IRAQI JOURNAL OF MEDICAL SCIENCES

Background:Surgical diode lasers have been used in oral surgical procedures with beneficial effects as compared to the conventional techniques.
Objective:To evaluate the efficacy and safety of 810 nm surgical diode laser in the field of oral and maxillofacial surgery.
Methods:Forty patients who had different oral lesions were attending consultation clinic of the Maxillofacial Surgery Department in the Al-Kadhimyia Teaching Hospital. The patients have been treated by 810 nm diode laser. The power of the diode laser was 2-5 Watts in continuous mode. Excisional biopsies were sent for histopathological examination. Intraoperative and postoperative clinical examinations were done.
Results:The clinical observations revealed no bleeding intraoperatively and postoperatively, no infection and minimal swelling was seen postoperatively.
Conclusion:The benefits of 810 nm diode laser application in oral and maxillofacial surgery have been justified based on its efficacy and safety. There is a good acceptance for this new modality of treatment by the patients.
Keywords:Surgical diode laser, soft tissue lesion, oral surgery

Background:Dexamethasone is a highly potent glucocorticoid. Treatment with dexamethasone results in several metabolic perturbations on nearly all organs of the body including the liver.
Objective:This study had been carried out in order to investigate the effects of dexamethasone sodium phosphate as synthetic form of glucocorticoids on the rabbit liver as a model for human liver, by a light microscope, using two extreme of doses and two durations to show the dose and duration dependency.
Methods:Liver specimens were obtained from rabbits treated with dexamethasone sodium phosphate and from control groups 1 and 2, the specimens were fixed and processed to evaluate the histological and histochemical changes.
Results:Vacuolation and ballooning of hepatic cells were observed in the liver of the treated groups associated with degenerative changes of these cells, dilatation and congestion of central hepatic vein and sinusoidal capillaries were observed, positive periodic acid schiff's stain (PAS) reactions were noticed in the treated groups. All these changes were dose and duration related.
Conclusion:Morphological changes induced in the liver by dexamethasone sodium phosphate could be accepted as side effects of these drugs.
Key words:Liver, dexamethasone, histology, glycogen.

Background:Earlier studies have suggested that total testosterone (Testo) concentrations influence lipid metabolism. Whether these concentrations are prospectively associated with an adverse lipid profile and an increased risk of incident dyslipidemia has not yet been investigated.
Objective:Test the hypothesis that increased levels of postprandial triglycerides (TG) are associated with hypogonodism in male patients with cardiovascular disease (CVD).
Methods:Forty male patients with CVD aged 30-60 years and 46 normal healthy controls were studied. Postprandial blood glucose, lipid profile, urea and creatinine were measured. In addition, Total testosterone, sex hormone binding globulin (SHBG), luteinizing hormone and follicle stimulating hormone were done by Enzyme-Linked Immuno-Sorbent Assay. Body mass index was calculated.
Results:Negative correlation between Testo, and postprandial TG in both CVD and control groups was found with significant differences in Testo between these two groups, while SHBG correlated negatively with postprandial TG, in control group.
Conclusion:Postprandial triglyceride levels were associated with risk of CVD. These findings are particularly interesting and may contribute to an explanation for the higher cardiovascular disease risk in men with lower total testosterone concentrations.
Key words:CVD, Dyslipidemia, postprandial TG, Testosterone.

Background:Lymphotoxin α, β and their receptor play an important role in the control of lymphoid organ development and support of immune responses against pathogens.
Objective:To investigate expression of the lymphotoxin α, β and their receptor TLβRs using immunohistochemistry technique in patients with chronic active hepatitis and hepatocellular carcinoma.
Methods:Thirty five formalin fixed, paraffin embedded liver tissues, obtained from Liver and Digestive System Technical Hospital and private laboratories in Baghdad, were studied. In addition, thirteen apparently normal liver autopsies were collected from the Forensic Medicine Institute Archives after permission and used as control group.
Liver tissue sections were cut at 4 µm and placed on positively-charged slides, used for the detection of lymphotoxin α, β and receptor TLβRs by immunohistochemistry technique.
Results:The expressions of lymphotoxin α, β and receptor TLβRs were detected in most patients infected with HCV, 88%, 84%, 76% respectively in patient with chronic active hepatitis and 80%, 70%, 90% respectively in patients with hepatocellular carcinoma while low level of expression of these markers was observed in healthy control group.
Conclusion:Lymphotoxin α, β and their receptor TLβRs may play an important role in the development and progression of HCV associated liver pathology.
Key words:lymphotoxin, TLR, carcinogenesis hepatocellular carcinoma.

Background:Road traffic accidents are global problems, which represent one of the major causes of disability and death worldwide leading to unpleasant results on individuals, their families and their society.
Objective:To study the incidence of road traffic accidents in relation to socio-demographic factors, and to find out the patterns and distribution of the resulting injuries.
Method:This study included (375) victims of road traffic accidents whom were brought to the casualty room in AL-Gamhoria Teaching Hospital in Aden-Yemen for medical and legal evaluation during the period from 1st January up to 31 December 2010. Information collected consisted of personal identification data, and accident characteristics that were obtained from patients, close relatives, and other available persons who were present at the time of incidence.
Results:Only 140 (37.4%) of victims were hospitalized. 32% of road traffic accidents (RTAs) was observed among those aged 21-30 years with predominance of male (82.9%). The illiterates were the victims in 38.7%, students (48%), and single (60%). Most of cases from middle and lower socio-economic classes (53.3% and 40%, respectively). Pedestrians (38.5%) and passengers (35.7%) were the victims in most of cases. Light motor vehicle was involved in 61.5%. Sideway and hit and run were the most common types of collisions seen in (33.3% and 30.2%, of all cases respectively). Most of the accidents occurred between 12.01pm to 06.00pm. Most of the accidents occurred during summer season, mainly in the weekend. Multiple superficial injuries like abrasions, contusions, and lacerations wee the commonest pattern of injuries. Limb injuries were the most (46.5%) followed by the head (26.4%).
Conclusion:The middle aged group males were more common involved in road accidents. The pedestrians were mostly affected. The Injuries were mostly caused by light motor vehicles than other vehicles. Accidents were more common in the summer season and during weekend, in afternoon hours. Multiple superficial injuries were the commonest injury, and the head and limbs were the most common site of injuries among victims of non-fatal road traffic accidents.
Key words:Non-fatal, road traffic accidents, injury patterns and distribution.

Background:Preeclampsia is a major cause of maternal morbidity and mortality with unknown aetiology. Placental hypoperfusion and diffuse endothelial cell injury are considered the central pathological process. Many adipocyte hormones like leptin play an important role in the inflammatory and atherosclerotic process and may be used as a marker for preeclampsia.
Objective:To find the role of serum leptin measurement in pregnant women as a marker of preeclampsia.
Methods:Seventy six primigravida women in their 3rd trimester of pregnancy were studied; 44 of them with severe preeclampsia, while the other 32 women with normal blood pressure without any history of previous diseases. Blood samples were taken for serum leptin, uric acid and creatinine levels, urine samples were collected for albumin. Serum leptin level was measured by ELISA kits.
Result: Serum leptin and uric acid levels but not the creatinine was different in eclamptic group than control group. Mean age, height and weight were not different between the two groups. The systolic and diastolic blood pressures were also different between the two groups. 26 cases (59.1%) had proteinuria of 3+ albumin and 18 cases (40.9%) with 4+.
Conclusion:Elevated serum leptin level can be used as a marker in the assessment of preeclampsia.
Key words:Primigravida, preeclampsia, serum lipten.

Background:The association of type 2 diabetes mellitus and risk of cardiovascular disease is well documented. Insulin resistance is the hallmark feature of type 2 diabetes and there is evidence to suggest that testosterone is an important regulator of insulin sensitivity in men, with a role for testosterone in lipid metabolism and specially the triglyceride fraction.
Objective:To emphasize the association of low level of total testosterone with that of the postprandial triglyceride in male patients’ with type 2 diabetes mellitus.
Methods:Forty two type 2 diabetes mellitus male patients and 42 healthy controls of age range between 30-60 years, during the period from December 2011 to June 2012. Postprandial venous blood used for random blood glucose, lipid profile, urea and creatinine measurement. Luteinizing hormone, follicle stimulating hormone, testosterone, and sex hormone binding globulin was done using Enzyme-Linked Immuno Sorbent Assay (Sandwich assay).
Results:A negative correlation between testosterone, and postprandial triglyceride, in both type 2 diabetes mellitus and control groups with a significant difference in testosterone between the two groups. The sex hormone binding globulin was also correlated negatively with postprandial triglyceride in only the control group.
Conclusion:Hypogonodism in male (decline in testosterone level) leads to increased postprandial hypertriglyceridemia, which could, both, be considered of predictors for cardiovascular disease risk factors in male patients with type2 diabetes mellitus.
Key words:Postprandial triglycerides, type2 diabetes mellitus, testosterone.

Background:Laparoscopic cholecystectomy is the gold standard in the treatment of cholelithiasis, but there are still some patients requiring conversion to open cholecystectomy for several factors.
Objective:To estimate the conversion rate and evaluate preoperative risk factors for conversion from laparoscopic to open cholecystectomy.
Methods:140 laparoscopic cholecystectomies were carried out from January 2008 to January 2011 at Al-Kindy Teaching Hospital. Preoperative clinical, laboratory and radiographic parameters for these patients assessed and analyzed prospectively.
Results:Conversion to open cholecystectomy was needed in 30 patients (21.4%). Multivariate analysis identified male sex, with positive Murphy's sign, gall bladder wall thickness > 3 mm, a history of acute cholecystitis and time from the onset of symptoms till the time of surgery > 3 days as independent predictors of conversion rate to open cholecystectomy.
Conclusion:The identification of certain risk factors for conversion from laporascopic to open cholecystectomy preoperatively such as male gender, age more than 40 years, onset of symptoms, gallbladder wall thickness can help the surgeon to plan and counsel the patients about the conversion rate.
Keywords:Acute cholecystitis, laporascopic cholecystectomy, open cholecystectomy

Background:Occurrence of adverse effects and advantages of the Ligasure diathermy system (or Ligasure vessel sealing system) in thyroidectomy have not been tested in prospective randomized studies comparing its use with that of the time-saving clamp-and-tie technique to ligate and divide thyroid vessels. The effectiveness of Ligasure in achieving vessel division and hemostasis remains dependent on vessel diameter, and the risk of damage to adjacent structures cannot be completely excluded.
Objective:To evaluate the operative time, hospital stay and postoperative complications that achieved by ligasure in versus with clamp-tie technique in subtotal and near total thyroidectomy.
Methods:One hundred patients with benign multinodular goiter underwent subtotal and near total thyroidectomy. Subtotal and near total thyroidectomy was performed in 45 patients using ligasure and in 55 patients using the clamp-and tie technique.
Results:Postoperative complication rate was 2.7-7% overall in ligasure group (group one) vs. 7-31% clamp-and-tie technique (group two) including all temporary postoperative disturbances. There are no permanent complications but statistically, there was difference in their incidence. The mean hospitalization time was 1.4 day in group one vs. 2.5 day in group two. Mean operative time was shorter in the Ligasure group with minimal time difference of 17 minutes.
Conclusion:The use of Ligasure is safe and effective at vessel division and homeostasis than the clamp-and-tie technique, with a statistically significant decrease in mean operative time and hospitalization time. Because of that decrease in operative time and low complication rate, this would allow more patients to undergo thyroidectomy by this technique.
Key words:Ligasure, clamp and tie, thyroidectomy, hemostasis

Background:Microdebrider-assisted turbinoplasty of inferior turbinate is a surgical procedure for reducing the size of turbinate and achieve patent nasal airways in a condition where an enlarged turbinate cause chronic nasal obstruction not responding to medical treatment.
Objective:To assess the results of microdebrider technique in the management of patients with chronic nasal obstruction due to inferior turbinate hypertrophy.
Methods:From January 2010 to March 2011, forty patients with chronic nasal obstruction due to inferior turbinate hypertrophy not responding to medical treatment were treated with microdebrider-assisted turbinoplasty. They were subjected to detailed study of medical history and clinical examination. Post-operative follow up was performed for subjective and objective evaluation up to one year.
Results:Thirty seven patients (92.5 %) had good airway passage during the first two weeks after operation and these results continued up to twelve months. The complications encountered with this procedure were limited to postoperative bleeding with no crusting or adhesions.
Conclusion:Microdebrider-assisted turbinoplasty is a safe procedure for achieving turbinate size reduction with acceptable morbidity in patients with nasal obstruction due to turbinate hypertrophy. Bleeding is a minimal complication. Preservation of mucosa leads to early healing and absence of crusting.
Keywords:Turbinate, partial turbinectomy, microdebrider

Background:Ectopic pregnancy is a major cause of maternal morbidity and mortality. Creatine kinase is an enzyme that its increase reflects tissue injury and could be useful in the diagnosis of tubal pregnancy.
Objectives:To evaluate the diagnostic value of total creatine kinase in women with ectopic pregnancy, tubal rupture ectopic pregnancy, spontaneous abortion, and normal pregnancy and to investigate the possible discriminatory ability of creatine kinase-MB for diagnosis of tubal rupture ectopic pregnancy.
Methods:Forty women with ectopic pregnancy, 17 with intrauterine abortion and 24 women with normal gestation were studied. The diagnosis of ectopic pregnancy was based on clinical assessment and transvaginal ultrasonography. Serum human chorionic gonadotropin levels were measured by enzyme linked immuno-sorbent assay. Total serum creatine kinase and creatine kinase-MB values were determined by spectrophotometrical analysis.
Results:Creatine kinase and creatine kinase-MB levels were significantly higher in tubal ectopic pregnancy compared with both intrauterine abortions and normal gestations. When using creatine kinase-MB of 4.55 IU/ml as a cut-off value for the diagnosis of tubal ectopic pregnancy from control groups, sensitivity 81.64%, specificity 84.3%, positive predictive value 88.5% and negative predictive value 71.4%. Creatine kinase level in the ruptured ectopic pregnancy group was significantly higher than in the unruptured ectopic pregnancy, and normal pregnancy. When using creatine kinase of 29.43 IU/ml as a cut-off value for the diagnosis of ruptured ectopic pregnancy from unruptured groups, sensitivity 92%, specificity 100%, positive predictive value 100%, negative predictive value 96% and efficiency 97.4%.
Conclusions:Women with ectopic had a significantly higher levels of creatine kinase-MB compared with women with normal pregnancy or intrauterine abortion and it has a high discriminatory ability for diagnosis of tubal rupture ectopic pregnancy.
Keywords:Ectopic pregnancy, creatine kinase-MB

Background:Hemoglobin of the mother during pregnancy is well established to be contributors to abnormal prenatal development and pregnancy outcomes.
Objectives:To study the effect of maternal anemia on anthropometric measurement of full term newly born babies.
Methods:Two hundred pregnant women at time of delivery were investigated for their Hemoglobin. Their newborns were investigated for anthropometric measurement (weight, length, head circumference and chest circumference) immediately after birth. The questionnaire involved questions about age, parity, economy, educational level, and antenatal care of the mothers, and also sex, gestational age, anthropometric measures (weight, length, head circumference and chest circumference) and outcomes of the newborns.
Results:From 200 pregnant women who were included in our study, 115 (57.5%) of them delivered by normal vaginal delivery and 85 (42.5%) delivered by caesarian section. Sixty (30%) of mothers were anemic. Five (2.5%) of the newborns were small for gestational age all of them from anemic mothers.
Conclusion:Anemia affects neonatal outcomes in full term babies; full term babies of anemic mothers were in the normal anthropometric range, but they were much lower than babies of normal mothers.
Keywords:Pregnancy, Anemia, Small for gestational age

Background:Knowing the bacterial pathogens and their antibiotic sensitivity is an important way of establishing a suitable guideline of treatment of infection.
Objectives:To isolate bacterial pathogens from patients with respiratory tract infections (RTI), and to determine the antibiotic sensitivity of isolates.
Methods:Sputum specimens were collected from 145 patients with RTI admitted to Al-Kindy Teaching Hospital from March 2011 to January 2012. Out of these, 88 (60.7%) patients (age rang 17-59 years) had an established bacterial etiology, and of these, 57 (64.8%) were males and 31 (35.2%) females. All isolates were diagnosed according to bacteriological and biochemical standard methods. For identified of antimicrobial susceptibility used from Kirby Bauer method according to (NCCLS).
Results:Klebsiella species and Pseudomonas aeruginosa were the most common isolates among the Gram negative pathogens (26.2% and 11.7% respectively), followed by Escherichia coli and Proteus species, while Streptococcus pneumonia was the most common isolate among the Gram positive organisms, identified in (15.2%) followed by Staphylococcus aureus and Streptococcus pyogenes. High rates of resistance to Amoxicillin and Cephalothin were demonstrated by all bacteria, whereas most isolates were found to be highly sensitive to Amikacin, Ciprofloxacin and Tobramycin. In contrast, Cefotaxim, Tetracyciln, Gentamycin and Erythromicin were less effect against most of isolates.
Conclusions:Klebsiella spp. was the most common pathogens, whereas Streptococcus pneumonia which ranks as second common pathogens from patients with RTI in the present study. Amikacin, Ciprofloxacin and Tobramycin were the most effect antibiotics in vitro against tested bacteria. Conversely, no or less effect of other antibiotic agents was obtained making them not to be considered the drugs of choice in treatment of patients with RTI.
Keywords:Bacterial pathogens, Antibiotics resistance, Patients RTIs.

Background:The importance of lead as a toxic metal and environmental pollutant has long been recognized to human and animal health. In Iraq, lead pollution was documented in Baghdad and in Sulaimaniya city.
Objective:To explore the protective role of vitamin E alone or in combination with the amino acid methionine against lead acetate side effects on hematological parameters of adult male rabbits.
Methods:Thirty male adult rabbits were divided equally into five groups four of them administered lead acetate for 90 days, as sub-chronic exposure, and the fifth was considered as control. Three of these groups were treated with Vitamin E and/or methionine for 90 days. At the end of experiment, blood and liver samples were collected for either hematological analysis or histopathological examination.
Results:Lead caused a significant decrease in lymphocytes and erythrocyte indices; and a significant increase in reticulocytes and neutrophils. At the same time, Vit. E, alone or mixed with methionine, corrected these values to semi normal values.
Conclusion:Decreased erythrocyte indices and reticulocytosis that is found in the present study, demonstrates regenerative anemia in rabbits that had administered lead acetate. Vitamin E, alone or mixed with methionine, was efficient in reducing the side effects of Lead on hematological parameters; while, methionine had little or no effect when administered alone against lead which may be attributed to the dose or duration of the treatment.
Keywords:Lead; vitamin E; methionine; hematological changes

Background:Children with acute abdominal pain represent most of the admitted cases to the pediatric surgical department, one third of these cases are acute appendicitis. Early diagnosis of “no appendicitis” or “appendicitis” on the basis of pediatric appendicitis score could potentially save emergency department's time and resource use and could avoid time cost and risks for further evaluation.
Objective:Evaluation of Samuel scoring system in diagnosing children with acute appendicitis and their need for surgery.
Methods:One hundred and twelve patients aged between 5 to 15 years who presented with abdominal pain suggestive of acute appendicitis were studied. A complete data from patients were analyzed by using Samuel score. The clinical findings used by previously mentioned scoring system were analyzed to determine reliability of pediatric appendicitis score (PAS). The Final diagnosis was determined by histopathological report for patients' undergone appendicectomy.
Results:The mean (median, SD) score for children with acute appendicitis and non-acute appendicitis were 4.9 (5, 1.8) and 4.6 (5, 1.7) respectively. No variable (of the known signs and symptoms regarded as pathognomonic for acute appendicitis) shows a significant value in the diagnosis of acute appendicitis. A PAS of ≥ 4 had a sensitivity, specificity, Positive predictive value (PPV), and Negative predictive value (NPV) of 0.78, 0.27, 0.87, and 0.16 respectively.
Conclusion:The diagnosis of acute appendicitis and the need for surgery is still a matter of clinical judgment which can be built with practice, and although the PAS could provide useful diagnostic information in children with suspected acute appendicitis, it cannot be used as sole method for determining the need for surgery.
Key words:Pediatric Appendicitis Score (PAS), acute appendicitis, appendicectomy.