Mustansiriya Medical Journal

Aims: To measure the level of Chromium and Vanadium in the serum of
Iraqi children with Type 1 diabetes in an effort to evaluate the status of
these elements.
Patients and Methods: Thirty – five children with type 1 diabetes were
involved in the study. They were all out- patients attending the National
Diabetes Center. Thirty seven non- diabetic apparently healthy children
were included in the study to compare these controls for age and sex
with the diabetics patients. Plasma glucose was measured using PAP –
Enzymatic method. HbA1c was estimated by using non–ion exchange
High Performance Liquid Chromatography. Trace elements including
chromium and vanadium were determined by flameless atomic
absorption.
Results: All diabetics showed a significantly decrease in both element (Cr
and V.) studied as compared with their controls matched for age and
sex. [(17.35 ± 1.81 ng/ml) (18.76 ± 2.9 ng/ml) and (43.47 ± 0.26 ng/ml)
(26.20 ± 0.97 ng/ml) (P< 0.0001)] respectively.
In addition to that, there was a significant positive correlation between
age and both plasma glucose and HbA1c levels for those patients with
type 1 diabetes (r=0.37, 0.33) (p<0.05) respectively, while there was a
significant negative correlation between age and both serum Cr and V
levels (r= 0.45, 0.52) (p<0.05) respectively. Results from controls,
showed a significant positive correlation between both plasma glucose
and HbA1c with serum Cr level (r= 0.39, r= 0.35) (p<0.05) respectively,
while there was a significant negative correlation between age and
serum Cr level (r= 0.40) (p<0.05).
Conclusions: Due to deficiency of these trace elements, supplementation
is indicated to diabetics especially to those with diabetic complications.
Things such as eating a better daily diet, in which elements content is
optimal, is .considered few of the major controllable areas of our lives.

Background: Neuroimaging has an important application in the diagnosis
and treatment of patients with seizures and epilepsy.
Aims: To determine the diagnostic yield of CT scan in children with
Epilepsy and recurrent seizures.
Patients and Methods: A total of 100 patients with epilepsy referred for
CT scan of the brain in Al-Yarmouk general hospital in Baghdad from
November 2008 to January 2010, with an age of patients in between 2
days to 15 years. (M 68: F32).
Results: Fifty one (51%) had abnormal neuro imaging of which 13 (13%)
were found to have possible treatable causes and lesions requiring
intervention.
A high yield of positive scans distained in children with the presence of
abnormal neurological examination focal EEG abnormalities and a history
of neonatal seizures.
Conclusions: Computed tomography is the standard clinical practice for a
child with recurrent seizures, especially with the presence of abnormal
neurologic examination and focal EEG changes.

Aims: To investigate the possible effects of hawthorn extract on blood
pressure & blood lipid profile in patients with stage I hypertension.
Patients and Methods: This 12 week randomized, double -blind, placebo
controlled study was conducted on newly diagnosed patients with stage
I hypertension (n=60). Patients were selected from outpatient clinic in
Al-Yarmuk Teaching Hospital, Baghdad and were divided into two groups
each comprising of 30 patients, they were given hawthorn extract
capsule 450 mg (Willmar Schwabe Pharmaceuticals) twice daily and
identical placebo capsule respectively. Systolic and diastolic blood
pressure was recorded and fasting lipid profile was done initially and at
the end of 4th, 8th and 12th week of treatment. Both of hawthorn and
placebo treated group were given diet and exercise plan.
Results: After 12 weeks the hawthorn treated group had a significant
reduction in both of systolic and diastolic blood pressure (p<0.01), serum
total cholesterol (p<0.001) and low density lipoprotein (p<0.001), while
the placebo treated group had a non-significant decrease in their blood
pressure (p>0.05), serum total cholesterol and low density lipoprotein
(p>0.05). High density lipoprotein was significantly increased in patients
treated with hawthorn (3.01 mg/dl, 8.13% P= <0.05) compared with
placebo group (1.06 mg/dl, 2.8 % P= > 0.05) but there was no significant
difference in triglyceride detected between two groups.
Conclusions: The study suggests that hawthorn does have an effective
antihypertensive ability, as well as lipid lowering effects.

Background: Irritable bowel syndrome is a chronic gastrointestinal
disorder affect quality of life for patients. Recently due to low level of
satisfaction with the available treatment, high percent of IBS patients
turn to complementary and alternative medicine especially herbal
medicine.
Aims: To examine the effectiveness of Anethum graveolens in the
Management of Patients with Irritable Bowel Syndrome.
Patients and Methods: Thirty two patients with IBS who diagnosed
according to Rome criteria were allocated into 2 groups: group A,
treated with the standard pharmacological agent mebeverine 135mg tid;
group B, treated with capsules containing powder of crude plant of
Anethum graveolens tid, for two weeks. The IBS symptoms were
assessed before therapy and after two weeks, the symptoms evaluated
were: pain severity, pain frequency, stool frequency, stool consistency,
abdominal distension, incomplete evacuation, urgency and passing of
mucus.
Results: Treatment of IBS patients with the tested herbal agents show
improvement in all IBS symptoms after two weeks in both of individual
symptom score or total score percent, treatment with Anethum
graveolens show significant P≤0.05 improvement in total score percent
78.13%, compared to mebeverine 53.13%.
Conclusions: Patients with IBS may benefit from two weeks treatment
with Anethum graveolens, administered as a capsule containing powder
of crude plant, the improving effect occur in all IBS symptomed without
any side effect reported indicating the efficacy and safety of Anethum
graveolens in the management of IBS symptoms.

Background: One of the factors affecting the accuracy of readings of
blood pressure is the equipment used. Defects or inaccuracy of the
sphygmomanometer may be source of error in blood pressure
measurement.
Aims: This study had two objectives. Firstly, to assess the accuracy of
sphygmomanometer used in general practice and secondly to assess the
physical condition.
Materials and Methods: A total of 50 mercury and aneroid
sphygmomanometers were tested for accuracy and physical condition.
Results: The results were that of the mercury and aneroid
sphygmomanometers tested, 30% were inaccurate, of these, 10%
recorded an error greater than 10 mmHg. Both types of
sphygmomanometers were evaluated for conditions of cuff/bladder,
pump bulb, and valve. Air leaks / holes in the pump bulb was found in 4%
and bladder damage in 6% and indicator needles not pointing to the zero.
Conclusions: It is necessary that all equipment used for blood pressure
measurement should be checked for accuracy on regular period.

Background: Nephrotic syndrome is a chronic disease with frequent
relapses and the accumulative dose of steroid play an important role in
developing growth retardation.
Aims: To detect the degree of growth retardation in long standing
nephrotic syndrome and frequent relapsing nephrotic syndrome, and to
identify the effect of nephrotic syndrome and steroid therapy on
puberty.
Patient and methods: A cross sectional study conducted in Child Central
Teaching Hospital from the first of January to first of July 2008, on 108
patients with steroid responding nephrotic syndrome, 60 of them were
males and 48 were females. All had anthropometric measurement of
height and the assessment depend on Tanner growth centile for age and
sex, so as the puberty staging according to Tanner staging. The ranges of
the patients ages were 2-17y and the mean age was 11.5+4 y. 59.25% (64)
were having steroid toxicity; no patient was on cytotoxic drug.
Results: The results were shown that 52/ 108 (48.18%) of the patients
have got growth retardation (2SD below the mean) Fifty of the patients
were at pubertal age, 30 were males and 20 were females. 39 patients
had delayed puberty (78%), 36 patients with delayed puberty had steroid
toxicity (94.73%). There is a significant relationship between frequency of
relapses, duration of illness and steroid toxicity with incidence of
delayed puberty and growth retardation.
Conclusions: There is a significant correlation between the growth
retardation and the development of steroid toxicity. With frequent
relapses and long standing nephrosis, there is a chance to develop
growth retardation. Delayed puberty is more with steroid toxicity and it
is more in males than females.

Background: Pseudomonas aeruginosa is a classic opportunist
pathogen with innate antibiotics and disinfectant. It is physiologically
versatile and flourishes as a saprophyte in warm moist situation within
human environment, including sinks, drains, respirators, humidifiers
and disinfectant solutions.
Aims: investigate the antibacterial activity of Viola odorata extract in
vitro.
Patients and methods: alcohol solvent was mainly utilized for such
extraction procedure with subsequent application of the extract
against resistance Pseudomonas aeruginosa isolating from different
body sites. Twenty two isolates, out of 222 samples, produced Beta
lactamase (β-lactamase) and such isolated bacteria was examined for
antibiotic sensitivity test toward ten antibiotics namely ampicillin,
Augmentin, cefotaxime, amikacin, gentamicin, ciprofloxacin,
tetracycline, trimethoprim, tobramycin, and imipenem.
Results: it was revealed that the alcohol extracts of Viola Odorata;
range with half concentration (500, 250, 125, 62.5, 31.25, 15.7 mg/ml);
exhibited broader spectrum as well as greater activity against
resistant Pseudomonas aeruginosa among those with/without tested
extracts with inhibition zone vary between (10-30 mm).
Conclusions: These data suggest that Viola odorata extract could
inhibit the growth of Pseudomonas aeruginosa strain in vitro and this
activity may contribute to its chemopreventive effect.

Aims: Stress hyperglycemia represents a transient increase in blood
glucose in reaction to acute illness. Cases with stress hyperglycemia have
higher mortality rates and worse functional outcomes than the ones
with known diabetes or normoglycemia. This study evaluated the
incidence of stress hyperglycemia in acute ischemic stroke patients and
its relationship with stroke risk factors.
Patients and Methods: WHO criteria is used to confirm hyperglycemia
and HbA1c test to detect stress hyperglycemia in a sample of 220
patients with acute ischemic stroke who were admitted to Al-Yarmouk
teaching hospital in Baghdad from 1 April to 31 December 2010.
Results: thirty nine patients with acute ischemic stroke had stress
hyperglycemia. There is significant effect of gender, hypertension, atrial
fibrillation and dyslipidemia on patients with stress hyperglycemia while
this is not found with obesity and smoking.
Conclusions: stress hyperglycemia is a common phenomenon in patients
who develop acute ischemic stroke.

Aims: To determine the effect of the addition of 25 µg/kg body weight
ketamine to 0.5% bupivacaine in infra-clavicular brachial plexus block.
Patients and Methods: In a randomized double blinded, placebo
controlled clinical trial, Forty patients, from the age of 20-60 years, with
ASA I, II and III, undergoing upper limb (below elbow) surgery, had been
chosen to be enrolled in the study. They had been divided randomly, into
2 groups. Group 1 will receive 30 ml of solution 1 (25 ml of 0.5%
bupivacaine with 5 ml of normal saline) as placebo or control group.
Group 2 will receive 30 ml of solution 2 (25 ml of 0.5% bupivacaine with 25
µg/kg body weight ketamine) as ketamine group. A nerve stimulator
(B/Braun Stimuplex® HNS 11) had been connected to 22G-10 cm length
insulated needle. Time of motor impairment was assessed by lack of
muscular coordination and heaviness feeling of the limb. Time of
parasthesia was assessed by loss of pin brick sensation.
Results: There was a quite noticeable prolonged time of analgesia in the
ketamine group. The mean ± SD was 698 ± 139 minutes in ketamine
group while the mean ± SD in placebo group was 140 ± 40 minutes
(p<0.05). Twelve patients out of 20 had recorded 800 minutes of
analgesia (60%) in ketamine group. There were no other clinical
differences in side effects or motoric latency in between both groups.
Conclusions: Low dose of ketamine added as an adjuvant to 0.5%
bupivacaine in infra-clavicular brachial plexus block, will prolong the time
of post-operative analgesia without any side effects.

Aims: to investigate hematospermia & study its clinical significance.
Patients & methods: a prospective study was carried out on 31 patients
with hematospermia at Al-Yermouk Teaching Hospital between January
2007 & January 2009. All patients were clinically assessed & subjected to
urinalysis & seminal fluid analysis. Other investigations were done
according to individual cases. More than 90% 0f the patients had no prior
genitourinary symptoms or significant factors in their history.
Results: The etiology of hematospermia was determined & found to be
of inflammatory and infective origin in most men especially the young. In
3 of the 31 patients studied, hematuria occurred with hematospermia &
was associated with significant lower urinary tract abnormalities such as
bladder tumor, however in none of these a relationship appeared
between hematospermia & the disease process.
Conclusions: From this study we can conclude that hematospermia is of
no importance, does not progress, tend to disappear in the course of
time & rarely is associated with any significant urologic pathology.

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Background: In the field of gynecology, studies have found high levels
of leukotriene in the endometrium and uterine smooth muscles of
patients with dysmenorrheal and menstrual pain.
Aim: to evaluate the effectiveness of montelukast in relieving the
symptoms of dysmenorrhea. Patients and methods: A randomized,
single-blind, prospective, placebo-controlled study was designed.
Seventy patients suffering from dysmenorrhea complete this study,
divided randomly into two groups: montelukast group (34 patients) and
placebo group (36 patients).Values before and after treatment were
compared over two menstrual cycles, using visual analog scale (VAS)
score and NSAID usage per menstrual cycle. Results: Post-treatment VAS
score and NSAID usage decreased significantly in both montelukast and
placebo group, compared to their pre-treatment values (P<0.05). The
mean decreases in VAS score and NSAID usage were more in the
montelukast group than in the placebo group, but the differences were
not statistically significant (p>0.05). The ratio of the highly effective
cases, for both VAS score and NSAID usage, was significantly higher in
the montelukast group than placebo group (P<0.05). Means of VAS
score and NSAID usage didn\\\'t change in all of endometriosis patients
after administration of montelukast or placebo therapy. Conclusions: For
some women, montelukast may be effective in relieving symptoms of
primary dysmenorrhea. It\\\'s safe and has no serious adverse effects.
Thus, it can be considered as a good option for treatment of primary
dysmenorrhea before starting with hormonal therapy.

Aims: To evaluate the relationship between serum Leptin, Growth
factor-1 (IGF-1) levels and untreated thyroid dysfunction patients.
Patients and Methods: A study was made on 50 untreated goiterous
patients (female and males) with range between (25-55) years; and25
controls subjects (females and males) with range between (14-55) years.
Serum T3, T4 &TSH were by Radio immune assay (RIA) method. Serum
Leptin and Insulin like growth factor-1 (IGF-1) was measured by ELISA
method.
Results: The mean Serum Leptin level was significantly lowest in
hyperthyroidism than control subjects. While Insulin growth factor level
was significantly highest in hyperthyroidism than control subjects (3.82
vs. 2.49)
Conclusions: the objective of the study was to provide new data on the
relationship between serum Leptin, Insulin like Growth Factor-1 levels
and thyroid dysfunction.

Background: although severe pain is not life-threatening in healthy
parturient women, it can have neuropsychological consequences.
Postnatal depression may be more common when analgesia is not used,
and pain during labor has been correlated with the development of post
traumatic stress disorder. In addition, one study suggested that the
impairment of cognitive function in the postpartum period can be
mitigated by the use of any form of intrapartum analgesia.
Aims: to compare a combination of epidural fentanyl and bupivacaine
with bupivacaine alone for epidural analgesia in labor and to evaluate
factors in addition to analgesia that may influence maternal satisfaction.
Patients and methods: a double blind controlled clinical trial carried on
218 multiparous parturient. The patients were randomly allocated in 2
groups. Group 1 (n=109) had received bupivacaine 0.1% with fentanyl
50µg and group 2 (n=109) (control group) had received bupivacaine 0.1%
only.
Results: in the bupivacaine group, 40 cases (37.7%) had required 2 top
ups and 26 cases (23.9%) had asked for 3 top-ups. On the other hand 14
(12.8%) cases from bupivacaine fentanyl group had asked for 2 top-ups
and no cases had recorded request for 3 doses, which was statistically
significant (P<0.0001).
Conclusions: maternal satisfactory rate is high in both groups; the
bupivacaine fentanyl group had shown a good response to the effect of
analgesia with the minimal medical intervention.

Background: The neurohormone namely melatonin is secreted by the
pineal body in brain. It could reach all the bodily tissues and cells;
affecting their function, depending on its biological level. Thymus
gland is well known to be the main central immunity director, and its
wellness is rather proportional to melatonin level.
Aims: This work was done to study the histopathological effect of
exogenous melatonin on thymic connective tissue bulk.
Materials and Methods: Dietary melatonin was supplied to adult rats,
for successive 30 days. Rats were divided 6 groups. Group 1 was the
control, group I was the control. Group II, III, IV, V and VI were
supplied with a daily measured quantity of melatonin as 125, 250, 500,
and 1000 µm/kg body wt, respectively. After the last day of treatment
all animals were killed then the left thymic lobe was removed under
anesthesia for histopathological study.
Results: No noteworthy effect of melatonin was seen on the thymic
connective tissue on its normal doses, whilst it had significant effect
on the connective tissue bulk with its large doses.
Conclusions: The treatment of dietary melatonin had no important
effects on the rat thymic connected tissues, on its little doses, but it
has considerable effects when administrated in large doses.

Background: Various types of plateletpheresis instruments are available
for single donor plateletpheresis. In plateletpheresis blood is withdrawn
from the donor in anticoagulant solution and separated into
components. Platelets are retained and the remaining components are
returned to the individuals.
Aims: Evaluation of Fresenius COM.TEC; apheresis machine in regard to
processing time, platelet (plt) yield efficiency, white blood cell (WBC)
content and safety.
Patients and Methods: Twenty two healthy male donors included in
single donor plateletpheresis by Fresenius COM.TEC between February
2006 and July 2006 at bone marrow transplantation Center, Medical City
Hospital, Baghdad / Iraq.
The donor’s age, height, weight, complete blood count, blood group
&Rh & vital signs were recorded and they were observed throughout the
procedure. Plateletpheresis operational variables and the product
variables were assessed.
Results: The plateletpheresis product data which includes, donor platelet
count with mean 229.424 x10³/cmm (range 185-336 x10³/cmm), product
platelet count x10³/cmm mean 1268.5 x10³/cmm (range 604-2525
x10³/cmm), Platelet yield with mean 3.39 x10¹¹/cmm (range 2.51-7.57
x10¹¹/cmm), 90.90%of the product >3x10¹¹plt. No. of yield with WBC
<1x106 18 out of 22 donors (81.18%), collection efficiency the mean 48,85%
(range 32.18-60.28), the collection efficiency >50% was seen in 13 out of
22 donors (59.09%).
Few donors exhibited adverse reactions mainly circumoral paresthesia in
two donors (9.09%) mild pain at the phlebotomy site in three donors
(13.63%). Only one had dizziness which account for 4.54%.
Conclusions: Fresenius COM.TEC; apheresis instrument collected
platelets safely, efficiently, with consistent leukoreduction product
according to the AABB (American Association of Blood Banks) & with
short time.

Background: Femoral neck anteversion (FNA) is a physiological torsion of
the femur that plays an important role in the stability & function of the hip
joint and has a great impact on the rotational movements of the limb.
Abnormal development of the FNA may be associated with a number of
orthopaedic problems affecting the hip joint & gait ranging from in-toeing
gait to disabling osteoarthritis. The assessment of the angle is therefore
important in assessing such problems & determining the best course of
action in their management.
Aims: this study aims at measuring the FNA angle in healthy Iraqi children
& examining its impact on hip rotational movements at different age
groups.
Patients and Methods: thirty-six healthy Iraqi male children divided into 3
age groups were examined clinically for the range of hip rotation & were
then subjected to X-ray estimation of the FNA angle of their hips using
Ogata’s Biplanar method.
Results: all the children had FNA angles & hip rotational movements
within the normal range for their age with a significant regression in FNA
angle with increasing age that may be related to muscular torsional forces
applied to growing epiphyses. The FNA angle was inversely proportional
to lateral rotation of the hip but directly proportional to medial rotation.
Sides to side differences were noticed in tested subjects and were
statistically significant in the (8-9 years) age group.
Conclusions: the understanding of the normal femoral neck anteversion
is essential to properly reassure and educate families, in addition to
identify more serious underlying structural problems that may exist.

Certain drugs could disturb physiological function and anatomical
structure of thyroid gland and; to some instance, the peripheral
thyroid hormone metabolism as part of their adverse reactions. In
fact, commonly prescribed drugs including anti-convulsants, non
steroidal anti-inflammatory drugs, Beta-adrenoceptor antagonists,
steroid hormones and heparin may produce an abnormal thyroid
function test, albeit an absence of detected clinical features for
thyroid dysfunction. Therefore, it is recommended to undertake a
routine monitoring of thyroid function test, both at baseline and every
3 to 6 months thereafter, in vulnerable individuals (for example, those
with thyroid antibodies or euthyroid goiter) receiving such
medication.

Background: Patients undergoing surgery for solitary thyroid nodules or
multinodular goiter are investigated preoperatively. These investigations
may define or possible cases of thyroid malignancy and so help in
planning the surgical approach and affect the outcome of the
management of the patient in general.
Aims: To evaluate the roles played by preoperative investigations in
cases of thyroid enlargement in deciding the probable outcome of the
operative procedure with emphasis on cases of thyroid malignancies.
Patients and Methods: All patients admitted for thyroid gland surgery at
Al-Yarmouk teaching hospital for the period from Oct.1 2008 to Oct.1
2009 were fully evaluated preoperatively. Clinical, radiological, hormonal
and FNA cytological findings were recorded. Operative findings were
reported. Histopathological diagnosis followed and reported.
Results: During the period of the study (102) patients were admitted
with management, the majority were females (82) in the fourth decade
of life (35 cases). The main clinical presentation was multinodular goiter
(84) ultrasonography revealed (78) cystic lesions and (24) solid lesions.
The main pre-operative investigation was F.N.A cytology. The majority of
the reports were normal (78) with four reports of malignancy. The main
finding at surgery was multinodular goiter (94 cases). The most common
operative procedure was sub-total thyroidectomy (59).
Histopathological examination revealed (85) benign pathology and (17)
malignant all of them papillary carcinoma.
Conclusions: F.N.A cytology is the most important pre-operative
diagnosis and because of the reported low sensitivity further experience
and training is recommended.

Background: This work aimed to isolate and identify fungi from different superficial fungal infection since these infections are widely distributed among low socioeconomic level people.
Patients and Methods: All clinical specimens from skin, hair, scalp and feet were diagnosed as dermatophytes or other fungi according to well-known established mycological methods for isolation and identification of certain fungi.
Results: This study was undertaken at AL-Yarmook Teaching Hospital during the period January 2008-December 2009 in which 55 clinically diagnosed as fungal infection were the source of clinical specimens. Out of 55 cases it has been found that 45 specimens (81.8%) were positive for fungi from which 21 (46.6%) were dermatophytes, 16 (35.5%) pityriases versicolor, 8(18.2%) candida albicans.
Conclusion: It is concluded that dermatophytes are the major cause of mycotic superficial infections and that skin is the predominant area of the body which is invaded by fungi.