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VOL. 8(4), 2010, 1431H ISSN 1608-8360

The Official Journal of the Iraqi Board for Medical Specializations

General Supervisor: Nazar B. Elhassani

Editor - in – chief: Zakaria Y. Arajy

Editorial board

Nazar B. Elhassani Misaied Lafta H. Al-Badri

Zakaria Y. Arajy Neda Salih Amen

Raja Kummoona Dawood Sadik Al-Obidi

Safa M. Al-Obaidi Raji H. M. Al-Hadithi

Khalifa E. Sharquie Samir H. Aboud

Rajaa' M. Hassan

All articles published represent the opinions of the authors and do not reflect official policy of the journal. All rights are reserved to the Iraqi Postgraduate Medical Journal. No part of the Journal may be reproduced or transmitted in any form or by any means, electronic or mechanical, including photocopying, recording, or via any storage or retrieval system without written permission from the journal. Publication Office: Ipmj, Iraqi Board for Medical Specializations Iraq P.O. Box; 5116 Tel; 00964-1-4140664, Fax: +00964-1-4140664 www.geocities.com/usamarifat/Iraqi_Journal.html E-mail: IPMJ 2000@ yahoo.com

VOL. 8(4), 2010, 1431H ISSN 1608-8360

The Official Journal of the Iraqi Board for Medical Specializations

National Advisory Board

Abdul Monaf Al -Jadiry Khalil Al -Shaikhly

Adil S. Abdul- Ghafor Maad M. Abdul Rahman

Ala H. Bashir Miqdad A Al -Ani

Amer Al-Hashimi Mohammed H. Al-Eshaiker

Amjad Daoud Niazi Mudher A. Amin

Abdul Baki M. Raof AL-Khatib Najim A. Al -Ruznamaji

Bassam A. Al-Brazanchee Saad H. Al Witri

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Hussam Al-Chermookly Waleed G. Al-Tawil

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Kais Kubba Reyad Al- Azzawi

International Advisory Board Farhan Bakir - U.S Mohammed El Kabroun - Libya

Abdullah Al-Qudah - Jordan Munthier Al-Doori - U.K

Fadel Derry - U.K Nizar Abbas - Syria

Ismail Al-Jalili - U.K Salam S. Daradkeh - Jordan

Mahir Al-Housami - Syria Tareq S. Al-Saody - Sweden

Marita Eisenmann klien - Germany

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List of Contents Volume 8 . (4).2009

Effect of Very Early Atorvastatin Initiation for Acute Myocardial Infarction on Creatine Kinase Release

Faris Abdul Kareem, Lewai S. Abdulaziz , Adnan A. Al.Adeem …309-313.

Experience in ICD Implantation and Follow –up in IBN Albitar Hospital Ali Abdul Ameer Mohammad , Kasim Abbas Ismael , Muthana Hameed Al-Qurashee , Ameer Rahman Bearm , Kasim Mohammad Jumaa Al-Doori …314-317.

Relation of Immuno- Inflammatory Markers (IL-6, CR Pand ESR Value) with Prediction of Ischemic Heart Disease

Mahdi Haider Al-Najy , Ikbal Khider Al-Joofy…318-322.

The Value of Using Echocardiography in Patients of Advanced Liver Disease with Cardio Pulmonary Complications

Basil. N. Saeed , Sameer Hakeam , Lutf Ahmed , Jalal Ahmed …323-326.

The Prevalence of Weight Loss Assessed by Body Mass Index in Patients with Stable Chronic Obstructive Pulmonary Disease

Kassim .M. Sultan, Muhammed .W.Al.Obaidy , Alaa. I.Hussein …327-331.

Scarring and Non Scarring Facial Acne Vulgaris and the Frequency of Associated Skin Diseases Khalifa E. Sharquie , Khalil I. Al-Hamdi , Adil A. Noaimi , Razan A. Al-Battat …332-338.

A Study on Humoral Immunity and Oral Bacterial Diversity in Patients with Trichomonas Tenax Infection Batool M. Mahdi , Waffa Hazim , Bassma Mekii , Ali Ghalib M. Mahdi , Mazin K. Ameen …339-343. The Lipid Profile in Children with Type 1 Diabetes Mellitus in Erbil Governorate

Abbas A. Alrabaty , Abdulkader A. Alnakshabandi , Nazar B. Yahya … 344-349.

Kerosene Poisoning In Children

Mahjoob Al-Naddawi , Mohammad Abdul-Qader Al-Chalabi, , Khawla Mohammad Kamil …350-355.

Cytogenetic Response of Peripheral Blood in Chronic Myeloid Leukemia Patients Treated with Imatinb Maysaa Abdul Razaq Dhahi, Daad Imad , Nidhal Abdul Mohaymen ,Nabeel Salman Murad …356-362.

Comparative Study between Ileo Colic Pedicle Versus Superior Mesenteric Pedicle Division for Mesenteric Lengthening Ibtesam Khalid Salih Al-Shadydy …363-367.

Computed Tomography Performance in Renal Cystic Diseases

Haider Qasim Hamood …368-374.

Study of Risk Factors for Breast Cancer in A Hundred Breast Cancer

Sroor Mahdi , Hassan Hadi Baker , Kholod Daher Habeeb… 375-379.

Indications of IV Fluids in Medical City

Bassam Hameed Al-Jarrah, Zeena Muthafer Al-Nema …380-383.

Postoperative Urological Complications of Renal Transplantation; Al Karama Hospital Experience

Yousuf M. Alhallaq, Shawqi Ghazala, Mohammad Batal, Ausama S. Abdul Muhsin …384-386.

Effectiveness of Immediate Mitomycin C Instillation in Patients with Low Risk Non-Muscle Invasive Bladder Cancer Usama Sulaiman Al-Nasiri , Wisam Ali Kareem …387-392. Evaluation of Focused Abdominal Sonography for Trauma (FAST) in Baghdad Teaching Hospital

Raed J .Wiwit , Saad Abdulla Ibrahim Sarsam , Salah M.Tajer ... 393-397.

Role of Antioxidant on Nephropathy in Alloxan Induced Diabetes in Rabbits

Israa F. Jaffar Alsamaraee , Huda Arif Jasim …398-402.

THE IRAQI POSTGRADUATE MEDICAL JOURNAL VOL.8, NO.4, 2009


Effect of Very Early Atorvastatin Initiation for Acute Myocardial Infarction on Creatine Kinase Release

Faris Abdul Kareem*, Lewai S. Abdulaziz **, Adnan A. Al.adeem***

PATIENTS AND METHODS:

Patients with AMI, admitted to Al-Kindy teaching hospital cardiac care unit (CCU) from February 2007 through February 2008, who fulfilled the following criteria, were included in the present study: (1) not on concomitant statin therapy before admission; (2) no history of myocardial infarction; (3) normal serum CK level on admission, followed by elevation of CK to more than the upper limit of normal; (4) finally to circumvent incomplete

ABSTRACT: BACKGROUND: It have been suggested that pre-treatment with a statin agent prior to myocardial infarction limitsmyocardial creatine kinase release, and thus may act to limit myocardial infarct size in humans. OBJECTIVE: To examine the effect of very early statin initiation for AMI, to the extent of myonecrosis as manifested by peak serum creatine kinase levels. MEHTODS: Patients with AMI admitted to Al-Kindy teaching hospital cardiac care unit from February 2007 through February 2008, who fulfilled the inclusion criteria cited in the present study, were randomly assigned into two study groups. The statin group patients have received a single oral dose of 40 mg atorvastatin at time of admission and repeated for the next days until discharge, patients not receiving statin serves as controls. Blood samples were obtained upon admission and every 8 h for another three consecutive samples to identify peak creatine kinase levels. RESULTS: Patients who had statin therapy initiated immediately after hospital admission have similar peak creatine kinase concentrations as compared to those not receiving statin therapy (1020 ± 621 IU/L vs. 911 ± 591 IU/L ; P= 0.332). CONCLUSION: Statin initiation in AMI patients fails to show any observable effect on creatine kinase release, which can be attributed to the need of an extended period for the statin agent to achieve the predictable outcome and suggesting the necessity of statin pretreatment in patients at high risk for AMI KEY WORDS: atorvastatin, AMI, CK, infarct size.




Experience in ICD Implantation and Follow-up in Ibn- Albitar Hospital

Ali Abdul-Amir M. Al-Musawi , Kasim Abbas Ismail , Muthanna Hameed Al-

Quraishi , Amjad Rahman Bairam , Kassim Mohamad J. Al-Doori

ABSTRACT: BACKGROUND: Survivals of sudden cardiac death (SCD) episodes have recurrence rate of 30-50% within two years, with malignant ventricular arrhythmias most often responsible1, 2. The overall survival rate for SCD in USA is 5%. Ninety-five percent of patients suffering their initial event fail to survive to become candidate for secondary prevention1.Because of the wide spread acceptance of implantable cardioverter defibrillator ( ICD ) as a method treating the survivals of SCD, attention has turned to primary prevention 1. Implantable cardioverter-defibrillator (ICD) is highly effective in primary and secondary prevention of SCD due to life threatening ventricular tachycardia (VT). OBJECTIVE: To register and interpret the results of implantation and follow-up of ICD during the period between 2002-2007 in Ibn Al-Bitar hospital. METHODS: Sixty patients with standard indications for ICD; data were pooled from patients history, ECG, Echocardiography, Holter, blood investigation and coronary angiography.75% males and 25% females.After implantation, class III anti-arrhythmic drugs (Amiodarone) were stopped, except for patients with a history of supraventricular tachycardia or recurrent VT. RESULTS: Coronary artery disease (CAD) was the most common presentation of patients for whom implantation was done; coronary artery disease (CAD) 43%, dilated cardiomyopathy (DCM) 26%, and hypertrophic obstructive cardiomyopathy (HOCM) 16%. Sixty-three of them had moderate-severe LV dysfunction (LVEF<40%). Recurrent VT was the most common cause of implantation (76%). Primary prevention was aimed in (60%) of patients and secondary prevention in 40%. Sixty percent of those with ICD implanted due to primary prevention fulfil MADIT II (Multicenter Automatic Defibrillator Implantation Trial II) criteria. The majority of patients had structural heart disease. Most non-sustained VTs reverted to sinus rhythm by antitachycardia pacing (ATP) therapy from ICD (90%).All VF events reverted to sinus rhythm by high energy shock from ICD devices. CONCLUSION: ICD is highly effective in primary and secondary prevention of life threatening VT/VF. KEY WORDS: CAD: coronary artery disease, ICD: implantable cardioverter-defibrillator, SCD: sudden cardiac death, VT: ventricular tachycardia.




Relation of Immuno-Inflammatory Markers (IL-6, Crpand ESR Value) With Prediction of Ischemic Heart Disease

Mahdi Haider Al-Najy *, Ikbal Khider Al-Joofy **

ABSTRACT: BACK GROUND: Ischemic heart diseases (I.H.D) become more common during 21st century as the dominant chronic diseases in many parts of the world, and it is predicted to be become the main causes of disability and death world wide. Many factors play a role in pathogenesis of I.H.D among those could be immuno-inflammatory markers which may lead to development of this disease. OBJECTIVE: The present study was conducted to obtain more clarification about the impact of some immuno-inflammatory markers (IL-6, CRPand ESR value) on the clinical expression of heart disease among Iraqi patients. METHODS: Hundred Iraqi patients with I.H.D (80 male and 20 female) ages ranged from 20 to 80 year were involved in this study, including 4 subgroups: 17 with heart failure (H.F). ; 26 with myocardial infraction (M.I); 12 with stable angina (S.A) and 45 with unstable angina (U.A) who was attending the Iraqi center for heart disease and Baghdad hospital from December 2006 to march 2007. Using enzyme amplified sensitivity immuno assay (EASIA) technique to measure the level of IL-6, and enzyme linked immunosorbant assay (ELISA) technique to measure the levels of CRP, in addition to westergren method to determine ESR were done for both patients groups and healthy control group. RESULTS: Significant increased (p<0.05) in the serum level of IL-6 in all patients subgroups: MI, HF, UA, and SA. Respectively compared with control group, also all patients subgroups: SA, HF, MI, UA, consequently revealed significant increased (p<0.05) in the mean of CRP concentration compared with control group. Moreover, highly significant elevated (p<0.01) in the erythrocyte sedimentation rate (ESR) value in the patients subgroups: SA, UA, MI, HF respectively compared with control group. CONCLUSION: Elevated levels of inflammatory markers, particularly CRP and IL-6 are a relatively strongly predictor of I.H.D and in one way or another ESR value and CRP level reflect the degree of the inflammatory status of these diseases. KEY WORDS: ischemic heart diseases, inflammation, IL-6, CRP, ESR.




The Value of Using Echocardiography in Patients of Advanced Liver Disease with Cardio Pulmonary Complications

Basil. N. Saeed *, Sameer Hakeam**, Lutf Ahmed**, Jalal Ahmed**

ABSTRACT: BACKGROUND: Patients with chronic liver disease are liable to get cardio – pulmonary complications, one of these complications is development of pulmonary hypertension ranging from mild to it's sever form – this complication could give some abnormal findings in chest x-ray, electrocardiography but more prominently by echocardiography. OBJECTIVES: To clarify the benefit of using the echocardiogram is detecting pulmonary hypertension prior to the use of invasive methods (catheterization) in patients with advanced liver disease. METHODS: A total of 50 patients with chronic liver diseases (cirrhosis, chronic active hepatitis) their age range is (25-70 years) (mean are 37.07 years), the fifty patients were free from any cardiac or respiratory diseases.The study extending from December 2007-August 2008. All patients went through full history and routine blood test: including complete blood picture, fasting blood sugar, blood urea & screatinne, lipid profile, liver function tests, clinical examination, and investigations included routine blood test, chest x-ray, and electrocardiography, echocardiography (Transthoracie and transoesphageal). The child-Pugh score used for assessing the severity and prognosis of chronic liver disease and it classified into three groups (A, B, C) used in this study. RESULTS: Fifteen patients from the 50 cases (30%) only proved to have cardio-pulmonary changes (i.e. pulmonary hypertension right ventricular hypertrophy and dilatation with the mean value of ≥ 25mm Hg at rest or ≥ 30mm Hg during exertion) those patients were having fatigue in (70%) of them while dysponea, chest pain, cyanosis, syncope were detected in 30%, 10%, 1%, 2% respectively in those cases of pulmonary hypertension with chronic liver disease. CONCLUSION: The use of non invasive methods especially echocardiography were helpful in detecting the presence of pulmonary hypertension in patients with chronic liver disease. KEYWORDS: echo, chronic liver disease




The Prevalence of Weight Loss Assessed by Body Mass Index in Patients with Stable Chronic Obstructive Pulmonary

Disease Kassim M. Sultan*, Muhammed .W.AlObaidy **, Alaa. I. Hussein **

ABSTRACT:BACKGROUND: The association between chronic obstructive pulmonary disease (COPD) and weight loss has long been recognized and is a common clinical observation and it is one of the systemic manifestations of COPD. A number of studies have identified weight loss and low body mass index (BMI) as independent predictors of mortality and worse prognosis. OBJECTIVE: We have undertaken this study to confirm the association between BMI, weight loss and COPD and the relation to its severity. METHODS: A cross section study of 100 patients with stable COPD have been identified and classified according to Global initiative for Chronic Obstructive Lung Disease (GOLD) guideline. BMI have been calculated according to the formula: BMI=Body Weight (kg)/Height2 (kg/m2) Subjects; were classified according to the BMI in to three groups using World Health Organization guideline: underweight, normal weight and overweight also classified as current cigarette smokers and ex smokers. RESULTS: It had been shown in this study that the underweight more common in COPD (23%),compared with the control subjects only (7%).low BMI significantly associated with more severe stages of COPD and in current smoker than in Ex-smoker and with increase in age ,but there is no significant difference between gender and nutritional status . CONCLUSION: Weight loss is a prevalent condition in patients with COPD and BMI can be used to assess this relationship there was an interaction between smoking habits and BMI in COPD patients. BMI correlates well with FEV1 and COPD severity and can be used by every clinician because it is a simple, inexpensive, readily available tool. KEYWORDS: chronic obstructive pulmonary disease (COPD), body mass index (BMI).




Scarring and None Scarring Facial Acne Vulgaris and the Frequency of Associated Skin Diseases

Khalifa E. Sharquie *, Khalil I. Al-Hamdi **, Adil A. Noaimi ***, Razan A. Al-Battat ****

ABSTRACT: BACKGROUND: Acne vulgaris(AV)is chronic inflammatory disease of pilosebaceous unit of young people. Patients with acne with or with out scarring might differ in regard to their immunological background from those free from acne. OBJECTIVES: To evaluate the problem of facial AV especially patients with scarring and to determine the frequency of associated skin diseases and to be compared with acne free control. METHODS: A cross sectional randomized controlled epidemiological study was conducted from Oct.2005-Oct.2006.Three hundred students from Basra University; 132 (44%) males and 168 (56%) females were enrolled, their ages ranged from 18-25 (20.9±1.8) years. They were divided into: Group A those free from acne (98 individuals),Group B with non scarring facial AV (96 patients), and Group C with scarring facial AV (106 patients). History and examination were done for their acne, scarring acne and associated skin diseases. Allen and Smith grading system for AV were used, and a new invented multiparametric scoring system for scarring acne was applied. RESULTS: AV was in 98(73.24%) males and 104 (61.9%) females. Scarring was 54 (50.95%) males and 52 (49.05%) females. Greasy skin was the most common type among Group B 67 (69.8%) versus 39 (39.8%) among Group A(P=0.000029) and was more common among Group C 84(79.2%) (P=0.00000001).Family history of AV was nearly similar in A and B Groups 55(57.29%) and 56 (52.83%) respectively, while in Group A was 39 (39.79%). Family history of scarring acne was in 35(33.02 %) of Group C, 16 (16.66 %) of Group B, and 3 (3.1%) in Group A; (P=0.00000017). The age of onset was similar in A and B Groups between 15-16 years. Majority of patients in Group B had non inflammatory type or mild inflammatory (papular) 65 (67.8%) patients, most of case were mild and moderate 86 (89.58%) patients, while high percent in Group C had inflammatory type 95 (89.62%), and more than half of them had severe and very severe types upon grading 56 (52.8%). The aggravating factors were similar in A and B Groups with stress and hot weather being the leading aggravating factors. Squeezing and digging habit was in 53 (50%) in Group C versus 23 (23.95%) in Group B(P=0.00024). In most cases of scarring acne, scarring was mild and moderate 85 (80.19%), and the most common type scars was the flat hyperpigmented [50 (47.17%) and 66 (62.26%) respectively].The most common effect of scarring acne on psyche was mild discomfort and mild dysmorphophobia 75 (70.75%).Associated skin diseases were more common among Group A 31 (31. 63%) than among Group B 22 (22.91%) and least common among Group C 14 (13.20%) (P=0.0067) and they were mainly dermatitis and skin infections. CONCLUSION: AV might reflect the immunological status especially among patients with scarring. The frequency of skin diseases was much less among patients with scarring acne. KEY WORDS: acne, skin diseases, immunity, scoring system for scarring acne.



A Study on Humoral Immunity and Oral Bacterial Diversity in Patients with Trichomonas Tenax Infection

Batool M. Mahdi*, Waffa Hazim*, Bassma Maki**, Ali Ghalib M. Mahdi***,

Mazin K. Ameen****

ABSTRACT:BACKGROUND: Trichomonas tenax (T tenax) is a protozoan that inhabit the oral cavity of poor oral hygiene. It is found in the dental caries, tartar and periodontal area. It feed on the normal flora of the mouth. It had been found to cause pulmonary infection and respiratory diseases in immunocompromised patients and patients with advanced cancer. OBJECTIVE: To determine the humoral immune response to Trichomonas tenax and studying if there is any relation with specific bacteria. METHODS: Forty patients who consult Al-Kindy Teaching hospital –maxillofacial and dental department from June-2008 to January -2009.Two gingival swabs were taken from those patients, one examined directly for the presence of T tenax by light microscope and other swab was cultured on Blood, Chocolate and MacConkey's agar for isolation of oral bacteria. Blood was collected from patients for estimation of serum IgG, IgA, IgM, C3 and C4 levels by using radial immune diffusion method. RESULTS: The study group consists of forty individuals, their ages range from 6-65 years. Male more than female (22:18), thirty of them was smoker, 25% of them were positive for T tenax. The types of bacteria that were isolated are a normal flora of the mouth like Streptococcus viridans. In spite of the level of Immunoglobulins and complement in both groups lie within normal values, there was a significant increased in serum IgM level and significant decreased in serum IgG, IgA, C3 and C4 level. CONCLUSION: There was increased in the prevalence of T tenax infection due to low social class and low oral hygiene .There was no specific bacteria that was confected with it. Lastly, increased in T tenaxinfection when there is an immune suppression as in advanced cancer patients and on radiotherapy and or chemotherapy. KEY WARDS: trichomonas tenax , immunity, bacteria.



The Lipid Profile in Children with Type 1 Diabetes Mellitus in Erbil Governorate

Abbas A. Alrabaty*, Abdulkader A. Alnakshabandi**, Nazar B. Yahya***

ABSTRACT: BACKGROUND: Diabetes Mellitus is the most common endocrine-metabolic disease in children. Diabetic patients with hyperlipidemia frequently develop atherosclerosis which is an important cause of morbidity and mortality.OBJECTIVE: The aim of this study was to evaluate serum lipids total serum cholesterol, total serum triglyceride (TGs), High density lipoprotein (HDL-C), Low density lipoprotein (LDL-C) and very low density lipoprotein (VLDL-C) in children with type-1 diabetes mellitus in comparison with controls, and to determine the relationship of lipid profile with gender, body mass index (BMI) and duration of diabetes among patients. METHODS: In this case-control study, the lipid profiles of 52 patients aged 6-18 years (27 males 25 females) with established type 1 diabetes were compared with those of 52 healthy controls of the same age and gender from the first of December 2007 to the 29th of February 2008. RESULTS: The lipid profiles of patients with type 1 diabetes mellitus showed the following values, the mean total serum cholesterol 175 ± 55 mg/dl, total serum TGs 140 ± 135 mg/dl, HDL-C 59 ± 19 mg/dl, LDL-C 93 ±51 mg/dl and that of VLDL-C 23 ± 13 mg/dl, whereas for the controls they were 136 ± 34 mg/dl, 74 ± 25 mg/dl, 53 ± 15 mg/dl, 68 ± 30 mg/dl and 15 ± 5 mg/dl respectively. CONCLUSION: The abnormalities in lipid profile regarding total serum cholesterol, total serum TGs, LDL-C and VLDL-C showed that they were significantly higher in diabetic patients than in control group, while HDL-C although it was higher among diabetic patients, but it was not statistically significant. Total serum TGs was significantly increased with the duration of diabetes. KEYWORDS: diabetes mellitus-lipid profile-BMI.



Kerosene Poisoning In Children

Mahjoob Al-Naddawi*, Mohammad Abdul-Qader Al-Chalabi **, Khawla Mohammad Kamil ***

ABSTRACT: BACKGROUND: Accidental kerosene ingestion is the commonest cause of poisoning and its subsequent mortality and morbidity in children less than five year of age in developing countries. Low socio- economic status and frequent use of kerosene for cooking, lighting and heating are the major cause. OBJECTIVES: To study the epidemiology, presentations and radiological appearance of kerosene poisoning in children. METHODS: A prospective study comprised fifty patients, who were admitted with accidental kerosene poisoning into children welfare hospital in medical city complex /Baghdad. In the period from the 1st of January to the 31st of august 2008. History was taken from the relatives on a specially designed questionnaire. Every patient was examined completely concentrating on symptoms of cough, dyspnea, cyanosis, drowsiness, vomiting, and fever. Chest X-ray was done to every patient after 6-8 hours from the time of ingestion. White blood cell count was done to 39 patients within the 1st 24 hour of admission. Fisher's exact test was considered for the statistical analysis with a significance level of P < 0.05. RESULTS: Of the fifty admitted children, 86% of them aged between 1-3 years, 31(62%) were boys, the majority from poor and crowded families, and the kerosene ingested, in the majority, from small containers. The most common presentations were cough (96%), fever (94%) and dyspnea (80%).Vomiting which occurred in 90%, had a significant association with the development of pneumonitis the major radiological abnormality was right lower lobe infiltration in 16 patients (32%). The major complication was pneumothorax, pleural effusion and respiratory failure. Fever appeared in 94% of the patients in the first 24 hours, lasting 2-7 days. Pneumonitis occurred in 42 patients who were diagnosed clinically and radiologically. All patients improved except one who died. CONCLUSION: All the kerosene poisoning was accidental, occurred in children under five year of age. Ignorance and poor storage of kerosene played a big role in the kerosene ingestion process. The respiratory system is the main target involved. Vomiting playing a role in the development of pneumonitis. KEY WORDS: kerosene, hydrocarbon, children, pneumonitis, vomiting.



Cytogenetic Response of Peripheral Blood in Chronic Myeloid Leukemia Patients Treated With Imatinb

Maysaa Abdul Razaq Dhahi*, Daad Imad**, Nidhal Abdul Mohaymen* ,

Nabeel Salman Murad**

ABSTRACT: BACK GROUND: Chronic myeloid leukemia (CML) is a stem cell disorder associated with an acquired chromosomal abnormality, Philadelphia chromosome (Ph), which arises from the reciprocal translocation of part of long arm of chromosome 9, in which proto-oncogene ABL gene (ablson) is located, to long arm of chromosome 22, in which BCR gene (break point cluster region) is located forming BCR-ABL fusion gene. The suppression of BCR-ABL is likely to be crucial for therapeutic success. The development of the BCR-ABL-targeted Imatinib mesylate represents a paradigm shift in the treatment of CML. OBJECTIVE: This is a prospective study designed as a try to apply cytogenetic technique as a conformational diagnosis of Philadelphia chromosome (Ph) in CML patients and also, to follow up CML patients treated with imatinib mesylate (IM) for assessment of cytogenetic response of peripheral blood at different IM treatment duration. METHODS: Prephral blood samples were collected from CML patients every 3-6ms. At first, (310) prephral blood(PB) samples related to 135 CML patients were cultured but only 181(58 %) cultures related to (42) patients were successful (gave obvious metaphases). The degree of cytogenetic response of peripheral blood was quantified according to the proportion of Philadelphia chromosome positive metaphases. RESULTS: The results showed that (64.28%) of CML achieved major peripheral blood cytogenetic response while (35.71%) achieved partial cytogenetic response. CONCLUSION: Conventional cytogenetic karyotyping is necessary for Ph–chromosome detection and also, as an assay for periodical assessment of cytogenetic response in CML patients treated with imatinib. Imatinib has resulted in cytogenetic responses in first line IM treated patients and in those who have failed previous IFN-α therapy and in CML patients at early and late chronic phase. KEYWORDS: chronic myeloid leukemia-philadelphia chromosome-imatinib-cytogenetic response.



Comparative Study between Ileo Colic Pedicle Versus Superior Mesenteric Pedicle Division for Mesenteric

Lengthening

Ibtesam Khalid Salih Al-Shadydy

ABSTRACT: BACKGROUND: Lengthening of the mesentery by vascular division may be necessary to perform an ileal pouch anal anastomosis without tension. Our objective is to compare the increase in mesentery length after division of ileo colic pedicle (ICP) and the superior mesenteric pedicle (SMP). OBJECTIVE: Was to compare the increase in length of the mesentery after division of the (ICP) and after division of the (SMP). METHODS: Total colectomy was performed in (14) patients. Which were then randomly divided into two groups. Pouch anal anastomosis was performed with division of the (ICP) in one group of seven patients and with division of the (SMP) in the other. The ileum was measured and the increase in length was recorded and compared statistically. RESULTS: The mean (s.d.) increase in length was 2.9 (0.8) cm. after (ICP) division and 6.5 (1.1) cm after (SMP) division (P<0.001). The distance between the end of the ileum and the point giving the greatest length was 27.5 (4) cm in the (ICP) group and 46.8 (4.2) cm in (SMP) group (P<0.001). CONCLUSION: The increase in mesenteric length was greater after (SMP) division than after (ICP) division, but if pouch-anal anastomosis is performed a short segment of small bowel must be removed. KEY WORDS: ileo colic pedicle, superior mesenteric pedicle, mesenteric lengthening, ileal pouch anastomosis .



Computed Tomography Performance in Renal Cystic Diseases

Haider Qasim Hamood

ABSTRACT: BACKGROUND: Renal cysts represent notably dilated nephrons or collecting ducts. A cystic kidney is a kidney with three or more cysts. The accuracy of CT diagnosis of typical simple renal cyst approaches 100% but many renal cysts do not fulfill the criteria for simple renal cyst, such lesions vary from simple renal cysts which do not require surgery to renal neoplasms with cystic component that need surgical resection. Contrast-enhanced helical CT scanning has 96% sensitivity and 95% specificity in detecting carcinoma in acquired renal cystic diseases. AIM OF STUDY: To confirm the sensitivity, specificity and performance of the spiral computed tomography (CT) in diagnosis and evaluation of the renal cysts and to study the CT criteria which categorize and separate the renal cystic lesions that require surgery (malignant neoplasm) from those that do not. METHODS: Fifty patients were scanned with spiral CT, 22 of them were males and 28 were females, their ages ranging from 20-70 years with mean age 50 yeas old, these patients undergo CT examinations with and without contrast enhancing material. All the patients were proved to have renal cysts radiologically and symptomatically. RESULTS: The patients presented with cortical simple renal cysts were 16 patients (32% of all the cases). Medullary simple renal cyst were found in 9 patients (18% of the total number of cases). 3 patients presented with autosomal recessive and dominant poly cystic kidney disease (8% of total cases). 1 case found with cystic kidney associated with tuberous sclerosis (2% of total cases). Para-pelvic renal cysts are seen in 7 patients (14% of total cases). Cystic angiomyolipoma (fat density) are seen in 3 patients (6% of total cases). Acquired renal cystic disease is found in 1 patient (2% of total cases). Complicated renal cysts (hemorrhagic) are seen in 2 patients (4% of total cases). Medullary cystic diseases were found in 2 patients ( 4% of total cases). Multicystic dysplastic kidney was found in 1 patient (2% of total cases). Malignant Cystic kidney lesion (cystic renal cell carcinoma) was found in 1 patient (2% of total cases). Females are more affected than the male, 28 females (56%) while the affected males were 22 (44%). The more involved age group was between 50-59 years old, they were 15 patients (9males and 6 females). The left kidney (34%) is more involved than the right kidney (32%), while both kidneys were involved in (34%) of the cases. CONCLUSION: The spiral CT scan is the most sensitive imaging modality useful in diagnosis of cystic kidney and it is of valuable importance in evaluation and categorization of cystic renal masses in attempt to separate the lesions that require surgical resection from those do not. KEYWORDS: Renal cystic disease, computed tomography (CT) performance.



Study of Risk Factors for Breast Cancer in A Hundred Breast Cancer Patients

Sorror Mahdi Latif *, Hassan Hadi Baqer**, Kholod Dhaher Habib***

ABSTRACT: BACKGROUND: Breastfeeding has been found to provide a measure of protection against uterine, cervical and ovarian cancers as well as breast cancer. . It's long been known that breast cancer is common in situations where women have few children and breast feed for short periods. Various physiopatholoical mechanisms are involved in the protective effect of breast feeding; anovulation , and cellular differentiation of the mammary cells. OBJECTIVE:To assess the impact of breast feeding on breast cancer incidence. METHODS:One hundred married Women with breast cancer were evaluated to find out the impact of breast feeding on breast cancer incidence in these women .Data on risk factors were collected by self-administered questionnaires .The questionnaire included data like woman's age of having breast cancer ,woman's age at menopause , woman's age of first full term pregnancy , number of pregnancies ,lactation period , the age at menarche ,woman's social habit like smoking , type of contraception ,and family history of breast cancer ,the data were collected and analyzed . RESULTS:We studied 100 married women with breast cancer .Their age groups were distributed between 22years and 55 years when they had been discovered to have breast cancer, most of women were house wives (81%).Only three of them were smokers. Seventy nine women had menarche between age of 13-15 years, and only 4 of them had menarche at 16-17 years. Thirteen women had one full term pregnancy, other 48 women had 2- 4 full term pregnancies and only 38women had more than 5full term babies. According to lactation periods we found that 21 women had never lactating their babies, 49 women lactated their children for 7-12 months and only 18 women lactated their children for 19-24 months. Regarding the age of women at first full term baby birth, there were 4 women had their first full term baby at age of 14-17 years ,58 women at age of 18-22 years , 37 women at age of 23-33 years and only one woman at age of 35year. CONCLUSION:There was significant increasing risk of breast cancer with reducing periods of lactation (p value <0.001), with decreasing age at menarche (p value<0.001), early age of marriage (p value <0.001), and early age of having first full term baby (p value<0.001) .We can conclude that lactation for more than 24 months can provides important benefits for the women's health, such as reduced risk of breast cancer. There was no evidence of a statistically significant difference in breast cancer risk between subjects who had ever smoked and those who had not. There was a statistically insignificant relationship between a positive Family history of breast cancer, and increasing risk of breast cancer, (p value >0.05). KEYWORDS: cancer, breast feeding, risk factor, breast cancer.



ABSTRACT: BACKGROUND: Intravenous (IV) fluids are the most commonly used drugs in the inpatient wards and the emergency units. They are not usually dealt with as a medication, and are frequently prescribed even by junior doctors and even the nursing staff. Serious side effects and complication may arise from this practice.OBJECTIVES: To evaluate the indications of IV fluid prescription in the Medical City. METHODS: A cross-sectional study of the use of IV fluids in surgical wards and emergency units in the Medical city in Baghdad during a period of ten weeks. Two hundreds and ninety three patients were collected. Studying the indication for prescription, monitoring of the patients, combinations and role of pharmacists. RESULTS: Most common IV fluid used was glucose water (28.3%). The most common indication in the emergency unit was vomiting and diarrhea (19.1%). While in the inpatient wards, routine postoperative hydration was the commonest indication for IV fluid (13.6%). Unnecessary or wrong uses were recorded in number of cases (36.8). Deficient monitoring of patients on IV fluids was noticed in most cases (95%). No apparent role for the clinical pharmacist in this respect was reported.CONCLUSION: There was a quiet high ratio of unnecessary or wrong use of IV fluids and also a high ratio of low or deficient monitoring of patients that necessitate more attention by the specialists and more supervision to the practice of IV fluid prescription. KEY WORDS: intravenous fluid, monitoring, emergency unit.

Indications of IV Fluids in Medical City

Bassam Hameed Al-Jarrah *, Zeena Muthafer Al-Nema**



Postoperative Urological Complications of Renal Transplantation; Al Karama Hospital Experience

Yousuf M. Alhallaq*, Shawqi Ghazala**, Mohammad Batal ***,

Ausama Saadi Abdul Muhsin****

ABSTRACT: BACKGROUND: Studying early post kidney transplant urological complication will provide a feed back evaluation for the surgical technique used and the way of complication management. OBJECTIVES: To study the postoperative urological complications and their management in the first 6 months following renal transplantation. METHODS: This is a retrospective study in which 123 patients with end stage renal disease (ESRD) underwent renal transplantation from January 2001 to October 2004 in Al Karama teaching hospital, Baghdad –Iraq. All the transplanted kidneys were from living donors. Direct matching between the serum of recipient and lymphocytes of the donor was negative. Extravesical ureteroneosystostomy was carried out using a stent across the anastomotic site. Postoperatively recipients were followed for 6 months by clinical and regular laboratory tests. Ultrasound and color Doppler examinations were performed when there was any evidence of decreased urinary output, allograft dysfunction, or clinical suspicion of rejection. RESULTS: In 123 patients aged 5 – 59 years with a mean age of 34 years, renal transplantation was carried out. Postoperative urological complications within the first 6 months were reported in 12 (9.75%) patientsincluding urinary leakage in 6 (4.8%), ureteral obstruction in 3 (2.4%), and lymphocele in 3 (2.4%)patients. CONCLUSION: Major urological complications after renal transplantation contribute to patient morbidity and compromise graft function. Early diagnosis and treatment will avoid loss of the graft. KEYWORDS: kidney transplantation, urological complications.



Effectiveness of Immediate Mitomycin C Instillation in Patients with Low Risk Non-Muscle Invasive Bladder Cancer

Usama Sulaiman Al-Nasiri *, Wisam Ali Kareem**

ABSTRACT: BACKGROUND: We determined if immediate instillation chemotherapy after transurethral resection (TUR) decrease the risk of recurrence and\or progression in patient with stage Ta T1 bladder cancer. OBJECTIVES: This study has been designed to analyze the impact of a single immediate mitomycin C instillation after transurethral resection of bladder cancer on recurrence and progression rates in patients with low risk superficial bladder cancer. METHODS: A total of 50 patients with low risk superficial bladder cancer were included in a prospective randomized controlled trial. All patients had a 3 cm. or less single, papillary bladder tumer. The tumor was completely resected before patients were randomized into 2 arms of no further treatment (control group) and a single immediate instillation (usually within 6 hours) of 40 mg. mitomycin c (mitomycin c group). Median follow up was 24 months .The events studied were the recurrence free rate, the recurrence rate/year, and the number of new tumors developing /year. RESULTS: At 24-month follow-up the recurrence-free rate was significantly increased (84.7% VS 54.2%). Recurrence (15.3% VS 45.8%), and recurrence per year rate (7% VS 20%) and tumor per year rate(11% VS 33%) were significantly decreased in the mitomycin c compared to the control group. CONCLUSION: This study confirms the positive effect of a single immediate mitomycin C instillation in patients with low risk superficial bladder cancer. Thus, this approach is an alternative to observation. This study also suggests cell implantation as a mechanism of early recurrence can be controlled with a single immediate mitomycin c instillation. KEY WORDS: transurethral resection, mitomycin c, non-muscle invasive bladder cancer.




Evaluation of Focused Abdominal Sonography for Trauma (FAST) in Baghdad Teaching Hospital

Raed J .Wiwit , Saad Abdulla Ibrahim Sarsam , Salah M.Tajer

ABSTRACT: BACKGROUND: Focused Abdominal Sonography for Trauma (FAST) is widely applied in the initial management of trauma patients, Being non invasive, repeatable and without risk of irradiation, make it attractive tool in evaluation of trauma patients. OBJECTIVE: Evaluation FAST sensitivity and specificity in detection of hemoperitoneum in abdominal trauma victims . METHODS: Prospective study conducted in the emergency department of Baghdad teaching hospital for one year period .The FAST done by a general surgeon or emergency physician during the secondary survey of blunt and penetrating abdominal trauma victims with equivocal clinical findings. RESULTS: Ninety three (93) patients included in the study, with over all sensitivity of FAST was 80.9 % and specificity 95.8 %. In blunt abdominal trauma the sensitivity was 92.3 % and specificity was 96 % while in penetrating abdominal trauma the sensitivity was only 62.5 % and specificity 95.2 %. CONCLUSION: FAST is highly sensitive and specific in detection of hemoperitoneum after blunt abdominal trauma ,but its lower sensitivity in penetrating abdominal injury require modification in the protocols like repetition of the scan or application of extra views. Its high specificity make it suitable as "rule in" test in both blunt and penetrating abdominal injury. KEY WORDS: abdominal trauma, ultrasound, focused abdominal Sonography for trauma.




Role of Antioxidant on Nephropathy in Alloxan Induced Diabetes in Rabbits

Israa F. Jaffar Alsamaraee*, Huda Arif Jasim **

ABSTRACT: BACKGROUND: The development and progression of diabetic nephropathy is dependent on glucose homeostasis and many other contributing factors. Diabetic nephropathy is a leading cause of end-stage renal failure, accounting for 35 to 40% of all new cases that require dialysis therapy worldwide. Recent clinical studies clearly demonstrated that hyperglycemia and oxidative stress is an important causal factor in mediating the development and progression of diabetic kidney disease. OBJECTIVE: To evaluate the therapeutic effect of levamesole in diabetic nephropathy . METHODS: The study included 10 rabbits Weight (1kg ±20 gm); they were followed up for 7months. Blood was aspirated from marginal ear vein after agitation with xylol for estimation of fasting blood glucose and malondialdehyde (MDA) which is used as marker of oxidative stress. Rabbits were given 110 mg / kg alloxan to induce diabetes. In the second month rabbits became diabetic without development of nephropathy. After 1 month from being diabetic a bosture dose of alloxan was given (125 mg\kg). After 1 month of the bosture dose blood glucose level further increased and rabbits developed albumin urea. Once rabbits developed albumin urea they received levamesole 2 mg\kg EOD for 6 weeks. RESULTS: The study results showed that diabetic nephropathy is associated with high blood glucose level (300-400mg\dl) and oxidative stress (significant increase in MDA level). The nephropathy (albumin urea) and oxidative stress can be reversed by levamesole. CONCLUSION: The antioxidant effect and immune modulating properties of levamesole provided a protective therapy against the development of diabetic nephropathy. KEY WORDS: diabetic nephropathy, levamesole, MDA.

160-8360الترقيم الدولي هجري1431, م 2010 االولدالعد ، التاسع المجلد

بيةــــات الطـاصـلالختصمجـلس العـراقي ال لةــمج

نيــــــــــــــــنزار باقــــــــــر الحس : االشــــراف العــام

رــــــــريـة التحـــئـهي

التـــــــالمراس

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ـدريـمســـاعد لفتـــه حــمزة الب نيـــــســـ الح أحــــمدـرـ باقنزار

ــــينـنـــدى صــــــــــــالح أمــــــ رجــيـــــــيى االعــــــريا يحــزآــ

ـــديـصـــــــــادق العـــبيـــداود رجــــــــاء آــــــاظم آـــمونـــــــة

ـديـصــــفاء مزهر مـــهدي العــبي يـين محمد الحديثـــــــاجي حسر

ـودـــســــــمــــير حســـــــــن عبــ ــــــــرقيـــــد الشـــــخــليفة عبيـ

رجاء مصطفى حســـــــن القطــــان

في دار الكتب والوثائقرقم اإليداع 1999 لسنة 687 ببغداد

الطبيةالمجلس العراقي لالختصاصات/ اإلعداد ألطباعي 160-8360الترقيم الدولي هجري1431, م 2010 االولالعد د، التاسعالمجلد

بيةــــات الطـاصـلالختصمجـلس العـراقي ال لةــمج

العراقية -ةاريـــشـتـــ االسهيئة ال

عبد المــناف حســـــــين الجـادري النائــــــبابراهيـــــم بشــــــــــــير

عـــــــالءحســـــــين بشــــــــــيــر ـيــــرانـــان رؤوف البحــــــــأحسـ

فخري محمد جاســـــــــم الحديثـي ـتــــــــــــة نهــــاد رفعـمــاـــــــأسـ

قيـــس عبد الحـــــمـيــــد آبـــــــة ــــــازيـــــد داود نيـــــــــــامجــ

محـــــــمد حســــــــن االشـــيـــقـر بســـــــام عبد الوهـاـب البرزنجــي

مظهــــــــــــر علــــي امــــــــــــين حسام الدين عبد المجيد الجرمـكلي

نـــــد الرحمت عبــــــد مدحـــــمع خليــــــل ابراهـــــــــيم الشـــيخـلي

مقـــــــداد عبد الجـــبارالعانــــــــي يـــرانــــــــــــر رؤوف البحـــزهـي

يـــــامجـنجم الدين عبد اهللا الروزن سعــــــد هاشــــــم الوتـــــــــــــري

ــريوفـــــاء رمــــــــزي العـمـــــ ورــــــــــبد الغفــعــادل سليــــــم ع

وليـــد غانـم بهـــنام الطــــــــويــل عامـــرشـــــــــاآر الهاشــــــــــمـي

رياض عبد الرزاق العـــــــــزاوي عبـد الباقـي محمد رؤوف الخطـيــب

العالمية-ةاريـــشـتـــ االسهيئة ال

ورياـس - امـــيـــــــــــــاهر ألحســـــــــــــــــم امـريكا- فرحــــــــــــــان بــــــــــاقـــر

بياـــلي - ـبرونـــــــد عبد الرؤوف القــــــمحم انـكلترا- اســــــماعــــــيل الجـــــليـــلي

ا الـماني- ماريتــــــــــــا اباســمن آـــــــــــالين االردن - ةــــالح درادآـــــالم صــــــــســ

انكـلترا - ــدوريـــــــــــــــذر الـــــــــــــــــــنـم السـويد - ودي ــــعيد آل سعــــــــارق ســـط

ورياـس - ــــاس ـــــــــــــــــزار عبـــــــــــــنــــ االردن - ـاةــــــــــضـــــــد اهللا القـــــــــــعبـــ

انكـلترا - ــعـــــريـــــــــ الضاضلــــــــــــــف

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