Volume 13, Issue 1, Spring 2017, Page 1-236


Post-Operative Complications After Repair Of Incisional Hernia

Al-Qadisiah Medical Journal, Volume 13, Issue 1, Pages 1-8

Background:-Incisional hernia is frequently met by the general surgeon, itis frequently complicated (3.8-11.5%)of patients after abdominal surgery. Repair of large incisional hernia is a difficult surgical problem with recurrence being a common. Numerous methods of repair have been described simple opposition in one layer or complex opposition and the use of prosthetic mesh.
The aim of this study is to report our experience with the use of mesh repair and risk factors that influence post operative complications.
Methods:-A prospective study done in Al-hussain teaching Hospital, Department of Surgery between January 2011 to December 2013.One hundred and ten patients with prosthetic repair of incisional hernia were included in this study.
History was taken and thorough examination was done, all patients were asked for history of diabetes mellitus, obesity, corticosteroid use, their original operations, primary or recurrent hernia and examined for their body mass index, size and duration of the hernial defect were recorded.
A proforma was completed for each patient, noting prophylactic antibiotics had been given or not, type of the sac and whether opened or inverted, type and size of mesh had been used, intraoperative and postoperative complications and postoperative hospital stay.
Results:-Of (110) patients, (62) were females, (48)were males,their median age was (45.5) years for women and (58) years for men,(31)patients(28.2%)weighted more than their ideal body weight and had body mass index equal or more than(30).Forty eight patients (43.6%) were diabetic and (24)patients(21.8%)were corticosteroid used.
The original operations were bowel related and gynecological in the majority of patients. Previous incisions were long midline in(38) .Twenty patients had one past operation, (13)had two,(5) had three and one patient had four past repair, the remaining were new Incisional hernia patients.
The main hernia size was (12.3) cm and (4.6) cm in vertical and horizontal direction respectively. Forty four patients had additional surgical procedures, consisted of Fallopian tube ligation in (12) ,division of small bowel adhesions in (8) ,suturing of small bowel perforation in (4) and abdominoplasty in (20) patients. In the majority of patients (78), standard polypropylene mesh had been used and vicryl-prolene (Vypro) mesh in the remaining (32) patients.
The main postoperative complications were seroma formation (17.3%), wound haematoma (10%), wound infection (9.1%), chest infection (6.4%), one patient developed intestinal fistula and mesh need to be removed. Five recurrent incisional hernias occurred. Most patients developed complications were obese, diabetic and corticosteroid used.
No death in our series.
Conclusion:-Tension free incisional hernia repair using prosthetic mesh is a safe and easy procedure with no major morbidity or recurrence.
The patient-doctor should advise weight loss to help reduce risks of surgery and improve the surgical results. Control of diabetes, corticosteroid drug use and smoking cessation are recommended for better results. Rigid sterile condition, precise and meticulous technique with the use of closed suction drains is important.

Evaluation of Use Full Thickess and Split Thickness Skin Graft in Management of Congenital Hand Syndactyly

Al-Qadisiah Medical Journal, Volume 13, Issue 1, Pages 9-17

Background :
Hand syndactyly is the commonest type of congenital hand anomalies and its management is a real challenge to the surgeon and stimulate continous search for newer concepts and methods for restoration of function .
Aim of the study :
The objective of this study is to evaluate the use of full thickness and split thickness skin graft in reconstruction of congenital hand syndactyly and to compare between complications that occur in using these grafts and identify the proper ways of avoiding these complications.
Patients and methods:
The study involved 16 patients presented to the department of plastic and reconstructive surgery in the hospital of surgical specialties and Al-Wasity hospital. The patients were evaluated preoperativey by talking full history and examination of the hand systematically ,plain radiographic studies were performed and all patients were adviced to use web elastic splint postoperatively and the patients were followed up by regular visits following surgery.
Results :
3rd web space was the commonest space involved by syndactyly and hyperpigmentation was the most frequent complication reported when using F.T.G. although it was reported in some cases of S.T.G. Shrinking of skin graft and extension lag were more frequently seen when using S.T.G. while web creeping occur commonly when using F.T.G. Other compications like rotational ,derivation deformaties and morbidity of scar at donor and recipient sites were reported.
Conclusion :
Using F.T.G. and S.T.G. in reconstruction of syndactyly give acceptable functional results although both types have their own disadvantages.

Outcome, Efficacy and Safety of Ureteroscopic Pneumatic Lithotripsy In Management of Lower and Mid Ureteric Calculi

Al-Qadisiah Medical Journal, Volume 13, Issue 1, Pages 18-27

OBJECTIVE: To determine the efficacy and safety of pneumatic lithotripsy in the treatment of mid and lower ureteric calculi.
DESIGN: prospective study.
DURATION: From 2014 to 2015
SETTING: Department of Urology, AL-Diwaniya teaching Hospital.
PATIENTS & METHODS:
Over a period of one year,one hundred (100) patients of ureteric stones were treated with pneumatic lithoclast. Twenty five (25) Stones were located in mid ureter, Seventy five (75) stones were located in lower ureter . Success rate was defined as symptom free, no residual stones larger than 2mm. General anesthesia was given to all patients.
RESULTS:
Over all success rate was 90%. Success rate in middle and lower ureteric stones were 82%, 92% respectively. Completely fragmented stones cleared spontaneously within two weeks in 95% of cases and all patients were free of stones one month after the procedure. In six (6) patients stone was migrated, later on submitted for ESWL and successful. Complications were encountered in 11% of cases and were managed conservatively.
Hospital stay was 24 to 48 hours.
CONCLUSION:
Pneumatic lithotripsy is reliable, highly effective rapid, safe and cost effective treatment modality for ureteric stones with negligible incidence of complications

Association between irritable bowel syndrome and cardiac rhythm abnormalities: a case control study

Al-Qadisiah Medical Journal, Volume 13, Issue 1, Pages 27-33

The issue of association between IBS and cardiac rhythm abnormalities has been raised in few published literature; however there is substantial amount of controversy in such a way that some authors deny this association while others support this association when one take into consideration particular symptoms and signs like severity of pain, pattern of sleep and associated anxiety and depression. The current study involved 50 patients diagnosed with irritable bowel syndrome and 50 apparently healthy control subjects and both groups was subjected to about 24 hour holter monitoring. The results showed significantly higher rate of cardiac premature ventricular complexes in patients with irritable bowel syndrome than that in control group 60% versus 32% (P<0.05)with no significant association with other rhythm abnormalities.
Conclusion: Irritable bowel syndrome is significantly associated with premature ventricular complexes and further studies are needed to clarify exact pathophysiology.

The Levels of Testosterone, FSH and LH in Pregnant Women with Chronic Toxoplasmosis in Najaf Province

Al-Qadisiah Medical Journal, Volume 13, Issue 1, Pages 34-41

Infection with the intracellular protozoan parasite Toxoplasma gondii is widely prevalent in human and vertebrate animals. A wide range effects of toxoplasmosis has been studied, but there are still unknown aspects which must be explored The present study investigates the changes of testosterone, follicle-stimulating hormone (FSH) and luteinizing hormone (LH) levels in pregnant women with chronic toxoplasmosis using mini-VIDAS technique. A total number of 59 toxoplasma-IgG positive pregnant women and 28 healthy toxoplasm-IgG seronagative pregnant women were involved. The results showed that pregnant women with Toxoplasma chronic infection revealed insignificant higher levels of testosterone and LH (0.44 ng/ml, 1.74 mIU/ml respectively), and insignificant lower levels of FSH (1.78 mIU/ml) in compared to non-toxoplasmic pregnant women (0.42 ng/ml, 1.68 mIU/ml, 2.25mIU/ml). These findings are to suggest that chronic infection with T. gondii has no association with significant changes of these hormones in pregnant women.

Comparative Effectiveness Of Noninvasive Ventilation vs Invasive Mechanical Ventilation In Chronic Obstructive Pulmonary Disease Patients With Acute Respiratory Failure

Al-Qadisiah Medical Journal, Volume 13, Issue 1, Pages 42-45

DESIGN OF STUDY: Retrospective cohort study.
DURATION: From 2011 - 2016
SETTING: Department of Anesthesiology, I.C.U., Aldiwaneya Teaching
Hospital.
PATIENTS AND METHODS: Over a period of 5 years, 200 patients with COPD exacerbated by acute respiratory failure, their ages range from 60-80 years, met the chriteria and admitted to the I.C.U. . 100 patients (50%) managed by invasive mechanical ventilation (IMV) (Group A) and the other 100 patients (50%) managed by noninvasive ventilation (NIV) (Group B), both groups with medical therapy (ABC) (Antibiotics,Bronchodilators,Corticosteroids).
RESULTS:
Group A: 78 patients (78%) died.
22 patients (22%) improved & discharged to the ordinary ward.
Group B: 73 patients (73%) had clinical biochemical improvement &
discharged well to the ordinary ward.
27 patients (27%) complicated & needed endotracheal
intubation & IMV, after 2-5 days, all died.
CONCLUSION: There is a significant outcome to the use of NIV vs IMV.

Role of the Triple Test in the Evaluation of Breast Mass

Al-Qadisiah Medical Journal, Volume 13, Issue 1, Pages 46-52

This prospective study was carried out on 210 female patients with a diagnosis of breast mass admitted to the surgical unit of Al-Diwaniya Teaching Hospital over a period of 2 years from January 2013 to December 2014. Each patient was assessed by the triple test which includes physical examination, imaging studies , and fine needle aspiration cytology (FNAC). The results of each modality of the triple test were classified as benign, suspicious or malignant and then compared with the final diagnosis obtained by the histopathological examination. Breast mass was more common in the fourth decade of life (40.47 %), and the most common associated clinical feature was pain in 30.95 % of cases. Fibroadenoma was the most common benign breast mass ( 41.9 %), while invasive ductal carcinoma was the most common malignant breast mass (27.14 %). The most accurate element of the triple test was FNAC with
a concordance rate of 0.89 (almost perfect agreement),while physical examination was the least accurate element with a concordance rate of 0.62(substantial agreement). The concordance rate of the triple test was 0.94 (almost perfect agreement) and it was higher than that of any modality used in the triple test. The sensitivity of the triple test was 93.85 % , specificity 99.31 % , positive predictive value (PPV) 98.39 %, negative predictive value (NPV) 97.30 % , and accuracy 97.62 % , and again these figures were higher than those of the elements of the triple test.So that the triple test can be safely used as an accurate and least invasive diagnostic test in the evaluation of patients with breast mass and to detect patients with breast cancer

Usefulness of bleeding Profile in Adenotonsillectomy

Al-Qadisiah Medical Journal, Volume 13, Issue 1, Pages 53-57

Introduction: Infectious and inflammatory diseases involving the pharynx, tonsils, and adenoids account for a significant proportion of childhood illnesses and pediatric health care expenditures. Preoperative assessment in patients undergoing adenotonsillectomy is crucial and may reveal problems that could complicate either surgery or the patient’s postoperative course. It is crucial to detect the existence of any coagulation abnormalities. routine evaluation of coagulation parameters before surgery in patients undergoing. adenotonsillectomy is controversial.
Aim of study: asseses the need for coagulation profile prior to adenotonsillectomy
Method: This study is prospective, consisted of 321 children complaining of adenotonsillar problem. Age, sex, history, physical examination, hemoglobin (Hb %) and bleeding profile in form of prothrombin time, partial thromboplastin time, international normalized ratio was done for all patients. Patients with risk factor for bleeding, abnormal bleeding profile and further work reveals clotting abnormality were excluded from study.
Results: Two patients of normal investigation developed secondary hemorrhage, which is due to infection and treated conservatively. Two of prolonged bleeding profile developed primary bleeding readmitted to theater one of them from adenoid remnant, and one from slip ligature.
Discussion: Bleeding problems in surgical patients are not uncommon and may occur for a variety of reasons if a bleeding disorder is suspected, a careful clinical history and examination make important contributions in reaching a diagnosis.in our study we find no significant intraoperative or postoperative bleeding occurs due to prolong bleeding profile so relevance of bleeding profile before adenotonsiilectomy is questionable.
Conclusion: The routine preoperative bleeding profile is not recommended in every patient undergo adenotonsillectomy operation unless past medical, family history or physical examination suggest bleeding disorders.

N-terminal Pro-brain Natriuretic Peptide in Apparently Healthy Smokers.

Al-Qadisiah Medical Journal, Volume 13, Issue 1, Pages 58-62

Background and objective
Smoking is a major cause of cardiovascular diseases. N-terminal pro-B-type natriuretic peptide (NT-proBNP) is a valid negative biomarker of left ventricular (Lv) dysfunction. The current study investigated whether smoking has an effect on NT-proBNP serum level.
Methods:
A total of 44subjects 22smokers and 22 non smokers as controls were enrolled in the study. History of cardiovascular or pulmonary disease was an exclusion criterion. Serum levels of NT-proBNP were measured using an enzyme linked immunosorbent assay.
Results:
Analysis of data showed that there was a significant difference (P < 0.05, in serum NT-proBNP between smokers and controls.proBNP were 410 and 111 pg/ml in smokers and controls, respectively. Also, serum NT-proBNP level correlated with both average number of daily cigarettes smoked and body mass index of smokers.
Conclusion
These results showed that smoking could increase serum levels of NT-proBNP. Accordingly, an elevated NT-proBNP could be a strong predictor of Left ventricular dysfunction in smokers

Detection of virulence factors of E.coli in patients with acute UTI

Al-Qadisiah Medical Journal, Volume 13, Issue 1, Pages 63-73

Aim: To define the most virulence factors of E.coli that causing acute urinary tract infection in some patients including diabetics, and showing the effect of this virulence on culture and sensitivity results in urine samples.
Patients and methods: 180 patients with age ranging from 18 up to 80 years of both genders with a features of acute UTI, E Coli was a causative agent found in 137 (76%) of them. Direct smear for microscopic features, culture urine samples on selective (Mackonky agar) and enrichment media (blood agar) to uptake standers colonies, then the bacterial was isolate and send for biochemical tests to identification the E.coli bacteria virulence factors then DNA samples using to detect virulence factors genes by PCR technique.
Result: 137 (76%) patients from 180 patients with acut UTI were causing by E Coli. The UTI shows that the youth age (20-30 years) and elderly age groups are more infected than others age group. Acute UTI are more commonly occur in female with a ratio about 72% of patients. Also UTI was more frequent in obese patients. 51 patients had poorly control diabetes mellitus. One or more of virulence factor genes were found in all patients while all virulence factor genes are seen in diabetic patients.
Conclusion: E.coli bacteria are more causative agent for UTI than other bacterial types and the virulancy of E.coli differ from patients to another as a result of chronic disease, pregnancy and other condition. Youth age group (20-30 years) are more exposure to infection with E.coli UTI , and the female had more chance for UTI than male.
Recommendation: Detection of virulence factors in infected individuals may be predict the response for treatment.

Aetiology of Hoarseness in Patients above 40 Years of Age

Al-Qadisiah Medical Journal, Volume 13, Issue 1, Pages 74-79

Objectives: this study is designed to determine the most common causes of hoarseness in patients above 40 years of age and the relationship between hoarseness causes and its duration.
Patient and Methods: the study is cross sectional study.
It considers 80 patients with hoarseness who were assessed between april 2011 and December 2011 at E.N.T. outpatient clinic ;department of otolaryngology in AL Diwaniya Teaching hospital. In AL Diwaniya city . Iraq.
Results :out of the 80 patients ,57 had hoarseness because of non neoplastic causes giving an incidence of 71,25% (infective laryngitis n= 23,28.75% ,acid laryngitis n =17,21.25% , allergic laryngitis n =13,16.25,% , vocal cord palsy n =2, 2.5,%, psychogenic n =2,2.5%, ) while hoarseness occured in the remaining 23 patients as aresult of neoplastic causes, giving an incidence of 28 , 75% (laryngeal carcinoma n = 12 , 15 % vocal cord polyp n =6 , 7.5 % ,vocal c. nodule n = 3, 3.75% ,laryngeal cyst n =1 ,1. 25%
granuloma n = 1,1.25% , benign tumor n = 0,0 %) we also found
that hoarse patients for aduration of more than one month were;
likely to have aneoplastic cause more than non neoplastic cause
Conclusions: the incidence of non neoplastic causes of hoarseness in patients more than 40 year old are more common than neoplastic causes.
Moreover. hoarse patients who have alonger duration of hoarseness have amore chance to have neoplastic cause than non- neoplastic cause.

PCNL under Ultrasound Guidance only in Al Diwaniya Teaching Hospital

Al-Qadisiah Medical Journal, Volume 13, Issue 1, Pages 80-91

Background: Urinary stone disease is a major health care problem due to its high prevalence and incidence. Percutaneous Nephrolithotomy (PCNL) is the preferred approach to large stones, stones in the lower pole, or stones that are resistant to less invasive technology. Fluoroscopy is commonly used imaging technique during PCNL. We evaluated the safety and efficacy of ultrasound guided PCNL for treatment of renal stones.
Aim of the study: to assess the safety and efficacy of ultrasound guided, as an alternative to radiographic guided, percutaneous nephrolithotomy in Al Diwaniyah Teaching Hospital.
Patients & Methods: 100 patients (62 males and 38 females) with renal stones were admitted to Al Diwaniya Teaching Hospital, urology unit were enrolled in this study From October 2013 to October 2015 All patients were evaluated by history, physical examination, laboratory investigation. The stone size, site, side, opacity and degree of obstruction were assessed by preoperative radiographic imaging studies, including IVU, ultrasound and computerized tomography (CT scan). PCNL has been performed under ultrasound guidance.
Results: The study revealed that the mid pole calyx was most commonly punctured (73%). Complete stone clearance was (84%). The average operative time was 71 ± 7.4 (45–110) minutes. The mean hospital stay was 3 ± 0.2 (2-5) days. With dual therapy (PCNL + ESWL/URS), stone clearance was (100%). No serious complications were encountered during the study.
Conclusion: PCNL under ultrasonography guide is an effective and safe method for renal stone treatment and is preferably replaced PCNL under fluoroscopic guidance.

Efficacy and Safety of a Single Rod – Contraceptive Implant (Implanon)

Al-Qadisiah Medical Journal, Volume 13, Issue 1, Pages 92-100

Background : Implanon is a subdermal contraceptive implant involves the delivery of a steroid progestin(68 mg of etonogesterel) from a single rod placed under the skin at the inner side of the non-dominant upper arm and the hormone diffuses out slowly at a stable rate providing contraceptive effectiveness for 3 years. Advantages of Implanon includes long term contraceptive action without requiring the user's or provider's attention , low dose of highly effective contraception without use of estrogen and fertility is readily reversible after the removal of implant.
Objectives: to assess contraceptive efficacy , safety and acceptability of Implanon .
Materials and methods: the study was conducted in Iraq- Al-Samawa and Al-Diwaniya maternity and pediatrics teaching hospital, family planning clinics and privet clinics from the period of October 2012 – October 2014 that includes 41 sexually active women 18-45 years seeking for contraception with normal menstrual cycles , no history of ischemic heart disease or stroke and no history of breast or genital tract malignancy.
Results: contraceptive efficacy of Implanon was 98% over 2 years follow up and the most common adverse experience was abnormal bleeding pattern in 100% of women ,as amenorrhea affects 51.22% , infrequent bleeding 26.82% ,prolonged bleeding 12.20% and metromenorhagia 9.76%.. Discontinuation rate was 2.44% because of menstrual bleeding abnormality. Other adverse experiences after Implanon insertion were weight gain of ≤ 5kg in7.32% after 2 years follow up , acne in 31.71% , mood changes in 21.95% and headache in 12.20%.
Conclusions: Implanon is a safe , highly effective and rapidly reversible new method of contraception and the safety profile is acceptable and not essentially different from progestogens in general.

Comparative study of Helicobacter pylori best diagnosis methods and the Effect of some Risk Factors associated with infection.

Al-Qadisiah Medical Journal, Volume 13, Issue 1, Pages 101-112

The present review is an attempt to find the best diagnosis method of H. pylori infection in patients with Peptic Ulcer Disease (PUD), as well as, determined the effect of some risk factors associated with this infection.
These prospective cesses included, Ten H. pylori isolates were isolated out of 110 tissue gastric biopsies specimens existed from the patient's stomach that were suffering from dyspeptic symptoms, whom attended to Gastroenterology Centre in AL-Yarmook Teaching Hospital. With an age range 15-85 years from both genders. These biopsies subjected to, bacterial Cutler test for investigate the presence of H. pylori spp. and other biopsy test is Urease test that was performed by Two methods (slant urea agar base and Rapid Urease Test Kit). A further 30 healthy volunteers individual, uninfected with H. pylori were involved as a control group. Besides that, 140 venous blood specimens were collected from patients and control group for Enzyme Linked Immuno Sorbent Assay, also for ABO blood group test. And the results obtained clearly showed increase the frequency prevalence of H. pylori distribution to reach 60 (54.55%) patients.

The validity of Immunohistochemical Expression of PTEN protein in detecting PTEN gene deletion in Prostate cancer.

Al-Qadisiah Medical Journal, Volume 13, Issue 1, Pages 113-124

PTEN gene is a tumor suppressor gene located in 10q23,3 that encode dual- specificity protein and lipid phospatase with tensin homologe. PTEN signaling regulate cell division and direct cells to enter natural cell death pathway. loss of PTEN leads to over –activation of AKt, which in turn , is associated with uncontrolled cell proliferation. In this cross section study, we examined 50 paraffin-embedded blocks belongs to 50 patients with proved prostate cancer, All slides subjected to IHC PTEN Ab to assess the expression of PTEN protein , and to molecular study of PTEN gene in all tissues by using CISH technique. The results show that 54.55% (6/11) of the heterozygous PTEN deletion had negative PTEN
protein expression, and the remaining cases 45.45% (5/11) had weak –positive PTEN expression , while all the cases of homozygous deletion of PTEN gene show negative PTEN protein expression.

Role of Cataract Surgery in IOP Lowering

Al-Qadisiah Medical Journal, Volume 13, Issue 1, Pages 125-129

Background:
Glaucoma is a neurodegenerative disease of the optic nerve, which can be pathologically explained either by direct ischemia by the intra ocular pressure or by direct pressure on the optic nerve fibers as they pass through the lamina cribrosa.
Glaucoma and cataract are frequently encountered in the same patient, there prevalence increasing with age.
Aim of the study:
Determine the effect of cataract surgery on level of intraocular pressure.
Patients and methods:
A prospective comparative study started since October 2012 until July 2015 eighty patients included of four groups 20 normal, 20 with pseudo exfoliation syndrome, 20 with pseudo exfoliation glaucoma, and 20 with primary open angle glaucoma (both types of glaucomas are controlled). Six readings IOP by Goldman applanation tonometry each included eye; one preoperative (phacoemulsification), one post operative 1 week, one month, three months, six month, and one year post operative.
Results:
All of the four included groups get lower intraocular pressure levels after cataract surgery

Multi-detector Coronary CT Angiography in Comparison with Invasive Coronary Angiography in the evaluation of Significant Coronary Artery Stenosis

Al-Qadisiah Medical Journal, Volume 13, Issue 1, Pages 130-140

Background: Multi-detector CT angiography (MDCTA) allows detection of coronary artery calcium (CAC) and after contrast injection, visualization of the coronary artery lumen. It is commonly assumed that the absence of coronary calcification makes the presence of obstructive coronary lesions highly unlikely. Coronary computed tomographic angiography (CCTA) is a promising way for diagnosis of coronary artery lesion; however, image quality is still impaired by motion artifacts and calcifications.
Objectives: To compare the ability of multi-slice coronary CT angiography (MSCCTA) with invasive coronary angiography (ICA) for detection of significant coronary artery stenosis.
Patients and methods: It is hospital-based cross sectional study, enrolled 65 patients who attended to Iraqi Center for Heart Disease (Baghdad) and Shaheed Al-Mehrab Cardiac Center (Babylon) from June-2012 to March-2015 complaining from chest pain and fulfill the appropriate use criteria (AUC) for CCTA. Patients who underwent MSCCTA, with lesions causing ≥ 50% stenosis were subsequently studied by ICA. A total of 450 native main vessels and secondary branches were analyzed by single blind observer.
Results: CCTA demonstrated a sensitivity, specificity, positive predictive value (PPV) and a negative predictive value (NPV), when compare with ICA, of 71.5%, 69.5%, 82.4%,67.12%; respectively for primary coronary arteries; and 56.25%, 97%, 62.5%, 95.25%, respectively for secondary coronary arteries. Overall sensitivity and specificity for all coronary arteries and their branches were 64% and 83.3% respectively; with a positive predictive value of 72.5%, and a negative predictive value of 81.1%.
Conclusions: The sensitivity, specificity, PPV and NPV of MSCCTA in the evaluation of significant coronary artery disease (CAD) were low compared with ICA.

The role of Laminin111 and Matrix metalloproteinase-2 Immunohistochemistry Expression in Prediction of Laryngeal Squamous Cell Carcinoma Prognosis

Al-Qadisiah Medical Journal, Volume 13, Issue 1, Pages 141-149

Objective: To investigate the role of laminin111 (LAM111) and matrix metalloproteinase-2 (MMP2) as a prognostic predictors in laryngeal squamous cell carcinoma (LSCC). Materials and Methods: The study was carried out on 30 patients with LSCC treated at the ENT Department, Al-Diwaniya Hospital in Al-Qadisiya province- Iraq. The clinical and histological data consisted of sex, age, site, clinical presentation, stage of the tumor, lymph node (LN) metastasis, and immunohistochemical studies (IHC). The IHC study was performed using anti LAM111and anti MMP2 monoclonal antibodies. Results: The majority of patients were above 50 years (73.33%), male affected more than the female with male to female ratio 2.8:1, 50% of tumors were located in glottic region, (86.67%) presented as mass. Most of the tumors were classified as well differentiated LSCC (53.33%), (76.67%) were recorded as negative LN metastasis, and 14 (46.67%) patients were in disease stage II. LAM111showed significant positive correlation with LN metastasis (P=0.027) and tumor stage (P=0.018), while MMP2 revealed significant positive correlation only with LN metastasis (P=0.029). There was a significant positive correlation between LAM111and MMP2 (P=0.014). Conclusion: Both LAM111 and MMP2 are poor prognostic markers for LSCC and predict LN metastasis.

Phylogenetic Analysis of MERSCoV in Human and Camels in Iraq

Al-Qadisiah Medical Journal, Volume 13, Issue 1, Pages 151-159

The present study was conducted to evaluate the genetic relationship among Middle East respiratory syndrome coronavirus (MERSCoV) of human and camels origin at the period from October 2015 to February 2016.One hundred samples were collected from camel and 100 from human. Nighty four from nasal swabs and six from oropharyngeal swabs Camel samples secerned by immunochromatographic assay (ICA) for detection of viral antigen. The total percentage of ICA positivity was 28%. Human and camel samples subjected to Revers transcription real time- PCR and carried out by RNA extraction by using specific primers and Taq- Man-Probe for detection of nucleocapsid gene 113 bp. The total positive result in camels were 15% ,there was no significant difference between sex and type of samples, in relation to the age group the results showed that age group more than ten years of camel was the heights percent. With significant difference at P<0.05. According to the months of the year October recorded the highest infection rate with significant difference at p<0.05. the result of RT-qPCR according to the regions of study showed that Al-shinafyah in western borders of Iraq-Saudi was the highest infection rate 35% .On the other hand ,100 human 81 nasal swabs and 19 bronchial lavage samples were collected from pilgrims and non-pilgrims. The total positive result was 5%. The pilgrims recorded the highest infection rate. The results of conventional PCR by using specific primers for detection of Nucleocapsid gene (217 bp) of MERSCoV. The results were confirmative. Three human and 11 camel positive samples were used in further sequencing and phylogenetic analysis by extraction and purification of the PCR products. Our clones sequence submitted in GenBank-NCBI for accession number.
The phylogenetic tree construction and analysis results showed that most of Iraqi variants of camel and human were located in clade-B in which Saudi Arabia strains were clustered. One of our clones (MERS-Iq.2Huh) of accession number KX150500.1 was located in clade-A in the same branch of Jordanian strain while bat corona virus, SARS corona and neoromica corona virus was out group clustered in separated branch.

Chromosomal Aberration Study of Human Lymphocytes exposed to Americium -241 in vitro

Al-Qadisiah Medical Journal, Volume 13, Issue 1, Pages 160-166

This study was intended to decide the impact of α-partcales for acceptance of chromosome deviation. The venous blood sample was drawn from 30 years old healthy male donor. The blood sample after cultured in RPMI was divided into two groups, the first was as control and the second was exposed to radiation from Am-241 to detect the effect of it on chromosomal aberration (CA). The cultures exposed to Am-241 have dicentric (52.8%), breaks (20%) , fragments(18.5%) and (6.8%) ring chromosomes . There was significant differences (p ≤ 0.5 ) compared with control sample. Dicentric show high percentage of chromosomal aberration compared with other CA. The mean of mitotic index (MI) and stander deviation was (2.212±2.236) for radiation exposed sample higher than that of control was(1.565±1.581). It has been concluded the exposure to low α-particales could caused chromosomal aberrations in human cells.

Evaluation of Retinal Changes in preclinical chlorouquine maculopathy using spectral domain optical coherence tomography

Al-Qadisiah Medical Journal, Volume 13, Issue 1, Pages 167-173

Purpose: evaluation of retinal changes using spectral-domain optical coherence tomography (SD-OCT) in early detection of Chloroquine maculopathy in Iraqi patients with rheumatoid arthritis (RA).
Methods: ninty six patients were included in this study .They were divided into two groups . First group compose of (46) patients with RA(rheumatoid arthritis) who received chloroquine therapy for more than two years. All patients had no clinical feature of Chloroquine retinopathy. Second group (control group)were (50)normal female. They were evaluated using SD-OCT.
Results:The mean central foveal thickness(CFT) was less in the Chloroquine group (228.94 µm ± 4.71) compare to normal controls (255.12 µm ± 11.54), which was statistically significant ( p value 0.001). The mean parafoveal thickness was thinner in the Chloroquine group than other group in superior,inferior and temporal quadrants .
Conclusions: In the preclinical stage, chloroquine toxicity might result in early thinning involving mainly central fovea and parafoveal zone ,this changes can be detected by SD-OCT

Improved endometrial thickness and vascularity following vitamins E and C administration in infertile women undergoing controlled ovarian stimulation

Al-Qadisiah Medical Journal, Volume 13, Issue 1, Pages 174-179

Background: The most frequently used treatment to induce ovulation is clomiphene citrate which, unfortunately has the disadvantage of causing impaired endometrial growth. For successful conception to be achieved, optimal endometrial conditions are mandatory. The idea of giving vitamin C and E to infertile women on clomiphene citrate has been raised in published literature; however the subject is still controversial.
Aim of the study: To study the effect of adding vitamins C and E supplementation to infertile women undergoing controlled ovarian stimulation, on endometrial thickness and vascularity.
Patients and methods: The present case control study included 80 infertile women visiting infertility unit at Maternity and children hospital / Al-Dewaniyha city/ Iraq. From June 2014 to June 2016. Their age range was 20 to 35 years. They were classified into two groups: the first one included 40 patients and were treated using combine therapy of clomiphine citrate and vitamin E and C and the second group included 40 infertile women treated with clomiphine citrate only.
Results: Median endometrial thickness was significantly greater in group 1 than that of group 2, 4.5 mm versus 3.1 mm on day 2 and 8.3 m versus 5.9 mm on day 12, respectively (P<0.001). Median endometrial vascular resistance was not significantly different in day 2; however it was significantly lower in group 1 compared to that of group 2 when assessed in day 12, 0.4 versus 0.6, respectively (P<0.001).

Distribution of Granulicatella adiacens and Porphyromonas gingivalis among ortho and non-orthodontic Patients with Gingivitis in Kufa City /Iraq.

Al-Qadisiah Medical Journal, Volume 13, Issue 1, Pages 180-196

This study aimed to investigate the distribution of Granulicatella adiacens and Porphyromonas gingivalis and the role of orthodontic wire on antibiotic resistance pattern of bacterial isolates. A total of 78 gingival swab samples have been collected from patient with orthodontic wires suffering from gingivitis and 71 samples were collected from healthy without orthodontic wire during four months from private dental clinics.
The results of isolation and identification of bacterial isolates by using culture and conventional biochemical tests as well as molecular technique using 16S rRNA for detection of G. adiacens and insertion seqence element IS1126 for detection of P. gingivalis showed that 54 (29.6%) isolates were belong to G adiacens and 4 isolates were belong to P gingivalis.
To explain the role of orthodontic wires on bacterial isolates a mutation experiment was carried out. The result showed the same change has been obtained when using both NiTi and stainless steel wire on G. adiacens and P. gingivalis after 24hr-96hr of incubation. Antibiotic resistance pattern of both original and treated isolates with NiTi and stainless steel showed increased in antibiotic resistance to bacitracin, ceftazidim, ogmentin, and erythromycin while other antibiotic remain sensitive such as cefotaxim and amikacin for all isolates.

Platelet-rich plasma as a treatment for DE Quervain's Disease

Al-Qadisiah Medical Journal, Volume 13, Issue 1, Pages 197-201

platelet-rich-plasma is increasingly used in De Quervain's Disease. This study show the clinical outcomes of a single PRP injections.my study was done between Dec. 2015 and Oct. 2016, thirty patient receive single injection of platelet-rich –plasma All patients underwent prospective clinical evaluation, including visual analog scale (VAS) for pain for six month follow up .most of the patient (VAS) significantly improve from 5.9,to 2.0 (p > 0.05) after injection with platelet-rich –plasma .
PRP injections in De Quervain's Disease showed better improvement in outcomes .

Synthesis and Characterization of Copper (II ), Zinc (II ),Cobalt (II) and Nickel (II) complexes Derived from2-Hydroxy-1-naphthaldehyde and DL- glycyl-DL- glycin

Al-Qadisiah Medical Journal, Volume 13, Issue 1, Pages 202-207

Copper (II ) , Zinc (II ) , Cobalt (II) and Nickel (II ) complexes with the Schiff base derived from 2-Hydroxy-1-naphthaldehyde and DL-glycine -DL-glycine were synthesized.These compounds have been characterized by elemental analysis , conductivity measurement, IR and UV-Vis.The molar conductance measurement indicate that the complexes are 1:1 non-electrolytes. The IR data demonstrate the tetradentate binding of the ligand .The COO- stretching bands in the IR spectra suggest that carboxylate acts as a monodentate group when binding with metal . The bonding sites are the carboxylate oxygen , imino nitrogen , amide nitrogen , and phenolic oxygen.

Optimization of silver nanoparticle biosynthesis process using cell-free filtrate of Aspergillus niger.

Al-Qadisiah Medical Journal, Volume 13, Issue 1, Pages 208-222

Nanotechnology and nanoparticle (NPs) research has attracted a lot of interest in recent decades, and there is growing attention to find more effective ways for their synthesis. The use of biological organism as bionanofactories provides a clean and promising alternative process for the fabrication of silver nanoparticles. This study confirmed the production of silver nanoparticles (SNPs) by a cost effective, safe and environment-friendly technique using silver nitrate and cell free filtrate of the fungus Aspergillus niger as the reducing agent. The optimization of different parameters, including the culture media, pH, reaction temperature, concentration of silver nitrate solution and reduction time, were carried out to achieve better control of size, shape, stability, and to increase the yield of SNPs production. The UV-visible spectrophotometric analysis of the biosynthesized silver nanoparticles by Aspergillus niger cell-free filtrate showed characteristic surface plasmon absorption peak at 420 nm. The presence of proteins as viable reducing agents for the formation and stability of SNPs was recorded using Fourier transform infrared spectroscopic analysis (FTIR) .Further scanning electron microscopy (SEM) micrograph showed the formation of spherical, well-dispersed nanoparticles with size ranging between 15 and 50 nm in diameter. The element composition of the mixture sample was obtained from the Energy Dispersive Analysis of X-ray (EDX). It concluded that the optimum condition for biosynthesis of SNPs were the use of Potato dextrose broth medium at pH 9, 30°C for 120 h with 1mM silver nitrate.

Use of isotretnion to decrease recurrence of chalazion

Al-Qadisiah Medical Journal, Volume 13, Issue 1, Pages 223-228

Chalazion; is a nodular swelling occur as a result of accumulation of sebaceous secretions from abnormally functioned sebaceous glands situated in the eye lid causing ocular surface problems like dryness , irritation and refractive error due to pressure effect on the cornea in addition to cosmetic blemish ,topical treatment usually ineffective so we do surgical drainage . isotretnion is one derivatives of retinol a chemical name of the essential micronutrients vitamin A which have important role in human reproduction and development in addition this drug is well known by dermatologist and it is commonly used for treatment of seborrhea and other skin problems related to sebaceous glands.
This present cross sectional study was done at AL-Diwaniah teaching hospital(ophthalmology department) at AL-Diwaniah city from September 2014- January 2017 ,110 patients (63 female,47 male) ,between 17-35years old are involved in this study attend ophthalmological department complaining from recurrent (or multiple) chalazion ,those patients had been given isotretnion orally a dose of 20 mg/day for10 - 12 weeks and followed for 6-12 months for re appearance of chalazion the result show decrease in the recurrence rate of chalazion with improvement in the tear film quality and ocular lubrication

Changes in the Superior Zygapophyseal Joints in the Lower Thoracic and Upper Lumbar Vertebrae in Babylon Population

Al-Qadisiah Medical Journal, Volume 13, Issue 1, Pages 229-236

Background: The articular processes of the vertebral column play a role in weight transmission as well as in governing the range and direction of movement between two vertebrae. The pattern of changes of orientation of these particular processes from thoracic to lumbar type was seldom mentioned in anatomical textbooks.
Objective: to study the pattern of changes of zygapophyseal joints in local citizen in Babylon Province.
Methodology: 140 persons (80 female and 60 male) aged 20-66 years (mean 46.84± 14.438) attending to radiology department in Marjan Teaching Hospital, Babylon, Iraq, were participated in this study, they were investigated to be free from any congenital anomaly or pathological change. Using computed tomography with axial sections, the lower four thoracic and upper lumbar vertebrae. The zygapophyseal joints were carefully observed to detect the site of changes in orientation from thoracic to lumbar type.
Results:
The present study revealed that there were two types of change in the orientation of zygapophyseal joint were observed; gradual and sudden.
21.42% of subjects showed gradual changes in orientation of zygapophyseal from thoracic type to lumbar type, with female ratio higher than male. The transition started mainly at T11-L2, some subjects showed transition at T12-L2.
While 78.58% of subjects showed sudden changes; mainly at T12-L1, and to a lesser extent at T11-T12.
Conclusions:
In the group of people who were studied it was clear that the change of the superior zygapophyseal joint from flat, posterolaterally oriented which is thoracic type to curved, posteromedially oriented which is lumbar type is more likely to occur as sudden change rather than the gradual change which observed in about one-fifth of the population.