Mustansiriya Medical Journal

Abstract: Objectives: To explore the biofilm formation and β‐lactamase production of H. influenzae isolated from lower respiratory tract infections. Materials and methods: For the period from 1st Jun/2004 to 30th April/2005, 142 sputum samples were collected from patients with lower respiratory tract infections. These patients were attending TB and Chest disease center or Baquba general hospital. The specimens were cultured on chocolate agar plates with multivitex (Multi‐vitamins, BDH‐UK) under 10% CO2. Isolation and identification of H. influenzae were based on standard bacteriological and biochemical criteria plus serotyping with specific antisera (Bio‐RAD Laboratories‐Japan). An in vitro biofilm formation was assayed by microtiter plate technique. The β ‐ lactamase production was determined by direct capillary tube method. Results: Forty isolates of H. influenzae were recovered throughout this study. The isolation rate from males was higher than females (72.5% vs 27.5%). The highest isolation rate was recovered from patients with 40 years and older 17(42.5%) compared to other age groups. 17.5% isolates were H. influenzae type b (Hib), and the remaining 82.5% isolates were nontype b. twenty percent of the isolates were found to be β‐lactamase producers. Furthermore, 37.5% of isolates were found to have the ability for biofilm formation and the majority (66.7%) was β‐lactamase producers. 

A prospective study was conducted at Al‐Yarmouk Teaching Hospital, during the period
January 2002 to October 2004, to describe the demographic distribution and clinical assessment of
patients with toxic goiter. There were 42 patients with toxic goiter out of 225 patients with goiter
who were operated on. The incidence of thyrotoxicosis was 18.67% .Toxic nodular goiter
represents 78.57%, Grave’s disease represents 14.29% and toxic adenoma represents 7.14% of
thyrotoxic patients. Palpitation was the most frequent presenting symptoms 92.86%.

Abstract:  Objective:  To determine cardiac involvement in patients with rheumatoid arthritis (RA) and its clinical and echocardiographic findings.  Methods:  Fifty five RA patients who fulfilled the revised criteria of American College of Rheumatology enrolled in the study. The patients subjected to clinical assessment and electrocardiography (ECG), chest x‐ray and echocardiographic study were done for them.  Results: Cardiac abnormalities were detected in 18(32.72% p value 0.0051) patients. Pericardial effusion was found in 4(7.27%) patients while left ventricular and right ventricular diastolic dysfunction detected in 8(14.54%) patients. Abnormal electrocardiographic findings were identified in 10(18.18%) patients including partial bundle brunch block, low voltage graph and non specific T wave changes. Chest x ray with increased cardiothoracic ratio found in 5 (9.09%) patients. Conclusions: Cardiac involvement is a recognized sequel of RA.  Pericardial effusion and diastolic dysfunction is not unknown. Non specific ECG changes were recorded. Frequent follow up regarding cardiac status in RA is recommended. 

Abstract: Background: Detection of high risk patients with unstable angina is one of the important steps in saving their lives and preventing possible major cardiovascular events that can affect their morbidity and mortality.  Objectives: This study had been designed to estimate the effect of age, gender and different clinical parameters on the short term outcome of patients with unstable angina.  Methods: This study is a prospective study that enrolled 100 patients with unstable angina. The included patients had been randomly selected from those who had been admitted to the Coronary Care Unit of Al‐Yarmouk Teaching Hospital during the period between the 1st  of July and the 31st  of December 2003. Each patients included in this study had been followed up for 72 hours to 2 weeks according to the period of admission in the hospital, searching for any mortality, new or recurrent myocardial infarction or recurrent ischemia that necessitate the referral to intervention cardiology center. Unfortunately there was no facility for catheterization in the hospital and no one of the included patients referred back to the hospital to knew the results of catheterization. All of the patients underwent thorough physical examination. All of them had been sent for ECG, chest X‐ray and echocardiographic examination.   Results: All cause mortality had been identified only in those patients whose age were 65 year old or older (6 patients, 6% of the whole sample). 66.7% of deaths (4 deaths) were observed among class III patients (only 26.3% of class III patients had relieved form chest pain) i.e. angina at rest and acute. Conclusions: All cause mortality, frequency of new or recurrent myocardial infarction and recurrent ischemia were increased with the increase in the severity class. According to the clinical circumstances related to unstable angina, secondary unstable angina i.e. class A was the least frequent type (only 5 patients, 5% of the sample). According to the intensity of therapy, the worse outcome had been observed among those patients who are under the maximally tolerated doses of anti‐ischemic drugs. 

A case of a 45 years old woman presented with bilateral breast masses with axillary and cervical
lympadenopathy and generalized ill health .Investigations including surgical biopsy for breast and
axillary masses revealed non Hodgkin\\\'s Lymphoma of the breast. This is a rare condition involving
the breast and should be differentiated from carcinoma as the treatment is different.

stract:
This study was designed to investigate the cellular changes of peripheral blood lymphocytes
(PBL) in children with type 1 diabetes mellitus (T1DM) by determining the surface antigens (CD
markers). Sixty T1DM patients who were newly diagnosed as type1diabetetics (duration of their
illness is less than five months) were selected from the National Diabetes Center at Al-Mustansiriya
University during the period May 2004 to October 2005. All the patients were treated with daily
replacement doses of insulin. Their age ranged from (3-17) years. Fifty apparently healthy control
subjects, matched with age (4-17) years and sex underwent the PBL phenotyping. Phenotyping of
lymphocyte surface antigens was done by direct Immunoflurocent (IF) technique using mouse
antihuman CD3, CD4, CD8, CD19 and CD56.
T1DM patients showed a remarkable lowering in CD3+, CD8+, and CD56+ cells but the
decrease in CD4+ cells percentage was not significant in patients in comparison to healthy controls.
In contrast, a significant elevation of CD19+ cell percentage and CD4+: CD8+ ratio were observed
in the patients.

Abstract:  Background:  The war in Iraq has had a tremendous impact on children.  Objectives: To investigate the frequency and severity of Posttraumatic Stress reactions in primary school Iraqi children who experienced school bombardments as war trauma. Methods: In the period from April to May 2005; 121 Children from four primary schools in Baghdad   completed self –report Child Post Traumatic Stress Reaction Index (CPTSD‐RI), Arabic version,  Results: The children reported severe to very severe PTSD reactions were 90 (74.4%) of the total number of participants. There was a highly significant correlation between severity and subscales of avoidance, arousal and experiencing (p>0.01). There were no significant correlations between younger and older age groups, and between boys and girls. The most frequently reported symptoms are identified as traumatic(67.77%), sleep disturabances (64.46%), easily startled (61.98%) and sense of foreshadowing (62.8%)                                                                                                                    Conclusions: Highly frequent rates of PTSD reactions reported in Iraqi primary school children who had experienced war trauma.   Severe and very severe reactions reported by children were also high.    

Chronic hyperglycemia in type 2 diabetes is responsible for both microvascular and
macrovascular complications that can lead to considerable morbidity and mortality. Several
studies have shown that maintaining good glycemic control can prevent or halt the progression of
these life threatening complications. With time a large number of type 2 diabetics fail to achieve
the recommended glycemic targets with diet, exercise and oral anti diabetic agents, and most of
them ultimately require insulin therapy. Actually many studies have shown that the early
introduction of insulin therapy for type 2 diabetes, will improve insulin sensitivity and secretory
capacity of the B‐cells of the pancreas.

Abstract:  Study of the correlation between changes in the white blood cell count (WBC), total lymphocyte count (TLC) and the CD4+ T‐helper lymphocyte count (CD4), have been carried out during Oct. 2004 through April. 2005 among 35 HIV seropositive Iraqi patients and 30 seronegative individuals. ELISA and Western blot assays were used to detect and confirm the presence of anti‐ HIV antibodies in the blood samples. Patients and control groups have been classified into (4) categories according to the obtained results of CD4 count: <200, 200‐500, 500‐1000, and >1000 cell/cmm. This categorization shows that: none of the HIV seropositives was found to be within the first category; six within the second category (mean CD4 = 383.2 cell/cmm, SD= 92.6) twenty‐one within the third category (mean CD4 = 787.9 cell/cmm, SD= 131.6); and eight within the fourth category (mean CD4= 1237.1 cell/cmm, SD= 159.4). While among the control group: none of them was found to be within the first category; only one within the second category (CD4= 464 cell/cmm); twenty‐six within the third category (mean CD4 = 745.7 cell/cmm, SD= 116.2); and three within the fourth category (mean CD4= 1333 cell/ cmm, SD= 331). Results showed that among HIV seropositives a strong significant, positive correlation was found between changes in CD4 and TLC within the second and the third categories, and even when the whole data (uncategorized) were used. While there was a moderate significant positive correlation within the fourth category. The correlation between total WBC and CD4 was found to be insignificant. 

Interleukin 6 (IL‐6) and tumor necrosis factor α (TNF‐α) may be used as a prognostic value in
breast cancer .Serum levels of IL‐6 , TNF ‐ α were elevated significantly, among the 40 sera
samples of female breast cancer patients compared to the 20 healthy control samples (P<0.05).
The level of IL‐6 and TNF‐α were significantly higher in metastasis breast cancer patients than
those with local site (P<0.05), Furthermore, these results showed a positive correlation between
IL‐6 and TNF ‐ α levels; the coefficient of correlation (r) was 0.98 which was statistically significant
(P<0.05). These results indicate that serum IL‐6 and TNF – α level may be used in the assessment
of breast cancer patients.

Abstract: Background: The prevalence of active epilepsy in a large number of studies has been shown to be fairly uniform at 4‐10 per 1000 population. Objective: In order to find the prevalence rate of active epilepsy, the possible etiology of epilepsy and to study the therapeutic pattern of epilepsy. Methods: A cross section study which included 254 patients 120 female and 134 male in AI‐Amen public clinic which serves a population of 145531. Epilepsy was classified into active and inactive epilepsy. Seizures were classified as symptomatic and idiopathic. Results: The prevalence rate of active epilepsy was 1.66/ 1000. Active epilepsy rate was 95.3% of the total sample. The etiology was unknown in 77.9% of cases, symptomatic epilepsy 22.1 % which was due to mental retardation (9.4%). head trauma (7.5%). Brain tumour (2.4%), cerebro‐vascular accident (1.6%), and meningitis (1.2%). The most frequent (75.2%) management strategy was monotherapy. The rate of patients on regular medical therapy was 57%. The mean duration of treatment was 10.7 ± 8.22 years. Last fit in 84.3% of cases occurred in a duration of one year prior to their participation in the study. Conclusion: Availability of medication is not enough unless an appropriate education program is applied to provide all patients with in formation about regular use of the drug. 

Abstract
Objectives
To assess the efficacy and safety of Repaglinide in achieving the recommended glycemic targets in type 2 diabetes.
Methods
Six months prospective interventional study (before and after treatment) was carried out on 125 type 2 diabetics treated by Repaglinide with/without metformin. Patients were interviewed three times, at the begining, after three and six months each time they were examined physically and investigated thoroughly.
Results
Efficacy and safety parameters, fasting plasma glucose (FPG), postprandial plasma glucose (PPG) and glycated hemoglobin (HbA1c) had shown a significant statistical reduction to meet the recommended glycemic control targets of the American Diabetes Association (ADA) and very close to the International Diabetes Federation, European Diabetes Policy Group (IDF) at the consecutive interviews. Lipid profiles values, Total cholesterol, LDL-C, HDL-C, non-HDL-C, triglyceride and atherogenic index (TC/ HDL-C ratio) were achieved significant statistical improvements.
Conclusions
Repaglinide as monotherapy or in combination with metformin was safe, efficacious and well tolerated for lowering plasma glucose in type 2 diabetes, achieving the internationally recommended glycemic targets and improving the lipid profile values.