6±5.4 (6-27) 19.3±7.4 (8.3-35) 0.045* *Significant using Students-t-test for two independent means at 0.05 level352LEFT VENTICULAR SYSTOLIC FUNCTIONTHE IRAQI POSTGRADUATE MEDICAL JOURNAL VOL. 16,NO,4. 2017Table 5 shows a statistically significant relationbetween MAPSE & LVEF in patients with LV dysfunction (LVD) (P-value: 0.0001)Table 5: The relation between MAPSE & EF in patients with LV dysfunction.MAPSE (mm) No. EF (%) (Mean) P-Value ≥102440.2±6.4 (29-53) 0.0001* 9.9-8 borderline 17 40.0±8.0 (28-52) <8 LVD737.9±7.5 (28-47) <7 Severe LVD 25 29.7±7.2 (17-51)*Significant using ANOVA test at 0.05 levelTable 6 shows a non-statistically significantrelation between EPSS & LVEF in patients with LV dysfunction (LVD) (P-value: 0.380)Table 6: The relation between EPSS & EF in patients with LV dysfunction (LVD).EPSS (mm) No. EF (%) (Mean) P-Value ≥77136.1±8.4 (17-53)0.380 <7 2 45.5±9.2 (39-52)*Significant using Students-t-test for two independent means at 0.05 levelTable 7: The sensitivity and specificity of different echocardiographic parameters for diagnosing LVD.Diagnosis of LVD by EF(Male <=52; Female <=54)LVD (n=73)Control (n=70) MAPSE Severe LVD (<7) 25 -LVD (<8)7- Borderline (10-8) 17 -Normal (≥10)2470 EPSS LVD (=>7) 71 10Normal (< 7 mm)260EPSS:Sensitivity=71/(71+2) x 100=97.26%; False negative=2.74%; Positive predictive value=71/ (71+10) x 100=87.65%Specificity =60/(10+60) X 100= 85.71%; False positive=14.29%; Negative predictive value=60/ (60+2) x 100= 96.77%Accuracy rate= (71+60)/143 x 100= 91.61%MAPSE:1. For MAPSE less than 8 for the detection of LV dysfunctionSensitivity = (25+7)/73 x 100= 43.84%; False negative %=56.16%; Positive predictive value =32/32x100=100%Specificity =70/70 X 100= 100%; False positive %=0%; Negative predictive value =70/ (24+17+70) x 100= 63.06%Accuracy rate= (7+25+70)/143 x 100= 71.33%2. For MAPSE less than 7 for the detection of LV dysfunctionSensitivity = 25/73 x 100= 34.24%; False negative %=65.76%; Positive predictive value =25/25 x100=100%Specificity =70/70 X 100= 100%; False positive %=0%; Negative predictive value =70/ (24+17+7+70) x 100= 59.23%Accuracy rate= (25+70)/143 x 100= 66.43%DISCUSSION:Assessment of LV systolic function & obtaining LV EF is sometimes difficult because of obesity, chest wall deformities, and poor window or in critically ill patients. So we have to look for other parameters, compare these parameters with EF & trying to know their sensitivity & specificity.Longitudinal shorting of the left ventricle is a sensitive marker reflecting heart function & can be obtained by measuring MAPSE. Measurement of MAPSE doesn’t require high imaging quality nor highly specialized personnel.353LEFT VENTICULAR SYSTOLIC FUNCTIONTHE IRAQI POSTGRADUATE MEDICAL JOURNAL VOL. 16,NO,4. 2017Although MAPSE & EF are strongly positively related, they are not completely related. MAPSE is more likely to assess longitudinal function of the LV i.e. subendocardial fibers & is more sensitive to subtle LV function changes while EF is more likely to assess radial LV function i.e.subepicardial (circumferential) fibers .(29) i.e. the longitudinal function could be impaired while the radial function can be preserved or even increased.The other method for assessment of left ventricular function is by measuring the distance between anterior MV leaflet & ventricular septum in diastole (EPSS) which can roughly assess LV EF.In diastole, the anterior MV leaflet should approach or even touch the septum. In LVD, the dilated LV with increased preload will pull valve away from the septum.It is easy to obtain, fast as it is a simple linear m-mode measurement obtained from parasternal long axis view.The current study showed that there are significant LV dilatation, a decrease in LVEF, decrease in MAPSE & increase in EPSS in patients group in comparison with control groups, & all are statistically significant (P-value=0.0001), Matos et al. (7) reported that the average systolic excursion of the mitral annulus correlated excellently with LVEF. Previous studies also stated that chronic heart failure patients showed a significant reduction of MAPSE, and there was a good correlation between MAPSE and EF (9). Qin et al (30) have shown that MAPSE measurement correlate well with other techniques for LV functional assessment including 3D echocardiogram & cardiac MRI imaging. Also, Tsang et al (31) studied the correlation of MAPSE, as derived from speckle-tracking echocardiography, with MRI-derived LVEF. They found a very strong correlation using this alternative MAPSE technique, suggesting a strong relation between MAPSE & LVEF.The current study showed that there are significant LV dilatation, decrease in LVEF & decrease in MAPSE in male patients in comparison to the females (P-values: 0.001, 0.002, 0.001 respectively). While there is no statistically significant deference between males & females regarding EPSS. The explanation is that women’s hearts are typically smaller than men’s, this could account (at least partially) for the observed differences between men and women. Matos et al (7) showed that although average MAPSE values did not differ significantly between men and women, EFs did (P-values 0.33 & < 0.001 respectively). For a given MAPSE value, thecorrelating EF was higher for women than for men. No other study to date has been published that evaluated gender specifically as a factor that affects the correlation between MAPSE and EF.The current study showed that LV dilatation, LVEF & MAPSE all showed a non-statistically significant difference between ischemic & non-ischemic (dilated cardiomyopathy) LV systolic dysfunction, while EPSS is statistically significant in non-ischemic (dilated cardiomyopathy) patients in comparison to the ischemic ones (P-value: 0.045). The explanation is that the LV takes on a more spherical geometry in dilated cardiomyopathy than ischemic LV systolic dysfunction & with progressive dilatation, the minor axis increases disproportionally, & the ratio of long to minor axis decreases i.e. sphericity index less than 1.5:1 implies marked pathological remodeling. There is no published data to date comparing MAPSE & EPSS between ischemic LV dysfunction & dilated cardiomyopathy.In this current study there is strong relation between MAPSE & EF (measured by M-mode), P-value:0.0001.In Walaa et al (32) study they found a significant positive correlation between average MAPSE & EF measured by M-mode (p<0.001), EF measured by Simpson’s rule (p<0.001), & EF measured by visual inspection (p<0.001). Our study failed to find a relation between EPSS & EF measured by M-mode (P value: 0.38).While in Conor et al study (33) they found that a prediction of LVEF from linear regression equation using EPSS measurement could theoretically be used to generate to generate a quantitative prediction of LVEF, while in Abdalla Elghaha et al (34) study they found that Correlation coefficient revealed to be very strong between Mitral EPSS measured by CMR & LVEF (r= -0.92; 95% Confidence interval for r= -0.95 to -0.87) with high significant level (P<0.0001).The current study showed that a MAPSE less than 8 had a sensitivity of 43.84%, a specificity of 100% & accuracy rate of 71.33% for the detection of LV systolic dysfunction & a MAPSE less than 7 had a sensitivity of 34.24%, a specificity of 100% & accuracy rate of 66.43% for the detection of severe LV systolic dysfunction. While in Walaa et al (32) study showed that an average MAPSE cutoff value of less than or equal to 5 provided the best balanced sensitivity (67.1%) and specificity (76.5%) to predict EF < 30%. A cutoff value of less than or equal to 3.9 could determine EF < 30% in 100% of the patients. Matos et al.(7) study stated that a MAPSE cutoff point of <6 served as an appropriate354LEFT VENTICULAR SYSTOLIC FUNCTIONTHE IRAQI POSTGRADUATE MEDICAL JOURNAL VOL. 16,NO,4. 2017cutoff point to predict severely depressed EF less than or equal to 30%. Elnoamany et al.[5] demonstrated that a MAPSE value of <7 mm had 92% sensitivity and 67% specificity for the detection of severe left ventricular dysfunction. Alam et al.(9) demonstrated that a mean MAPSE < 7 mm could detect an EF < 30% with sensitivity of 92% and specificity of 67% in patients with dilated cardiomyopathy with severe congestive heart failure.Our study showed that EPSS ≥7 had a sensitivity of 97.26%, a specificity of 85.71% & accuracy rate of 91.61% for the detection of LV systolic dysfunction. In Conor et al (33) study they found that an EPSS greater than 7 may be used to predict patients with severely reduced LVEF. In another study, EPSS of 7 mm would determine severe left ventricular dysfunction (EF <30%) with 100% sensitivity.Study limitation:1. This is a small observational case-control study, a large randomized multicenter study for extended period is required2. Inclusion of diastolic function assessment3. Inclusion of patients with Valve diseases4. Comparing MAPSE & EPSS with Speckle tracking derived-, MRI derived- or 4 D echocardiogram derived EF.CONCLUSION:Despite the introduction of a sophisticated echocardiogram methods like 4D echocardiogram, Speckle tracking derived strain & CMR for the assessment of LVEF, we believe that both MAPSE & EPSS parameters are simple, easy to obtained & require no time especially in patients with poor acoustic window.An average MAPSE of less than 7 mm & EPSS of more than 7 mm can be used as a surrogate of LV systolic dysfunction with acceptable sensitivity & specificity.So we believe that both MAPSE & EPSS should be acquired routinely in all studies, & be used as an alternative method for assessing LV systolic function.REFERENCES:1. Alam M, Hoglund C, Thorstrand C: Longitudinal systolic shortening of the left ventricle: an echocardiographic study in subjects with and without preserved global function. Clin Physiol. 1992;12: 443-52.2. Jones CJ, Raposo L, Gibson DG: Functional importance of the long axis dynamics of the human left ventricle. Br Heart J. 1990;63:215-20.3. Hu K, Liu D, Herrmann S, Niemann M, Gaudron PD, Voelker W, Ertl G, Bijnens B, Weidemann F: Clinical implication of mitral annular plane systolic excursion for patients with cardiovascular disease. Eur Heart J Cardiovasc Imaging. 2013;14:205-12.4. Willenheimer R, Israelsson B, Cline C, Rydberg E, Broms K, Erhardt L: Left atrioventricular plane displacement is related to both systolic and diastolic left ventricular performance in patients with chronic heart failure. Eur Heart J. 1999;20: 612-18.5. Elnoamany MF, Abdelhameed AK: Mitral annular motion as a surrogate for left ventricular function: correlation with brain natriuretic peptide levels. Eur J Echocardiogr. 2006;7: 187-98.6. Willenheimer R: Assessment of left ventricular dysfunction and remodeling by determination of atrioventricular plane displacement and simplified echocardiography. Scand Cardiovasc J Suppl. 1998;48:1-31.7. Matos J, Kronzon I, Panagopoulos G, Perk G: Mitral annular plane systolic excursion as a surrogate for left ventricular ejection fraction. J Am Soc Echocardiogr. 2012;25: 969-74.8. Bergenzaun L, Gudmundsson P, Ohlin H, During J, Ersson A, Ihrman L, Willenheimer R, Chew M: Assessing left ventricular systolic function in shock: evaluation of echocardiographic parameters in intensive care. Crit Care. 2011;15: R200-9. Alam M, Hoglund C, Thorstrand C, Philip A: Atrioventricular plane displacement in severe congestive heart failure following dilated cardiomyopathy or myocardial infarction. J Intern Med. 1990;228: 569-75.10. Willenheimer R, Cline C, Erhardt L, Israelsson B: Left ventricular atrioventricular plane displacement: an echocardiographic technique for rapid assessment of prognosis in heart failure. Heart. 1997;78:230-36.11. Emilsson K, Wandt B: The relation between ejection fraction and mitral annulus motion before and after direct-current electrical cardioversion. Clin Physiol. 2000;20: 218-24.12. Emilsson K, Wandt B: The relation between mitral annulus motion and ejection fraction changes with age and heart size. Clin Physiol. 2000;20: 38-43.13. Höglund C, Alam M, Thostrand C: Atrioventricular Valve Plane Displacement in Healthy Persons. Acta Med Scand. 1988;224:557-62.355LEFT VENTICULAR SYSTOLIC FUNCTIONTHE IRAQI POSTGRADUATE MEDICAL JOURNAL VOL. 16,NO,4. 201714. Rydberg E, Arlbrandt M, Gudmundsson P, Erhardt L, Willenheimer R: Left atrioventricular plane displacement predicts cardiac mortality in patients with chronic atrial fibrillation. Int J Cardiol. 2003;91:1-7.15. Brand B, Rydberg E, Ericsson G, Gudmundsson P, Willenheimer R: Prognostication and risk stratification by assessment of left atrioventricular plane displacement in patients with myocardial infarction. Int J Cardiol. 2002;83: 35-41.16. Carlhäll C, Wigström L, Heiberg E, Karlsson M, Bolger AF, Nylander E. Contribution of mitral annular excursion and shape dynamics to total left ventricular volume change, Am J Physiol Heart Circ Physiol , 2004; 287: H1836-41.17. Claus P, Weidemann F, Dommke C, Bito V, Heinzel FR, D'Hooge J, et al. . Mechanisms of postsystolic thickening in ischemic myocardium: mathematical modelling and comparison with experimental ischemic substrates, Ultrasound Med Biol , 2007;33:1963-70.18. Simonson JS, Schiller NB. Descent of the base of the left ventricle: an echocardiographic index of left ventricular function, J Am Soc Echocardiogr , 1989; 2: 25-35.19. Silva JA, Khuri B, Barbee W, Fontenot D, Cheirif J. Systolic excursion of the mitral annulus to assess septal function in paradoxic septal motion, Am Heart J , 1996;131:138-45.20. Hoffman EA, Ritman EL. Invariant total heart volume in the intact thorax, Am J Physiol , 1985; 249 : H883-90.21. Carlhäll CJ, Lindstrom L, Wranne B, Nylander E. Atrioventricular plane displacement correlates closely to circulatory dimensions but not to ejection fraction in normal young subjects, Clin Physiol , 2001;21:621-8.22. Wandt B, Bojö L, Tolagen K, Wranne B. Echocardiographic assessment of ejection fraction in left ventricular hypertrophy, Heart , 1999; 82:192-8.23. Aurigemma GP, Silver KH, Priest MA, Gaasch WH. Geometric changes allow normal ejection fraction despite depressed myocardial shortening in hypertensive left ventricular hypertrophy, J Am Coll Cardiol , 1995;26:195-202.24. Wandt B, Bojö L, Wranne B. Influence of body size and age on mitral ring motion, Clin Physiol , 1997;17:635-46.25. Wandt B, Bojö L, Hatle L, Wranne B. Left ventricular contraction pattern changes with age in normal adults, J Am Soc Echocardiogr , 1998;11:857-63.26. Lew W, Henning H, Schelbert H, Karliner J. Assessment of mitral valve E pointseptal separation as an index of left ventricular performance in subjects with acute and previous myocardial infarction. Am J Cardiol 1978;41:836–45.27. Engle SJ, Disessa T, Perloff J, Isabel-Jones J, Leighton J, Gross K, et al. Mitral valve E point to ventricular septal separation in infants and children. Am J Cardiol 1983;52:1084–7.28. Emilsson K, Wandt B: The relation between ejection fraction and mitral annulus motion before and after direct-current electrical cardioversion. Clin Physiol 2000;20:218–24.29. Emilsson K, Wandt B: The relation between mitral annulus motion and ejection fraction changes with age and heart size. Clin Physiol 2000;20:38–43.30. QinQin J,Shiota T, Tsujino H. al.e. Mitral annular motion as a surrogate for left ventricular ejection fraction: real-time three-dimentional echocardiography & magnetic resonance imaging studies. Eur j Echocardiogr 2004;5:407-15.31. Tsang W, Ahmad H, Patel A. al. e. Rapid estimation of left ventricular function using echocardiographic speckle tracking of mitral annular displacement. J Am Soc Echocadiogr 2010;23:511-15.32. Walaa A, Alaa M, Mohamed Nabil. Mitral annular plane systolic excursion-derived ejection fraction: A simple & valid tool in adult males with left ventricular systolic dysfunction. Echocardiography 2016;33:179–84.33. Conor J. McKaigney, Mori J. Krantz, Cherie L. La Rocque et al. E-point septal separation: a bedside tool for emergency physician assessment of left ventricular ejection fraction. j.ajem.2014.01.04534. Abdalla Elagha, Anthon Fuisz. Mitral valve E-Point to Septal Separation (EPSS) measurement by cardiac magnetic resonance Imaging as a quantitative surrogate of Left Ventricular Ejection Fraction (LVEF). J Cardiovasc Magn Reson. 2012;14(Suppl 1):154.356LEFT VENTICULAR SYSTOLIC FUNCTIONTHE IRAQI POSTGRADUATE MEDICAL JOURNAL VOL. 16,NO,4. 2017

Keywords

KEY WORD: MAPSE --- EPSS --- LV function.


Article
The Possible Role of Helicobacter pylori Infection in Hashimoto’s Thyroiditis

Author: Zainab A. Hamid زينب عبد الحسين حامد
Journal: Journal of the Faculty of Medicine مجلة كلية الطب ISSN: 00419419 / 24108057 Year: 2017 Volume: 59 Issue: 1 Pages: 79-82
Publisher: Baghdad University جامعة بغداد

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Abstract

Background: Autoimmune thyroiditis is one of autoimmune thyroid diseases. The cause of Hashimoto’s thyroiditis is not clearly identified; however, both genetic and environmental are suggested to play a role in pathogenesis of the disease. Helicobacter pylori (H pylori) is one of the possible causative agents.Objectives: The aim of this study is to look for the association of H. pylori infection with Hashimoto’s thyroiditis.Patients and Methods: a case-control study involved patients with Hashimoto’s thyroiditis (n=100) and control group (hyperthyroidism n=50, healthy persons n=50), the study groups were subjected to serological investigation of anti- H. pyloriIgG antibodies, anti-thyroid peroxidase antibody, and anti-thyroglobulin antibody(anti-TG Ab) using ELISA technique; besides, demographic data were collected from study groups.Results: Eighty two percent of Hashimoto’s thyroiditis patients were females; 57% of Hashimoto’s thyroiditis patients were positive for anti- H. pyloriIgG antibodies while the positive result was detected in only 22% of control group and the results were statistically significant (p <0.05). The strength and direction of the relationship between the concentrations of anti-HP IgGAbs and anti-TPO antibodies in Hashimoto’s thyroiditis group revealed positive correlation (r = 0.6241).Conclusion: the infection with H. pylori is one of the possible predisposing factors to etiology Hashimoto’s thyroiditis. The association between H. pylori infection and other genetic and environmental factors that are related to Hashimoto’s thyroiditis should be studied in depth.Key word: Hashimoto’s thyroiditis, H. pylori, Anti-TPO.


Article
Proposed Handwriting Arabic Words classification Based On Discrete Wavelet Transform and Support Vector Machine
مقترح مصنف للكلمات العربية المكتوبة بخط اليد بالاعتماد على تقنية محول المويجات المتقطعة ( ( DWTوآلة داعم المتجهات SVM

Authors: Alia Karim Abdul Hassan علياء كريم عبد الحسن --- Mohammed Alawi محمد علاوي عباس
Journal: Iraqi Journal of Science المجلة العراقية للعلوم ISSN: 00672904/23121637 Year: 2017 Volume: 58 Issue: 2C Pages: 1159-1168
Publisher: Baghdad University جامعة بغداد

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Abstract

A proposed feature extraction algorithm for handwriting Arabic words. The proposed method uses a 4 levels discrete wavelet transform (DWT) on binary image. sliding window on wavelet space and computes the stander derivation for each window. The extracted features were classified with multiple Support Vector Machine (SVM) classifiers. The proposed method simulated with a proposed data set from different writers. The experimental results of the simulation show 94.44% recognition rate.

تم اقتراح خوارزمية لاستخراج الصفات من الكلمات العربية المكتوبة بخط اليد. تستخدم الطريقة المقترحة التحويل الموجي (DWT) على الصورة ثنائية، بعد ذلك تم مسح الصورة ذات التحويل الموجي باستخدام نافذة ، ومن ثم يتم حساب قيمة الانحراف المعياري لكل نافذة . تم تصنيف الميزات المستخرجة بواسطة المصنفات SVMs . تم اقتراح قاعدة بيانات جديدة كتبت من قبل عدد مختلف من الكتاب .وهذة القاعدة تم استخدامها لاختبار العمل القترح وان النتائج التجريبية للنظام اظهرت معدل تميز 94.44٪.


Article
Administration of I.V. lidocaine before induction of general anesthesia prolong suxamethonium action in caesarian section surgeries. clinical assessment

Author: layla Khalil *
Journal: Al-Kindy College Medical Journal مجلة كلية الطب الكندي ISSN: 18109543 Year: 2017 Volume: 13 Issue: 2 Pages: 104-107
Publisher: Baghdad University جامعة بغداد

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Abstract

Background: Known as suxamethonium or succinylcholine, is a medication used to cause short-term paralysis as part of general anesthesia. The duration of operation is one of the important factors accounting to the success of the operation. Simple safe available drug can change the plan of anesthesia.Objective: The purpose of this study was to assess adding Lidocaine three minutes intravenously before induction of general anesthesia on the duration of optimum prolongation the action of Suxamethonium . With other group with regular method.Type of the study: a cross-sectional study Methods: A 100 candidate to compare the effect of Lidocaine for unpremeditated patients ,American society of anesthesia( ASA) physical status II .patients were scheduled for caesarian section surgery were randomly assigned to two groups: Group I patients received 1.5 mg/kg Lidocaine 3 minutes before induction of general anesthesia, Group 2 patients received just the anesthetic agents. For assessment of prolongation of action the researcher Deepened on the clinical signs of recovery from Suxamethonium which are: spontaneous breathing, ability to swallow when we open the patient's lower jaw ( observing movement of the tongue ).between the two group Both groups received general anesthesia. Results: The of prolongation of Suxamethonium in elective cases in Group I was a about 7 - 15 minutes, while in Group II the time of Suxamethonium was about 3 - 5 minutes Conclusions : The study concluded that there was a significant difference between the two groups from the side of suxamethonium time in group one( lidocaine group)as there was prolongation of time more than group two .


Article
An Effective Preprocessing Step Algorithm in Text Mining Application

Authors: R. M. Hadi --- S. H. Hashem --- A. T. Maolood
Journal: Engineering and Technology Journal مجلة الهندسة والتكنولوجيا ISSN: 16816900 24120758 Year: 2017 Volume: 35 Issue: 2 Part (B) Scientific Pages: 126-131
Publisher: University of Technology الجامعة التكنولوجية

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Abstract

Text mining was a process of mining the significant information from the text documents. Any text mining system was created its process by preprocessing step; which involve tokenization, stop words removal, stemming and finally creating term frequency and inverse document frequency matrix (TF-IDF matrix). These steps provide the highest time consuming stage in knowledge discovery. The proposed method tries to build effective preprocessing step to even win area of memory space and time requirements. That by proposed a method for improved stop words removal algorithm and improved stemming algorithm based porter stemming algorithm. The proposed method is tested in two levels, first level uses only vector space model which based on used traditional stop words removal and with traditional porter stemming and the second level uses vector space model with combined features of improved stop words removal algorithm and improved stemming algorithm. The results show that using second level as effective preprocessing step for text mining application achieves good performance from reducing storage space used in memory about 10% and the processing time become faster which achieves good performance to build the final TF-IDF matrix.


Article
The Effect of Age on Clinical Presentations of Patients with Atrial Fibrillation

Author: Ali Jabbar Al-Ibrahemi* , Taghreed Khazal Mohammed** , Mahmood Riyadh Al-Haleem*
Journal: Iraqi Academic Scientific Journal المجلة العراقية للاختصاصات الطبية ISSN: 16088360 Year: 2017 Volume: 16 Issue: 2 Pages: 169-175
Publisher: The Iraqi Borad for Medical Specialization المجلس العراقي للاختصاصات الطبية

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Abstract

ABSTRACT:BACKGROUND: Atrial fibrillation(AF) is a supraventricular tachyarrhythmia characterized by uncoordinated atrial activation with consequent deterioration of atrial mechanical function.OBJECTIVE: To demonstrate the effect of the age on clinical presentations of patients with atrial fibrillation.METHODS: This is a descriptive cross sectional study carried out in a tertiary cardiac center for 191 patients with atrial fibrillation who attended the selected hospital for any complaint.Their age was ranging from 18 years and above of both sexes. RESULTS: The more frequent age group for both sexes was between (40-65years). Palpitation was significant presentation in patient above 65 years and dyspnea and hypotention were more in patients below 40 years.The age is also had a significant effect on cardiomegaly on CXR, and on the echocardiographic findings of dilated LA, dilated LV, diastolic dysfunction and segmental wall abnormalities.CONCLUSION: The incidence of atrial fibrillation is age and gender related and age has an important effect on certain clinical presentations.


Article
Attitude Towards Mentally Ill People Among University Students in Baghdad

Author: Mushtaq Talib Hashism
Journal: Iraqi Academic Scientific Journal المجلة العراقية للاختصاصات الطبية ISSN: 16088360 Year: 2017 Volume: 16 Issue: 4 Pages: 408-411
Publisher: The Iraqi Borad for Medical Specialization المجلس العراقي للاختصاصات الطبية

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Abstract

ABSTRACT:BACK GROUND:Recent literature show a high prevalence of stigma in Iraq toward mental illness, discrimination towards people suffering from mental illness is still common in Iraqi society and this can negatively affects the attitudes of university students to ward patients with mental illness and till now the publications of stigma among youth is scarce.OBJECTIVE:To estimate the prevalence of stigma against mental illness among university students.SUBJECTS & METHODS:A total of 405 university students from different governorates in Iraq. They were randomly selected from colleges of Engineering, Arts, Education and Science. Stigma was measured by community attitude toward mental illness questionnaire (CAMI) scale. CAMI consists of four subscale: authoritarianism (oppressive attitude), benevolence (sympathetic attitude), social restrictiveness (belief that mentally ill patients are threat to society) and community mental ideology (CMH1) (community oriented care for mentally ill patients.RESULTS:The age of participants in the study sample was 21.3 ± 2.5 year giving male: female ratio of 0.58:1. Students from Baghdad were 370 (91.1%), and 154 (38.0%) were living in houses of > 2 crowding index.Stigma was clearly noticed in 307 (75.8%) students. Three hundred ten (76.5%) were Authoritarians, 23 (5.7%) were benevolent, social restrictiveness was noticed in 298 (73.5%) and negative CAMI was seen in 320 (79.0%). Out of males, in the study (77.9%) and out of females 191 (74.6%), are showed stigma toward mentally ill patients, no significant role in developing stigma between sex and educational stages (p=0.4 for both). Both those with crowding index > 2 and ≤ 2 have no significant effect on stigma (p=0.2).CONCLUSION:High prevalence of stigma was noticed among university students.


Article
Umbilical cord drainage versus intraumbilical cord oxytocin injection in management of third stage of labour

Authors: Farah S.Dawood فرح سامي داوود --- Najmah M. Miran نجمه محمود ميران
Journal: Journal of the Faculty of Medicine مجلة كلية الطب ISSN: 00419419 / 24108057 Year: 2017 Volume: 59 Issue: 1 Pages: 19-24
Publisher: Baghdad University جامعة بغداد

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Abstract

Background: Postpartum hemorrhage is an important cause of maternal morbidity and mortality. Considerable difference of opinion exist regarding the optimal approach to the management of the 3rd stage of labour, practice varies between countries &between units.Objectives: To evaluate the effectiveness of intra umbilical vein injection of oxytocin and umbilical cord driange in shortening the duration of third stage of labour.Patient and Methods: In this randomized controlled study, 100 women were enrolled in this study they divided into three groups. (Group 1 ,N =30 )received 20 units of oxytocin diluted in 20 ml 0.9% saline solution injected in the umbilical vein after clamping.(Group 2, N = 34) placental cord drainage.(Group 3, N= 36) with no intervention. The primary outcome was mean duration of third stage of labor.Results: The third stage of labor was significantly shorter in group 1 and 2 as compared to group 3. Groups 1 shorten the duration of third stage of labor by 3 min. and group 2 shorten the duration of third stage of labor by 4.27 min.There were no reports of need for manual removal of placenta or retained placenta.Conclusion: The use of intraumbilical injection of oxytocin and placental cord drainage in the third stage of labor significantly reduced the duration of the third stage.Key word: intraumbilical cord oxytocin, umbilical cord drainage, third stage of labour.


Article
لفظة (شركائي) في القراءات القرآنية

Author: رياض رحيم ثعبان المنصوري
Journal: journal of Human Sciences مجلة العلوم الانسانية ISSN: 19922876/25239899 Year: 2017 Volume: 1 Issue: 24 Pages: 278-286
Publisher: Babylon University جامعة بابل

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Abstract

Between researcher and voice illness to delete a connecting (my partners), deletes odd, given that most of the scientists from the door of his enemy elongated Palace, between and spluttered in this. It seems for the researcher to delete Hamza was caused by something else, which is that these Hamza Animations unprecedented thousand, and requires mitigate that change J frictional, or to make a connecting between, and the faces of Thagalan; because replaced J requires being J broken, broken and Omega heavy, which increases the pronunciation difficulty three voices bug: (thousand, broken up a meeting, open AZ) as follows:ــًـ ي ــِـ ي ــَـ )) does not live up first and Tdgham per second; because it is unprecedented thousand, does not inhabit the second because it Mtheloh Bsakn, and making this view more stable in the soul lack of reading delete hamza in (our partners, and your partners, and their partners).

بيّن الباحث العلة الصوتي لحذف همزة (شركائي) الذي عُدَّ حذفًا شاذاً، فأغلب العلماء عدّوه من باب قصر الممدود، وبين الباحث وهمهم في هذا. وأثبت أنَّ حذف الهمزة سببه شيء آخر، وهو أنَّ هذه الهمزة متحركة مسبوقة بألف، ويقتضي تخفيفها أن تُبدل ياء احتكاكية، أو أن تُجعل همزة بين بين، والوجهان ثقيلان؛ لأن إبدالها ياءً يستوجب كونها ياءً مكسورة، والياء المكسورة ثقيلة، وممَّا يزيد النطقَ صعوبةً اجتماع ثلاثة أصوات علة: ( الألف، والياء المكسورة، والياء المفتوحة ) بالشكل الآتي: ( ــًـ ي ــِـ ي ــَـ ) ولا تُسكن الياء الأولى وتُدغم في الثانية؛ لأنها مسبوقة بألف، ولا تُسكن الثانية لأنها متلوة بساكن، وممَّا يزيد هذا الرأي استقرارًا في النفوس عدم وجود قراءة بحذف الهمزة في (شركائنا، وشركائكم، وشركائهم ) فمردّ الحذف إلى تجاور الأصوات اللغوية على نمط معيّن استدعى الخروج عن الطريق الذي اختطه علماء اللغة، والضوابط العامة التي وضعوها لتخفيف الهمز.

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