Mustansiriya Medical Journal

Background: Recently a new premixed insulin analogue has been introduced with good results achieved in
different parts of the world particularly regarding good glycemic control and safety.
Objective: This clinical study was conducted to evaluate the effectiveness and safety of introducing new
insulin (biphasic insulin aspart 70/30)for the treatment of type 2 diabetic patients.
Methods: This prospective follow up study included 68 type 2 diabetic patients who has been randomly
selected from those attending the National Diabetes Centre (NDC)of Almustansiria University during the
period between 1st of oct.2004 to 31st of march 2005.Each patient had been followed for an average period
of 6 months. Detailed history had been recorded and thorough physical examination has been performed for
each patient. Readings of fasting and postprandial plasma glucose (FPG,PPPG), HbA1c,body mass index
(BMI), and the frequency of hypoglycemic attacks had been recorded at the baseline ,interim, and the final
visit which had been separated by 3 months between each other. At the baseline visit , each patient has been
instructed how to use insulin pen properly and biphasic insulin aspart 70/30 had been supplied to the patients
included in this study freely. Statistical analysis using students t-test had been used to assess the difference
between different means using a p value of less than 0.05 as the level of statistical significance.
Results: This study showed that there was significant difference between the mean human insulin dose used
before the study(48.3u/day) and the mean premixed insulin Aspart(36.88u/day) P value less than 0.05.The
use of insulin analogue was associated with significant reduction in FPG (130.5mg/Dl in the last visit
,compared with 216mg/Dl in the 1st visit )P value less than 0.001,and the PPPG (160.2mg/Dl compared with
280mg/Dl in the 1st and last visit respectively)P value less than 0.001, and the mean HbA1c (7.1%
compared with 9.41%)P value less than 0.001.There was no significant difference between the 1st and last
visit recordings of BMI (27.9Kg/m2 compared with 28.1Kg/m2 respectively )P value more than 0.05 ,and in
the average incidence of mild hypoglycemic episodes (1.01 compared with 0.42 episode respectively)P value
more than 0.05.
Conclusion: This study showed that the use of this type of insulin analogue for type2DM lead to marked
and statistically significant improvement in the glycemic control ,mainly in the PPPG. In addition the use of
this type of insulin was associated with only mild elevation in the BMI and slight lowering in the incidence
of hypoglycemic episodes ,both non-significant statistically.

Background: Apoptosis is a terminal cell fate that eliminates physiological unneeded or dangerous
cells. The Bcl-2 oncoprotein encodes a mitochondrial protein that blocks apoptosis. High levels of
Bcl-2 protein are found in different malignancies including acute leukemias and it is thought to be
directly involved in the emergence of drug resistance by disrupting &/or delaying apoptotic
program and promoting tumor survival.
Objectives: To analyze the significance of any variation in the level of Bcl-2 expression according
to disease progress (from time of diagnosis to time of remission or resistance) in cases with acute
leukemia, and whether to consider this variation as a prognostic marker.
Methods: Through a prospective study, 25 samples of bone marrow aspirates were taken from
different patients who attended the hematology unit of Baghdad teaching hospital in the medical
city from December 2005 to July 2006, who proved to have acute leukemia in its different types or
subtypes(ALL and AML) & at a variable phases of the disease course. Monoclonal antibody
targeted against Bcl-2 oncoprotein via immunocytochemistry staining techniques of these aspirates
was performed in order to define the level of Bcl-2 protein carrying cells &looking for any
differences in this expression in relation to disease progress or treatment hoping to translate these
findings in terms of prognosis.
Results: Despite the heterogenous expression of Bcl-2 protein carrying cells in each case(0-500
cells out of 500 cells)of AML or ALL , it was found to be in positive correlation with the density of
blast cell percentage in the marrow(r=0.515,p=0.008) unlike the relation with total leucocyte count
(r=0.364,p=0.074).
Conclusion: A good clinical clue to intractable resistant course of the disease at diagnosis is
verified in this study when very high level of Bcl-2 protein carrying cells was found.
This finding may have a useful clinical application through the recommendation to change
therapeutic strategy, at time of diagnosis, to more aggressive protocols, which is agreed by others.
There was no chance to study the application of high level of Bcl-2 protein in terms of long-term
survival due to short follow up.

Background: Extra hepatic biliary tract (EBT) injuries are injuries that involve the gall bladder
(GB), the common hepatic (CHD) and the common bile ducts (CBD). They are rarely encountered
during external abdominal traumas. They are serious and associated with high morbidity and
mortality when the ductal system is involved and because of the associated visceral and vascular
injuries and thus they need special care to be diagnosed early, and managed properly.
Objectives: To study the incidence, clinical presentation, management, and complications of
extrahepatic biliary tract injuries.
Methods: Retrospective review was done for all the patients who had laparotomy for their
abdominal traumas during a year at Al Yarmouk Teaching Hospital with special emphasis on
extrahepatic biliary tract injuries.
Results: Nearly 700 people had severe abdominal injuries necessitating an explorative laparotomy
for their management. Out of this number only 8 definite extrahepatic biliary tract injuries were
discovered. 6 of them had cholecystectomy and 2 had biliary ductal injuries for which drainage was
the major step in their management. 4 cases were labeled to have missed EBT injuries.
Conclusion: Extrahepatic biliary injuries are rare coincidences on exploring traumatized abdomen.
They are serious injuries associated with high morbidity and mortality when the ductal system is
involved and are usually accompanied by severe other visceral injuries. Their management should
be done by the most senior surgeon and if possible in a well equipped center

Design: This prospective study was carried out at the magnetic resonance imaging (MRI) unit at the
department of diagnostic imaging of Al-Kadhmiya Teaching Hospital over a period of 26 months.
Objective: To establish a strategy for the use of MRI of the pituitary region in patients with
hyperprolactinaemia based on the possibility of finding a pathology in the pituitary region as a
cause of hyperprolactinaemia with respect to serum prolactin (PRL) as well as the analysis of serum
PRL in relation to the size of adenoma in the pre & post medical treatment evaluation to determine
the need for MRI in the follow up in patients with pituitary adenoma.
Subjects & Methods: We selected 69 women recently found to have clinical & biochemical
evidence of hyperprolactinaemia with serum PRL exceeding the double the upper normal level of
the control. MRI of the pituitary region & serum PRL were assessed at the initial presentation for all
patients & after the institution of bromocriptine (BRC) treatment for 28 patients who were shown to
have either micro or macroadenomas at the initial MRI. The diameter of the adenoma served as a
predictor for its size & was considered for correlation with serum PRL level at the follow up period
of 3 , 6 & 12 months of treatment.
Results: At the initial MRI, 27 patients had microadenomas (39.1%), 12 patients had
macroadenomas (17.4%), 9 patients had empty sella turcica (13.1%), and 21 patients (30.4%) had
no obvious abnormality in the pituitary region The analysis of individual serum PRL level to
establish a cut-off point of serum PRL above which all cases were positive for a pathology in the
pituitary region on MR imaging, revealed a cut-off value = 84.6 ng/ml. A strong correlation has
been found between the size of adenoma and serum PRL level at the initial presentation as well as
at the follow up assessment that revealed a parallel reduction in adenoma diameter & serum PRL
level.
Conclusion: MRI of the pituitary region is justifiable in women with hyper-prolactinaemia when
serum PRL level is approximately two & a half folds of the upper normal level where its likely to
reveal an abnormality , but it should not be used routinely for the follow up of patients on treatment
as the assessment of serum PRL level will suffice as a predictor of tumor shrinkage unless there is
no response to medical treatment or the patient developed new symptoms that suggest increase in
the size of the adenoma or involvement of the surrounding structures.

-

Background: Haemorrhoidectomy is an operation for third and fourth degree hemorrhoids
Aim: To compare the closed (Ferguson) and open (Milligan-Morgan) methods.
Methods: A prospective study, eighty patients admitted with hemorrhoids were randomly allocated
to either open or closed methods.
Results: Mean operative time was shorter in the open method. Analgesic requirement were less in
the closed method. Healing time was shorter in the closed method.
Conclusions: The closed technique is associated with less pain during early post operative period
and faster healing.

Abstract:
Background: Colorectal cancer is the second most common internal malignancy and the second
leading cause of cancer death (after lung cancer).The condition becomes increasingly common after
the age of 50.Because it is a common problem in certain areas of the world and because its insidious
nature of onset that sometimes is too late when diagnosed , keeping high index of suspicion with
developing screening tests that are reliable and easily performed are vital in diagnosis.
Objective: To highlight some of the demographic, laboratory, and histopathological criteria of
colorectal cancer in a group of Iraqi patients.
Methods: This study is a descriptive cross sectional study that had enrolled 30 patients with
colorectal cancer. The patients included in this study had been selected from those patients who had
attended the endoscopic unit / department of medicine at Al-Yarmouk teaching hospital during the
period between the 1st of September 2006 to the 1st of September 2007. Patients diagnosed to have
colorectal cancer by colonoscopy, and biopsy samples were taken for histopathological study, and
blood samples were taken for carcinoembryonic antigen.
Results: This study revealed that 80% of the patients were older than 50 years of age with a male:
female ratio of 2.75:1.63.33% of the patients were smokers. The study revealed that the presentation
of the disease is usually insidious with abdominal pain, change in bowel habit and haematochezia
and melena seen in 83.34% of the patients. 66.67% of the tumors were located in the
rectosigmoid.All the tumors were adenocarcinoma. Carcinoembryonic antigen was +ve in 60% of
the patients.
Conclusion: Colorectal cancer is more common in old male patients with smoking habit.

Objective: To evaluate the relationship between serum Leptin levels and metabolic syndrome, in
(obese, non obese) control subjects, untreated hypothyroid and hyperthyroid patients.
Methods: A study was made on 63 goitrous patients and 25 control subjects. Body mass index
(BMI) was calculated. Serum T3, T4, TSH were measured by RIA method, serum lipid profile was
measured by spectrophotometric method, serum Leptin was measured by ELISA method.
Results: The mean serum Leptin level was significantly higher in obese than in non obese control
subjects (29.1 vs. 5.8 ngm / ml) and higher in hypothyroid patients
lowest levels in hyperthyroid patients (3.4 ngm /ml).
(27.9 ngm /ml), and
Conclusion: Leptin reduce body weight by decreasing food intake (appetite), fat deposition and
increasing energy expenditure. Serum Leptin is highly correlated with the body mass index (BMI),
other indices of adiposity (lipid profile) in normal obese human and hypothyroid patients.

Background: Diabetes is likely to be the fifth leading cause of death. Global excess mortality attributable to
diabetes is estimated at 2.9 million deaths which is equivalent to 5.2% of world all-cause mortality.
Compliance with medical advice is essential for controlling the disease; it is affected by many factors related
to the patient, the disease, the physician and the family.
Objective: To assess the level of diabetic patients’ compliance with diet, drugs and visits, and to assess its
effect on the disease control through certain indicators.
Methods: A total of 300 diabetic patients from different age categories, both males and females, were
included in this study. The patients are usually either self-referral or referred from other hospitals, primary
health care centers, governmental general practice clinics or private clinics. A questionnaire form was
constructed to collect data about the demographic characteristics of the patients, about diet and medications.
Files of the patients were reviewed to have an idea about their compliance.
Results: Compliance with diet was medium in half of the patients, while with drugs; it was good in 60.3%,
and 38.7% had good compliance to visits. The best compliance with diet (38.2%) was seen in the age group
40-49 year while the least (19.2%) was in the age group (30-39)[ (χ²=2.65, P>0.05), 37.4% of the patients
who are using oral hypoglycaemic agents, and 36.7% of those using insulin had good compliance with diet
(χ²=7.10, P<0.05).
Conclusion: We can conclude from this study that the diabetic patients (represented by the study sample)
have poor compliance with diet and visits, the duration of the disease was the most common variable found
to predict compliance

Background: One of the major complications of colonic resections is anastomotic leak that may
convert in some cases into permanent faecal fistula, presented with discharge of faecal material
from the site of the wound or drain.
Objective: To know the incidence of faecal fistula after colonic surgery, and to analyse the
associated factors that enhance or reduce its formation and its recurrence.
Method: A prospective study of one hundred and thirty seven patients who were undergone colonic
surgery in the period from Jan.1996 to Jun.2005. Those patients were followed up for at least one
month after the operation of the anastomosis of the colon. The operations were done for different
pathologies or lesions. All of the operations in this study were elective with bowel preparation,
while 126 patients (92%) had previous colostomy because of an urgent operation in the past.
Results: It had been found that the majority of the operations on the colon were closure of the
colostomy (92%), especially that due to missile injuries (75.5%). Anastomotic leak appeared in 14
cases (10.2%) of the total operations, ten of them closed spontaneously with conservative treatment
and the remaining 4 cases (2.9% of the total) transformed into faecal fistulae. All of these fistulae
were in the patients originally injured by high energy missiles. Re-operation for those four patients,
after bowel preparation, included excision of the fistula with resection of the affected segment
of the colon and reanastomosis. The fistula disappeared in three of them but recurred in the fourth.
Conclusions: Although mortality reduced markedly in elective colonic operation, by the modern
surgery, faecal fistula still remains a challenge to the surgeons. Bowel preparation, prophylactic
antibiotics, good vascularity of the ends of the colon, proper approximation of the ends of the colon
without tension, delicate suturing, prevention of perioperative hypotension, and good nutrition of
the patient; all are prophylactic measures against formation of the fistula. Once the fistula was
formed, then simple suture closure of the fistula alone is not beneficial, preferably resection of the
affected segment of the colon is indicated.

Abstract:
Objective: To estimate the types of hand deformities in patients with rheumatoid arthritis (RA).
Methods: A group of 100 patients who had been admitted to the department of rheumatology and
rehabilitation center in Sulaimany general hospital and those who had been attended to the rheumatology
and rehabilitation center between June 2006 and January 2007 were included in this study.86% were females
and 14% were males . Patients who had undergone articular surgery and patients below 16 years had been
excluded.
Results: Hand deformities recorded in 47% of cases. The frequency of deformities was as follow; swan neck
deformity (48.90%), boutonniere deformity (43.04%), Z deformity(59.5%), ulnar deviation of the
metacarpophalangeal joints (MCPJ) (78.7%), radial deviation of the wrist (91.48%), subluxation of the wrist
(27.6%), and subluxation of the MCPJ(36.17%).There was a significant correlation between disease duration
and development of deformities,other factors that had been studied but had no effect on the development of
deformities were rheumatoid factor positivity ;occupation of the patients ;effect of weather;and geographical
distribution of the patients.
Conclusion: Rheumatoid arthritis is an important disease that affects the hands and cause deformities.
Understanding these deformities is necessary for the proper management of these patients. This study is
representative for RA related hand deformities and factors that contribute to their development.

Background: A gel filtration technique has been used for the isolation and purification of soluble
testosterone receptors from benign and malignant prostatic tumors. Two types of testosterone receptors from
benign and malignant prostatic tumors were eluted from the sephadex G-200 column. This work was carried
out to characterize and quantify human nuclear androgen receptors from benign and malignant prostatic
tumors.
Methods: The study involved twenty five patients with benign prostatic hyperplasia (BPH) and thirteen
patients with prostatic adenocarcinoma (PCA) attending Al-Kadhimiya teaching hospital from the period of
November 2005 till july 2006.
Results: The purification folds of two benign separated receptors (BI &amp; BII) were 11.588 and 19.582 fold
respectively whereas for the two malignant separated receptors (MI &amp; MII) were 24.280 and 29.111 fold
respectively.The choice of most appropriate conditions of the binding of 125I-testosterone with its receptors
were also carried out.The concentrations of binding sites and the equilibrium dissociation constants for the
binding between 125I-testosterone and its purified receptors have been determined using Scatchrad analysis
and the specificity of the binding has been examined. The concentrations of two benign separated receptors
(BI &amp; BII) were 0.931 and 1.140 pmole/mg protein respectively whereas separated malignant receptors (MI
&amp; MII) have 1.056 and 2.163 pmole/mg protein respectively at 37ºC.
Conclusions: Gel filtration technique and Scatchard analysis confirmed the presence of two types of
testosterone receptors in each tumor type. The first eluted receptor (I) has a relatively higher molecular
weight with a lower affinity constant for testosterone binding than the other(II).

Background: Fatal head injuries are frequently seen in medico-legal practice. Death occurs immediately in high percentage of cases and may be delayed after different periods according to the seriousness of the condition.
Objectives: To know the period between severe head injury and death, to determine the ultimate cause of death and the importance of that especially from the medico-legal aspect.
Methods: A full autopsy examination had been done on cadavers of 667 persons dead from head injuries in medico-legal institute of Baghdad during six months period from 1/3/2002- 31/8/2002. Those deaths were either immediate or delayed. All required information had been collected and converted to tables and figures to reach the objectives of the study.
Results: The percentage of fatal head injuries was 40.7% of total number of deaths, and 50.8% of violent deaths. Immediate death occurred in 76% of the cases and delayed in 24% after different periods from the admission to the hospital. In addition to the other results of the study.
Conclusions: Fatal head injuries have high percentage among medico-legal deaths. This refers to its importance and seriousness. Immediate death may occur in most of the cases. This study also concluded the importance of medico-legal studies for different medical branches.