VOL.

9(2), 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 Zakaria Y. Arajy Raja Kummoona Raji H. M. Al-Hadithi Khalifa E. Sharquie Misaied Lafta H. Al-Badri Neda Salih Amen Dawood Sadik Al-Obidi Safa M. Al-Obaidi 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. 9(2), 2010, 1431H

ISSN 1608-8360

The Official Journal of the Iraqi Board for Medical Specializations

National Advisory Board
Abdul Monaf Al -Jadiry Adil S. Abdul- Ghafor Ala H. Bashir Amer Al-Hashimi Amjad Daoud Niazi Abdul Baki M. Raof AL-Khatib Bassam A. Al-Brazanchee Fakhri M. Al-hadeethi Hussam Al-Chermookly Ibrahim B. Al-Naib Ihsan R. Al- Bahrani Kais Kubba Khalil Al -Shaikhly Maad M. Abdul Rahman Miqdad A Al -Ani Mohammed H. Al-Eshaiker Mudher A. Amin Najim A. Al -Ruznamaji Saad H. Al Witri Usama N. Rifat Waleed G. Al-Tawil Wafa Al- Omari Zuhair R. Al-Bahrani Reyad Al- Azzawi

International Advisory Board

Farhan Bakir Abdullah Al-Qudah Fadel Derry Ismail Al-Jalili Mahir Al-Housami Marita Eisenmann klien - U.S - Jordan - U.K - U.K - Syria - Germany Mohammed El Kabroun Munthier Al-Doori Nizar Abbas - Libya - U.K - Syria - Jordan - Sweden

Salam S. Daradkeh Tareq S. Al-Saody

Instruction to Authors
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List of Contents
Cardiovascular Manifestations of Primary Hypothyroidism.

Volume 9 . (2).2010

Abdulla Janger Minshed,Adel Saleem abdul-Ghafor,Ahmed Shaker113-119 Influence of Primary Hypothyroidism on Serum Leptin Level. Maryam S. Mohammad, Abdul Hussein A. Farage ,Aras A. Abdullah120-124 Compliance Issue in Type II Diabetes: Does it Reduce the Prevalence of Cardiovascular Risk Factors? Yousif Abdul Raheem125-134 Visceral Leishmaniasis Complicated by Secondary Bacterial Infections in Iraqi Kala-azar. Mohammed F. Al-Timmimi, Sami Y. Guirges, Abdul Rahman A. Al-Tae 135-139 Treatment of Acne Vulgaris With Nigella Sativa Oil Lotion. Nasir Abdul-Ameer Hadi Al-Harchan 140-144 Compliance and Knowledge of Hypertensive Patients Attending Shorsh Hospital in Kirkuk Governorate. Haitham Issa Al Banna, Layla hassan Mohmed145 -150 Is Chlamydia Pneumonia an Independent Risk Factor in Ischemic Heart Disease? Eman Sh. AL-Obeidy, Basil. N. Saeed....151-154 Leptin Effect in the Development of Obesity Related Hypertension in Postmenopausal Women. Waleed Kh. Hussein...155-157 Drug Compliance in Epileptic Children in Sulaymani Governate. Ibrihem Khasro, Salem Rahma158-162 Laparoscopic management of symptomatic renal cysts Saad D. Farhan1163-168 Proportion and Determinants of Incomplete Vaccination Among Children Aged Less Than Two Years in Baghdad City. Loai S. Fadil ,Faris Al-Lami169-173 Early Neonatal Indirect Hyperbilirubinemia in Full Term Newborns and Types of Feeding. Numan Nafie Hameed, Farah Kadem Nama174-180 The Impact of Resistin and IL-6 on Type I Diabetes Mellitus (T1DM) and Its Duration in Children. Manal k. Resheed AL-Ani, Hadef D. El-Yassin, Ban A. Majaad,Mahjob AL-Nedawy181-188 Surgical Treatment of Hydatid Cyst of the Liver Tariq E. Al-aubaidi189-195

Hepatectomy Experience in Baghdad Teaching Hospital. Saieb S. Al-Gailani, Omar R. Mahjoub, Safa M. Al-Obaidi196-199 Surgical Treatment of Squamous Cell Carcinoma (SCC) of the Lip in Northern Iraq Saadallah M. Alzacko200-205 Substance Abuse and Dependence : In the Records of the Iraqi Hospitals and Health Centers During the Year 2008. Nesif Al-Hemiary , Mushtaq Talib206-209 Estimation of GM-CSF in Hepatitis B Virus Infected Patients and Individuals Vaccinated With Recombinant HB Vaccine. Rukia Muhammad. Al-Barzinji , Hiwa Abdul -Rahman Ahmed210-213 Cardiac Troponins as Prognostic Markers in Acute Heart Failure. Muataz Fawzi Hussein214-220 Progeria (Case Report ) Abdul-Karem Jasem albahadle221-224

CARDIOVASCULAR MANIFESTATIONS OF PRIMARY HYPOTHYROIDISM

THE IRAQI POSTGRADUATE MEDICAL JOURNAL

VOL.9, NO.2, 2010

Cardiovascular Manifestations of Primary Hypothyroidism

Abdulla J Minshed Al-Farttoosi ,Adil S .Abdul-Ghafour, Ahmed Shaker Al-Zaidi
ABSTRACT:
BACKGROUND: Primary hypothyroidism accounts for 90 to 95 %of all cases of hypothyroidism. Thyroid hormone deficiency increases systemic vascular resistance, decreases contractility and slow the heart rate . OBJECTIVE: To investigate cardiac changes in primary hypothyroidism. METHODS: In this prospective study 36 patients with untreated primary hypothyroidism were compared with 30 healthy persons. Cardiovascular evaluation of all subjects had been made both clinically and by the following studies :Chest X-Ray, electrocardiography, serum lipid and Echocardiography. RESULTS:: The main cardiac manifestations of hypothyroidism were: Easy fatigability) 88.9%), exertional dyspnea (75%o),obesity or gaining weight( 66.7%), sinus bradycardia ( 47.2%)and peripheral edema(11.1%)Electrocardiography showed sinus bradycardia in( 47%) low QRS voltage in (33.3%) , flat or inverted T wave(27.8%), prolonged QT interval (19.5%), first degree heart block in( 19.5 %) .Echocardiography showed the following :a decrease in global systolic function, asymmetric sepal hypertrophy in (91.6%) Pericardial effusion in (38.8%).Low QRS voltage was found to be related to thyroxin level and age of the patient .No correlation was found between heart rate and thyroxin level. CONCLUSION: Primary hypothyroidism accompanied by significant changes in cardiovascular system which may explain the development of premature coronary artery disease in these patients. KEYWORDS: primary hypothyroidism, cardiovascular manifestations.

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THE IRAQI POSTGRADUATE MEDICAL JOURNAL PRIMARY HYPOTHYROIDISM AND SERUM

LEPTIN LEVEL

VOL.9, NO.2, 2010

Influence of Primary Hypothyroidism on Serum Leptin Level

Maryam S. Mohammad*, Abdul Hussein A. Farage*,Aras A. Abdullah**
ABSTRACT:
BACKGROUND: Leptin is the protein product of the ob gene, secreted by adipocytes. It has been suggested that it may plays an important role in regulating appetite and energy expenditure, but beside that, little is known about the physiological actions of leptin in humans. OBJECTIVE: To evaluate a possible influence of primary hypothyroidism on serum leptin levels. METHODS: Fifty-six newly diagnosed patients with primary hypothyroidism (40 females and 16 males) and 32 normal controls matched for age, ethnic status and body mass index (BMI) were studied. Body mass index (BMI; kg/m2), thyroid function(using enzyme-linked immunoflourescent assay) and serum levels of leptin, thyroid autoantibodies (measured by enzyme-linked immunosorbant assay) and lipid profile(measured by enzymatic colourimeteric assays) were assessed in all studied subjects. RESULTS: No significant difference in serum leptin levels was recorded between hypothyroid patients and controls (16.314.9; 14.8 12.9, P> 0.05), but women in each group had significant higher leptin concentrations than men (patients: 19.6 16.3 vs. 8.3 5.0; controls: 19.0 14.4 vs. 7.7 4.1; P< 0.05). Serum levels of cholesterol (p<0.002), LDL-cholesterol (p<0.004) and atherogenic ratio (p<0.03) were generally higher in patients than controls. The serum leptin concentration correlated positively with BMI within both patients (r=0.32; p<0.016) and controls (r=0.28; p<0.024). However, no association was demonstrated between values of serum T3, T4, TSH, triglyceride, HDLcholesterol and thyroid auto antibodies. CONCLUSION: Circulating thyroid hormones do not appear to play any significant effect on leptin levels in patients with primary hypothyroidism. KEY WORDS: leptin, lipids and lipoproteins, primary hypothyroidism.

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VOL.9, NO.2, 2010

THE IRAQI POSTGRADUATE TYPE II DIABETES COMPLIANCE ISSUE IN MEDICAL JOURNAL

VOL.9, NO.2, 2010

Compliance Issue in Type II Diabetes: Does it Reduce the Prevalence of Cardiovascular Risk Factors?
Yousif Abdul Raheem
ABSTRACT:
BACK GROUND: Type 2 diabetes, which is the most common form of diabetes, has an alarming increasing rate. It is a recognized risk factor for cardiovascular disease (CVD). Non-compliance with healthy life styles, anti-diabetic drugs and diet are the central issues in patient's management as it might synergist other CVD risk factors. OBJECTIVE: The aims of this study were to find out the compliance, prevalence of CVD risk factors, and any association between them in type 2 diabetic patients. METHODS: A cross-sectional design and a convenient sample of 820 diabetic patients were used in conducting this study for the period from the 1st October, 2006 to 31st December, 2008. A Structured questionnaire was used to collect demographic information from the patients. 10 questions were used to determine the patient's compliance. The classic risk factors; obesity, hyperglycemia (HG), hypertension (HT), and hypercholesterolemia (HC), have been studied for each patient and compared with his/her compliance to find any association. RESULTS: The results of this study revealed that there were only 187 out of 820 (22.80%) with good compliance and 297 (36.22%), 336 (40.98%) patients with fair and poor compliance respectively. The prevalence of obesity, over weight, uncontrolled HG, HT (systolic, diastolic or both) and presence of HC in our diabetic patients were 27.32%, 36.83%, 51.95%, 40.73 and 30.37 respectively. Good compliance was associated significantly with normal body weight, controlled HG, absence of HT, and absence of HC. CONCLUSION: The study concluded that less than one third of our diabetic patients had good compliance. CVD risk factors are prevalent among them, and this prevalence is associated significantly with the level of compliance. Understanding the reasons behind these forms of non-compliance is an important key to the successful development of potential program to decrease the CVD risk factors and associated Table complications. 1: Compliance of the diabetic patients regarding their demographic characters KEYWORDS: compliance, diabetes, cardiovascular

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THE IRAQI POSTGRADUATE MEDICAL JOURNAL COMPLICATED VISCERAL LEISHMANIASIS

VOL.9, NO.2, 2010

Visceral Leishmaniasis Complicated By Secondary Bacterial Infections in Iraqi Kala-azar

Mohammed F. Al-Timmimi*, Sami Y. Guirges * , Abdul Rahman A. Al-Tae **
ABSTRACT:
BACKGROUND: Kala-azar is a vector borne parasitic disease endemic in Iraq. This disease is complicated by secondary bacterial infections which may lead to death. OBJECTIVE: The study was carried out to detect the bacterial infections associated with kala-azar and the effective treatment. MATERIALS AND METHODS: Collection of blood, urine, stool and ear exudate specimens from 63 proved kala-azar patients. The bacterial isolates from the specimens were subjected to antibiotics sensitivity test. RESULTS: 63 (46.7%) of 135 hospitalized children with visceral leishmaniasis, developing 102 episodes of infections. The sites of these infections were urinary tract 46(45.1%), lower respiratory tract 37(36.3%), gastrointestinal 10(9.8%) and middle ear 9(8.9%). Both Gram negative and Gram positive bacteria were isolated. Most of the isolated bacteria belong to the family Enterobacteriaceae. The antibiotics gentamicin, amikacin and co-trimoxazole were the most effective. CONCLUSION: Bacterial infections were common among hospitalized children with kala-azar. The commonest were Gram negative bacteria of the family Enterobacteriaceae. KEY WORDS: Kala-azar , secondary bacterial infection, antibiotic sensitivity.

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VOL.9, NO.2, 2010

THE IRAQI POSTGRADUATE MEDICAL JOURNAL

VOL.9, NO.2, 2010

Treatment of Acne Vulgaris With Nigella Sativa Oil Lotion

Nasir Abdul-Ameer Hadi Al-Harchan
ABSTRACT:
BACKGROUND: Acne vulgaris is the most common chronic inflammatory disease of the skin. Despite the vast array of treatment modalities available for acne, there is considerable dissatisfaction in acne treatment among patients and doctors. Cost limitation, adverse effect or lack of efficacy limit the use of current therapy. Herbs and their extracts have been used for treatment of skin disease for centuries. One of the most popular herbs in our society is Nigella sativa; this plant had diverse clinically useful activity. OBJECTIVE: To use nigella sativa oil as natural plant remedy in the treatment of acne vulgaris. METHODS: This study was conducted in the Department of Dermatology and Venereology in Baghdad Teaching Hospital, Iraq during the period between October 2005 and April 2006. In this single-blind randomly controlled therapeutic study, ninety three patients were enrolled, their ages ranged from 13-23 years. There were 51` females and 42 males. The patients were divided into 2 groups; group A (47 patient) instructed to use nigella sativa oil lotion twice daily for 2 months, while group (46 patient) used a control solution. Acne vulgaris was graded as mild and moderate acne by counting the number of papules and pustules. Statistical analysis was carried out by computer using t-test, f-test, and chi-square when needed. RESULTS: Eighty-one patients completed the study. In group A (43 patients), we noted a significantly reduced mean lesion count of papules and pustules after 2 months of therapy. The response of patients to treatment was good in 58%, moderate in 35% and no response in 7%. The satisfaction of patients with treatment was full in 67%, partial in 28%, and no satisfaction in 5%. In group B (38 patients), the lesions showed no significant reduction after 2 months and the response of patients to treatment was good in 8%, moderate in 34%, and no response in 58%. The satisfaction of patients with treatment in this group was full in 8%, partial in 24%, and no satisfaction in 68%. The mean difference in outcome after 8 weeks between the 2 study groups was statistically significant. CONCLUSION: The nigella sativa oil lotion has proved its efficacy as a topical therapy for acne vulgaris. This is a new natural plant extract, which lacks any side effects. KEYWORDS: nigella sativa, lotion, acne vulgaris

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THE IRAQI POSTGRADUATE MEDICAL JOURNAL

VOL.9, NO.2, 2010

Compliance and Knowledge of Hypertensive Patients Attending Shorsh Hospital in Kirkuk Governorate
Haitham Issa Al Banna*, Layla Hassan Mohmed**
ABSTRACT:
BACKGROUND: Medical non-compliance has been identified as a major public health problem in the treatment of Hypertension. OBJECTIVE: To identify factors related to non-Compliance with the treatment of patients with Hypertension. PATIENTS AND METHODS: A total number of (400) hypertensive patient was enrolled to assess compliance rate at Shorsh General Hospital from July 21/2006 to July 21/2007, using a structured questionnaire. RESULT: The study revealed a low compliance rate among hypertensive patients, Males were less compliant (65.6%) than females (46%). Smokers (61.7%) more than non-smokers (50.6%),non-regular follow-up (76.7%) more than regular, primary and secondary education (68.5%) more than illiterate and high education, more than one medication (66.9%)than single medication. Poverty was the main cause of noncompliance (38.1) while absence of drugs and medical staff are the least to cause non-compliance (2.7%). CONCLUSION: Compliance rate in general is low in our study. Compliance rate is more in female, no family history, single drug medication, non-smokers, no other chronic diseases, more than 10 years of hypertension. Patients knowledge about their disease is insufficient because there are no health educational programs. KEY WORDS: hypertension, compliance rate, knowledge.

THE IRAQI POSTGRADUATE MEDICAL JOURNAL RISK FACTOR OF ISCHEMIC HEART DISEASE

VOL.9, NO.2, 2010

Is Chlamydia Pneumonia An Independent Risk Factor In Ischemic Heart Disease?

Eman Sh. AL-Obeidy*, Basil. N. Saeed **
ABSTRACT:
BACKGROUND: Immune system may interplay between Chlamydia pneumoniae infection and ischemic heart disease (IHD).Major histocompatibility genes regulate innate and adaptive immunity.. OBJECTIVE: This study was established to shed light on the possible association between ischemic heart disease (IHD) with Chlamydia pneumoniae infection and HLA antigens. PATIENTS AND METHODS: Microlymphocytotoxicity assay has been applied for HLA-typing of 150 blood samples of 100 IHD patients and 50 healthy normal controls, In addition enzyme linked immunosorbant assay (ELISA) used to detedct C pnuminiae IgA and IgG. RESULTS: An increased frequency of HLA-A*2, B*35 alleland HLA-A*2-B*35 haplotype was observed for patients group versus control group with P-value (0.0001, 0.05, and 0.001) respectively. CONCLUSION: This finding demonstrated that the HLA-B*35 positive haplotypes confer the C.pneumoniae-related risk for IHD. HLA-DR3,DR4 and DR7 might play a role in AIH susceptibility. KEY WORDS: ischemic heart disease, HLA, C. pneumoniae.

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THE IRAQI POSTGRADUATE MEDICAL JOURNAL LEPTIN EFFECT IN THE DEVELOPMENT OF OBESITY

VOL.9, NO.2, 2010

Leptin Effect in the Development of Obesity Related Hypertension in Postmenopausal Women

Waleed Kh. Hussein
ABSTRACT:
BACKGROUND: Obesity in humans causes hypertension, myocardial hypertrophy and coronary atherosclerosis, and increased cardiovascular morbidity and mortality that is thought to be related to sympathetic overactivity. Leptin is an adipocyte-derived hormone that acts in the hypothalamus to regulate appetite, energy expenditure and sympathetic nervous system outflow. One of the major mechanisms leading to the development of obesity-induced hypertension appears to be leptin-mediated sympatho-activation. OBJECTIVE: This study is done to evaluate the contribution of leptin in the development of obesity related hypertension in post menopausal women. SUBJECTS AND METHODS: A total number of 64 subjects (post menopausal women) included in the study were divided into obese hypertensive group (n= 38 )and non obese non hypertensive group (n=26) , age(57+4.5year) and (56+2.7year) respectively(mean+SD). Obese hypertensive group defined as (BMI 30 kg/m2 and blood pressure 140/90 mmHg with or without history of taking anti hypertensive medications)and Non-obese non hypertensive group defined as (BMI < 30 kg/m2- blood pressure < 140/90 mmHg).In the present study leptin had been measured. RESULTS: Leptin level is higher in obese hypertensive group than in non obese non hypertensive group and it was 29.2+4 and 15.2+2.1(mean+SD) respectively and this difference is statistically significant with p value < 0.001. CONCLUSION : leptin may play a role in the development of obesity- related hypertension and may be an independent predictor of hypertension. KEYWORDS: leptin , obesity , hypertension.

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THE IRAQI POSTGRADUATE MEDICAL CHILDREN DRUG COMPLIANCE IN EPILEPTICJOURNAL

VOL.9, NO.2, 2010

Drug Compliance In Epileptic Children In Sulaymani Governate

Ibrihem Khasro*, Salem Rahma**
ABSTRACT:
BACKGROUND: Compliance behavior depends on the specific clinical situation, the nature of the illness, and the treatment program. OBJECTIVE: Determine the rate of drug compliance in families caring for a child or adolescent with epilepsy and to describe some associated factors. METHODS: Two hundred patients with epilepsy under 18 years of age, who were attending the pediatric clinic for a twelve month period (August 2007-August 2008) and their families, were interviewed. RESULTS: Drug compliance was satisfactory in 123(62.5%) and was poor in 77(37.5%) of the patients according to their self or parental report. Age of the patient, gender, residence, etiology of epilepsy, and monotherapy versus polytherapy did not significantly influence the drug compliance but duration of the disease, parental education, family size and positive family history of epilepsy were more significantly associated with drug non compliance. CONCLUSION: In this study, drug compliance was satisfactory in 62.5% of the patients. There was a significant association between drug non compliance and socioeconomic status (large family size, family history of epilepsy, low parental education) KEY WORDS: epilepsy, children, compliance and drug.

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THE IRAQI POSTGRADUATE MEDICAL MANAGEMENT OF RENAL CYSTS JOURNAL

VOL.9, NO.2,2010

Laparoscopic Management of Symptomatic Renal Cysts

Saad D. Farhan
ABSTRACT:
BACKGROUND: Simple renal cysts are common, with incidence increasing with age. Symptomatic renal cysts have traditionally been initially treated by percutaneous aspiration with or without injection of sclerosant agents; however, this has a high rate of recurrence.Open surgical cyst decortication for pain relief through a flank or chevron incision is associated with considerable morbidity and protracted convalescence. OBJECTIVE: To assess the efficacy of laparoscopic Surgery in the treatment of symptomatic simple renal cysts. Renal cysts are common in the adult population. METHODS: From April 2007 to July2009 ,11patients (7 males and 4 females) underwent laparoscopic decortications of symptomatic simple renal cysts with renal cyst wall excision and fulguration of the epithelial lining. Complex renal cysts were excluded. The Wong-Baker pain scale was used to assess the preoperative and postoperative pain scores. Radiologic success was indicated as no recurrence on the most recent computed tomography scan. RESULTS: Of the 11 procedures were completed laparoscopically , the mean operative time was 100 minutes (range 80 to 120). Symptomatic and radiographic success was achieved in 90.9% of patients, with a median follow-up of 12 months (range 6 to 18). CONCLUSION: Long-term follow-up has confirmed that laparoscopic cyst decortication is an effective and durable treatment option for symptomatic simple renal cysts during long-term follow-up. The greater and durable success rates of this minimally invasive technique may favor this treatment option over other treatment modalities. KEY WARDS: renal cysts, laparoscopic surgery.

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THE IRAQI POSTGRADUATE MEDICAL JOURNAL INCOMPLETE VACCINATION AMONG

VOL.9, NO.2,2010

Proportion and Determinants of Incomplete Vaccination among Children Aged Less than Two Years in Baghdad City
Loai S. Fadil ,Faris Al-Lami
ABSTRACT:
BACKGROUND: Immunization is the most important public health advance of the 20th century and the most cost-effective and a life-saving intervention. The public health initiative is to get 90% of the nation's children adequately immunized before their third birthday. OBJECTIVE: To determine the proportion and determinants of incomplete vaccination among a sample of children aged less than two years in Baghdad city. Design: A cross sectional study. Setting: A random sample of 11 Primary Health Care Centers in Baghdad city. Data Collection time: Feb/1st-May/31st / 2008 SUBJECTS AND METHODS: A systematic random sample of 562 children aged less than two years, living in Baghdad city, and attended the selected Primary Health Care Centers for various health complaints apart from immunization. Vaccination status of children was verified for their age and according to the national Expanded Program of Immunization. RESULTS: The proportion of incomplete vaccination was18.8%; 0.5% were completely non-vaccinated. The proportion of incomplete vaccination increased with increasing age (P=0.000). Males showed higher proportion of incomplete vaccination (24.1%) than females (14.2%) (P =0.003). The major proportion of incomplete vaccination was among children of illiterate mothers (43%) (P =0.000). The main causes of incomplete vaccination were immigration problem (46.23%), security problem (29.25%), and parents related problem (15%), and other causes (9%). CONCLUSION: Around one of every five children aged less than two years in Baghdad was incompletely vaccinated; immigration and security obstacles were the main causes of incomplete vaccination. KEY WORDS: proportion, determinants, incomplete vaccination, Baghdad

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THE IRAQI POSTGRADUATE MEDICAL JOURNAL NEONATAL INDIRECT HYPERBILIRUBINEMIA

VOL.9, NO.2,2010

Early Neonatal Indirect Hyperbilirubinemia in Full Term Newborns and Types of Feeding
Numan Nafie Hameed* , Farah Kadem Nama **
ABSTRACT:
BACKGROUND: Neonatal jaundice remains the most common and, perhaps, the most controversial problem in full-term newborns during the immediate postnatal period. OBJECTIVE: To evaluate the relationship between types of feeding and neonatal indirect hyperbilirubinemia in full term neonates in the first week of life. METHODS: In the period from the first of January 2008 to the first of August 2008, populations of 140 full term newborns admitted to the neonatal care unit in Children Welfare teaching Hospital in Medical CityBaghdad were studied. A serum bilirubin level >12.9 mg/dL was considered significant. RESULTS: Of the population studied, most newborns received supplementary feeding 73 (52.1%), followed by breast feeding 50(35.7%), while only 10(7.1%) and 7(5.0%) were on mixed and formula feeding, respectively. Ninety (64.3%) of the jaundiced neonates were males and 50(35.7%) were females with a male to female ratio of (1.8:1). CONCLUSION: This study revealed that, no significant association could be found between different types of feeding and indirect hyperbilirubinemia in full term newborns. Besides, giving water, dextrose water or formula with breastfeeding will adversely affect the volume of milk transferred to the baby and the volume of milk produced by the mother. KEYWORDS: fullterm, neonate, indirect hyperbilirubinemia, feeding, jaundice

THE IRAQI POSTGRADUATE MEDICAL JOURNAL

VOL.9, NO.2,2010

THE IRAQI POSTGRADUATE MEDICAL TYPE I DIABETES MELLITUS IMPACT OF RESISTIN AND IL-6 ONJOURNAL

VOL.9, NO.2,2010

The Impact of Resistin and IL-6 On Type I Diabetes Mellitus (T1DM) and Its Duration in Children
Manal k. Resheed AL-Ani *, Hadef D. El-Yassin*,Ban A. Majaad**, Mahjob ALNedawy ***
ABSTRACT:
BACKGROUND: Type I diabetes mellitus is characterized autoimmune destruction of - cells . IL-6 is a cytokine (one of a class of immune system regulators ) it plays a role, in acute phase inflammatory response to cellular injury. Human Resistin gene is expressed in pancreatic islets , pre- adipocytes and bone marrow and is of relevance for inflammation processes. OBJECTIVE: To investigate serum concentration of resistin and pro inflammatory IL-6 in T1DMchildren and to study the impact of the duration of disease on these parameter. In order to shed some light on the mechanism of initiation and propagation of -cell damage in those patients. SUBJECTS AND METHODS: Sixty diabetes children ( 33 males and 27 females), aged (1.3-13) years (mean SD) (5.62.8) years , consecutively admitted to the AL-Mansour Teaching Hospital for children , were enrolled in this study. All had T1DM . Duration of disease varied from ( 0.13- 84) months . Age matching group of thirty healthy volunteer children , (18 females ,12 males) was included as a control without any family history of diabetes. Resistin and IL-6 were measured ( by enzyme linked immunosorbant assay , ELISA) . RESULTS : Fasting serum Resistin levels were lower in patients compared to controls although the correlation was not significant .However serum resistin levels were higher in females compared to males in both groups ( patients and controls) with a significant correlation between the groups of the same gender .Duration of the disease had no impact on either gender.On the other hand IL-6 showed a significantly higher serum level in patients than control. Un like Resistin , the duration of disease had a great impact on IL-6 serum levels as shown in text. CONCLUSION : Resistin levels in patients with (T I DM) non significantly lower than in control individuals , thats meaning T I DM), as disease did effect the levels of serum Resistin sub clinically by the treatment with insulin leading to hyper insulinemia .Resistin antagonizes insulin action, leading to decrease in patients more than controls . Resistin levels tended to have higher in females than male ,however this trend did not reach statistical significant in total population due to sex hormone . The highly significant positive correlation between the levels of IL-6 and duration is due to persistente production and elevation for long time of patients with T1DM indicating of ongoing - cell destruction .But Resistin was non dependent on the duration of the disease because human resistin gene is expressed in pancreatic islets cell. KEY WORDS : resistin , IL-6 in type 1diabetes mellitus.

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THE IRAQI POSTGRADUATE MEDICAL JOURNAL HYDATID CYST OF THE LIVER

VOL.9, NO.2,2010

Surgical Treatment of Hydatid Cyst of the Liver

Tariq E. Al-aubaidi
ABSTRACT:
BACKGROUND: Human Hydatid disease or echinococcosis, caused by larval form of Echinococcus granulosus, has a worldwide distribution and is endemic in many countries especially in Mediterranean region, middle and Far East. OBJECTIVE: To compare of different surgical procedures used in treatment of hepatic Hydatid cysts and their outcomes and complications. PATIENTS AND METHODS: All patients with hepatic Hydatid cysts disease both symptomatic and asymptomatic of both sexes and any age group were evaluated by history, examination and investigations and data was collected, all patients underwent surgical treatment of different procedures, outcome and complications of such procedures were analyzed. RESULTS: All patients were treated surgically. Surgical procedures included external drainage, simple closure, marsupialization (group A), partial cystectomy with omentoplasty, pericystectomy and segmentectomy (group B). Group A techniques carried out a higher complication rate (39.1%) compared with group B techniques (10%) (P-value <0.05). CONCLUSION: Partial cystectomy with omentoplasty and radical procedures as pericystectomy and segmentectomy carry a lower complication rates compared with external drainage and marsupialization but the former procedures should be reserved to more peripheral cysts and should be done with a low operative risks. KEYWORDS: hydatid cyst, omentoplasty, pericystectomy.

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THE IRAQI POSTGRADUATE MEDICAL JOURNAL HEPATECTOMY

VOL.9, NO.2,2010

Hepatectomy Experience in Baghdad Teaching Hospital

Saieb S. Al-Gailani, Omar R. Mahjoub, Safa M. Al-Obaidi
ABSTRACT:
BACKGROUND: Hepatectomy is usually performed because it is the most effective way of removing liver tumour(s). Cryosurgery, Radiofrequency, Laser, Microwave and Chemo-therapies are less effective alternatives. OBJECTIVE: To review the experience of hepatectomy in Baghdad Teaching Hospital Medical city,Iraq with a review of the obstacles and needs for promotion and development. PATIENTS AND METHODS: During the period from March 1999 to September 2005, Out of 27 patients admitted to the second surgical unit in Baghdad Teaching Hospital Medical City with liver tumours, 15 had hepatectomy done by the same surgical team. The remaining 12 cases were beyond resection. RESULTS: The age of patients ranged from 2 to 65 years old with mean age of 34.4 years. Only one (6.7%) patient underwent left lobectomy, 2 (13.3%) left segmentectomy, while the rest 12 patients (80%) underwent right partial or total lobectomy, divided equally between anatomical & non-anatomical resection. Two main techniques were used in transection of liver parenchyma: CUSA Dissector which is used in 9 patients (60%) and clamp-crushing or finger fracture technique was used in the remainder. In addition to CUSA knife, argon beam was used in 5 cases (33.3%). Postoperative mortality rate was 26.7% (4patients). The histopathological examination of resected segments of the liver revealed 11 (73.3%) cases of hepatocellular carcinoma, 2 (13.3%) of hepatoblastoma, 1 (6.7%) case metastatic colorectal carcinoma, and 1 (6.7%) case of benign cells (haemangioma). CONCLUSION: Hepatectomy for liver tumours can be performed with acceptable safety and efficacy in a suitably staffed and equipped center. The outcome will improve with time and experience. KEY WORDS: hepatectomy, liver tumour, hepatocellular carcinoma (HCC).

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THE IRAQI POSTGRADUATE MEDICAL JOURNAL SURGICAL TREATMENT OF SQUAMOUS

CELL CARCINOMA

VOL.9, NO.2,2010

Surgical Treatment of Squamous Cell Carcinoma (SCC) of the Lip In Northern Iraq
Saadallah M. Alzacko
ABSTRACT:
BACKGROUND: Lip cancer develops in the vermilion border of the lip. The great majority of these malignancies are squamous cell carcinoma (SCC). The primary treatment of these lesions is surgical resection. The management of the resulting defect remains a significant reconstructive challenge. OBJECTIVE: To provide information about the experience of surgical treatment of patients with squamous cell carcinoma (SCC) of the lip admitted to the plastic surgery unit, Mosul teaching hospital, between Mar. 1998 - Feb. 2008. MATERIALS AND METHODS: Case-series study. Plastic surgery unit, Mosul teaching hospital, during the period from Mar. 1998 Feb. 2008. Sixty six patients were included; they were 51 men and 15 women. The age ranged between 15-90 years. RESULTS: Of 66 patients with squamous cell carcinoma of the lip, there were 51 men (77.3%) and 15 women (22.7%) , ranging in age from 15 to 90 years (mean 60.7 years) with the peak incidence at 60-70 years. Ulcer was the main presenting complaint. Lower lip was the commonest site in 61 patients (92.4%). Cervical lymph node metastases were found in 13 patients (19.7%) at the time of first presentation. Reconstruction of lip after excision was done by primary suture in 31 patients, by Estlander flap in 9 patients and by McGregor flap in 10 patients. CONCLUSION: Early diagnosis is essential and contributes to successful reconstructive surgery. Lip reconstruction in the form of primary repair, Estlander flap and McGregor flap were performed depending on the size and site of tumor. KEYOWRDS: squamous cell carcinoma, lip, estlander flap, mcgregor flap.

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THE IRAQI POSTGRADUATE MEDICAL JOURNAL SUBSTANCE ABUSE AND DEPENDENCE

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Substance Abuse and Dependence : In the Records of the Iraqi Hospitals and Health Centers During the Year 2008
Nesif Al-Hemiary *,Mushtaq Talib*
ABSTRACT:
BACKGROUND: Substance abuse is expected to be a growing problem in Iraq after 2003. Hospitals and health centers records can provide valuable information about this problem. OBJECTIVE: To know the number of substance abuse cases presented to our health services during 2008, to explore the socio-demographic characteristics of patients and types of substance use, and to compare the results with those of 2001,2002, and 2007. METHODS: The records of substance abuse that are periodically sent from hospitals and health centers to the Ministry of Health were studied. Records of 2008 were studied in details and compared with the figures recorded in the years 2001, 2002, and 2007 to have an idea about the progress of the problem of substance abuse before and after 2003. RESULTS : There was 1462 cases recorded in 2008. Males were much more than females (96.4% vs. 3.6%), most cases were above the age of 18 years of age (95.8%). Most cases (87.5%) were presented to the outpatient clinics rather than to inpatient units. Prescription drug abuse was the most common type (74.6%). There was no increase in cases recorded before and after in 2003. CONCLUSION: This study may indicate that the size of substance abuse related health problems in Iraq is small or is underreported. The socio-demographic pattern is similar to what was found by other studies in Iraq. KEY WORDS: substance abuse, dependence, Iraq , 2008.

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THE IRAQI POSTGRADUATE MEDICAL JOURNAL ESTIMATION OF GM-CSF IN HEPATITIS B VIRUS

VOL.9, NO.2,2010

Estimation of GM-CSF in Hepatitis B Virus Infected Patients and Individuals Vaccinated With Recombinant HB Vaccine
Rukia Muhammad. Al-Barzinji*, Hiwa Abdul -Rahman Ahmed**
ABSTRACT:
BACKGROUND: Hepatitis B virus (HBV) infection is a major public health problem. Successful clearance of the virus depends on a complex interaction between the virus and the host immune response. OBJECTIVE: This study was designed to estimation granulocyte macrophage-colony stimulating factor (GM-CSF) in HBV infected patients and individuals vaccinated with recombinant HB vaccine. METHODS: Study groups were classified into patient group 31(15 acute (AH) and 16 chronic (CH)), 33 vaccinated group (20 responder (RD) and 13 Non-responder (NRD)) and 16 healthy control (HC) during May to November 2007. Blood samples were taken from patients and hospitals staffs to detection hepatitis B surface antigen(HBsAg), anti-hepatitis B core antibody(IgM)(Anti-HBc Ab(IgM), anti hepatitis B surface antibody) (Anti-HBs Ab), GM-CSF level in serum by enzyme linked immunosorbent assay (ELISA) test. RESULTS: A highly significant elevation (p<0.001) of GM-CSF level was reported in AH patients compared to the CH patients and HN controls, according to F-test, while in CH patients the elevation was not significant as compared to HN control (p>0.05) according to LSD- test. The level of GM-CSF also significantly higher (p<0.05) in RD at age 30 years than NRD and HN groups by F-test. Also a significant differences was recorded when compared between HN versus RD and RD versus NRD (P<0.027) and (P<0.023) respectively. CONCLUSION: In this study highly significant elevation of GM-CSF levels was observed in AH patients compared with CH patients and healthy control. GM-CSF level also significantly higher in RD at age 30 years than NRD and HN groups. KEYWORDS: granulocyte, macrophage , hepatitis B virus, vaccine.

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THE IRAQI POSTGRADUATE MEDICAL JOURNAL CARDIAC TROPONINS

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Cardiac Troponins as Prognostic Markers in Acute Heart Failure

Muataz Fawzi Hussein
ABSTRACT:
BACKGROUND: Cardiac troponins provide diagnostic and prognostic information in acute coronary syndromes, but their role in acute decompensated heart failure is unclear. OBJECTIVE: Describe the association between elevated cardiac troponin levels and adverse events in patients hospitalized with acute decompensated heart failure. METHODS: Troponin was measured at the time of admission in 340 patients who were hospitalized to Baghdad Teaching Hospital for acute decompensated heart failure between October 2007 and October 2008. A positive troponin test was defined as a cardiac troponin I level of 0.5 ng/mL or higher. RESULTS: Overall, 30 patients (8.8%) were positive for troponin. Patients who were positive for troponin had lower systolic blood pressure on admission [13830 vs. 14430 mmHg, P value 0.01], a lower left ventricular ejection fraction [mean 3315 % vs. 3816%, P value 0.002] and higher in-hospital mortality [3 patients (10%) vs 8 patients (2.58%), P value 0.001] than those who were negative for troponin. The adjusted odds ratio for death in the group of patients with a positive troponin test was 2.45 (95% confidence interval [CI], 2.14 to 2.79; P<0.001) by the Wald test). CONCLUSION: In patients with acute decompensated heart failure, a positive cardiac troponin test is associated with higher in-hospital mortality, independently of other predictive variables. KEYWORDS: cardiac troponin, heart failure

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THE IRAQI POSTGRADUATE MEDICAL JOURNAL PROGERIA

VOL.9, NO.2,2010

CASE REPORT

Progeria
Abdul-Karem Jasem albahadle
BACKGROUND: Hutchinson-Gilford Progeria Syndrome (HGPS) is a very rare genetic disorder with a frequency of 1 in 8 million live births. It is characterized by premature aging phenotype. The median age at death is 13.4 years. KEYWORDS: hutchinson-gilford progeria syndrome, failure to thrive, alopecia .

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