Mustansiriya Medical Journal

Aims: To find the demographic distribution, by analyzing the data such
as age, gender, residence, chief complaint, pharyngotonsillar bulge and
seasonal distribution, among Iraqi patients. Patients and Methods: Cross-sectional study of 42 patients attending
outpatient ENT department in Al-Yramouk Teaching Hospital with
suspected peritonsillar abscess, for one year period, only 3o patients
diagnosed as having peritonsillar abscess, confirmed by positive needle
aspiration, were included and analyzed for most common affected age
,gender, chief complaint , residence , pharyngotonsillar bulge and
seasonal distribution, while the remaining 12 patients having only
peritonsillar cellulitis confirmed by negative needle aspiration, so
excluded from the current study.
Results: The most common age group affected were 16-24 years ( 40%),
the most common gender was male (male to female ratio 1,5:1), the most
common chief complaint is trismus (77%), the most common months of
presentation was November and December of the year (13 and 20 %
respectively) and the most common degree of pharyngotonsillar bulge
was moderate (63%) .The most common residence was urban (70%).
Conclusions: The most common age group is young adult male, trismus
is main chief complaint, and the commonest degree of pharyngotonsillar
bulge is moderate.

Background: Mobile phones are widely used non-medical portable electronic
devices. The uses of mobile phones occur in hospital wards, Consultation clinic,
laboratories, and pharmaceutical warehouse and also in operation rooms. Over
the past decade, mobile phones have become an essential accessory in our
social and professional life. The mobile phones of health care workers harbor
many harmful pathogens which serve as a reservoir for nosocomial infections.
Aims: We aimed to investigate Microbial contamination for cellular mobile
devices used by medical staff and healthcare workers in Al-Yarmouk Teaching
Hospital, Baghdad, and detection of microbes that cause these contaminations,
whether bacterial, fungal or parasitic.
Materials and Methods: Samples were collected from mobile devices of 16
physicians, 23 residents, 18 interns, 10 pharmacists and 35 nurses. Three sterile
swabs moistened with sterile saline and each was rotated over the surface of
both sides of the mobile phones.
Results: Out of 102 mobile samples of medical staff in Al-Yarmouk Teaching
Hospital evaluated, growth was observed in 80 samples (78.4%) and the
remaining 22 (21.6%) were sterile. Eight species of Bacteria were isolated,
35(34.3%) Staphylococcus epidermidis, 29 (28.4%) Staphylococcus aureus,
13(12.7%) Escherichia coli, 8(7.8%) Klebsiella spp, 7(6.9%) Streptococcus
pyogenase, 6 (5.9%) Proteus mirabilis, 4 (3.9%) Bacillus spp and 3 (2.9%)
Pseudomonas aeroginosa. There were fungal isolates as follows: 6 (5.88%)
Candida spp, 4 (3.92%) Aspergillus spp, 3 (2.9%) Mucor spp, based on mycelia,
color and spores. Eggs & cysts of parasite haven’t seen under microscope. The
highest rates of single growth was 13 (12.7%) reported among Resident, while
the higher percentage of single growth recorded in General Surgery
department. There were statistical relations between microbial growth and
gender, profession and department of healthcare workers.
Conclusions: The current study showed that 78% of 102 samples taken from
mobiles of medical staff in Al-Yarmouk Teaching Hospital in Baghdad city, were
contaminated by several microbes, most of which belonged to the natural flora
of the human body as well as airborne fungi and soil. So it is necessary to
sterilize your hands after contact with cell phones as an important source for
the transfer of these microbes.

Splenic abscess is a rare entity with a wide variability of causative
pathogens Its reported mortality rate is still high, up to 47%, and can
potentially reach 100% among patients who do not receive antibiotic
treatment. The timely and widespread use of imaging methods (eg,
computed tomography [CT] scanning, ultrasonography) facilitates early
diagnosis and guides treatment, thus improving the prognosis. We are
reporting a 42-year-male patient presented with an abscess in the spleen.
The etiology was due to typhoid fever. It was diagnosed by CT-scan and
treated by splenectomy. A review of the modalities of treatment is
discussed.

Background and Aims: Platelets have a significant role in the pathogenesis of
atherosclerosis and coronary artery disease. It is well established that large platelets are
involved in the development of atherosclerotic plaque and acute coronary syndromes.
Aim: The aim of this study was to define the relationship between platelet volume indices
and development of acute coronary syndrome.
Patients and Methods: Our study included 50 patients admitted to AL-Yarmouk teaching
hospital with acute coronarysyndrome;20 patients had unstable angina (UA) and 30
patients had acute myocardial infarction (AMI) diagnosed on the basis of history,
characteristic electrocardiographic changes, and increased cardiac biomarkers activities.
Mean platelet volume (MPV), platelet crit (PCT), platelet count and platelet distribution
width(PDW) were done using automatedhematology analysis and compared them with
50 age and sex matched healthy controls.
Results: All platelet volume indices—mean platelet volume (MPV), platelet distribution
width (PDW), platelet count and platelet crit(PCT)—were significantly raised in patients
with AMI and UA. In patients with myocardial infarction, the mean values of MPV, PDW,
platelet count and PCT were 10.9fL, 21.6%, 352.2(x 10^9/L) and 0.171% respectively; while
in normal healthy control the mean values of these indices were 7.1fL, 15%, 256.2(x 10^9/L)
and 0.153% respectively. A statistically significant difference in mean values of these
indices was found (p value < 0.001). Similarly, in patients of unstable angina mean values
of MPV, PDW, platelet count and PCT were 11.1fL, 21.1%, 300.7(x 10^9/L) and 0.165%
respectively. Statistically significant differences in mean values of these indices were
found.
Conclusions: Larger platelets are haemostatically more active and are a risk factor for
developing coronary thrombosis and subsequent acute coronary events (myocardial
infarction and unstable angina). Patients with larger platelets can easily be identified
during routine hematological analysis and could possibly benefit from preventive
treatment.

Background and Aims: recently it has been established that abnormal
adipocytokines may contribute to insulin resistance in diabetes. The current
study designed to investigate adiponectin to leptin ratio (A/L) as a reliable
marker for insulin resistance in good and poor glycemic controlled type 2
diabetics.
Patients and Methods: A total 120 males were recruited in the study, out of
them there were sixty persons with type2 diabetes (29 of them with good
glycemic control, and 31 with poor glycemic control), there were sixty persons
serves as healthy controls. They were matched for age, and BMI. Fasting venous
blood samples were collected for measuring fasting serum glucose (FSG),
glycated hemoglobin (HbA1c), and lipid profile, insulin, adiponectin, and leptin.
Blood pressure, waist circumference, and BMI were determined for all
participants. Homeostasis model assessment (HOMA)-insulin resistance (IR)
index, and adiponectin/leptin ratio (A/L) ratio were calculated.
Results: the result showed a significant decline in adiponectin, and A/L ratio, and
a significant rise in serum leptin, insulin, HOMA-IR, FSG, HbA1c, and serum
triglycerides TG in diabetes group as compared to healthy control group. On the
other hand, correlation analysis revealed that A/L ratio is the most likely markers
that closely linked with insulin resistance parameters than HOMA, adiponectin,
and leptin; even after multiple regression analyses, it was correlated more than
HOMA-IR with insulin resistance parameters. When patients were divided
according to their glycemic control (poor and good controlled), the result
showed a lowered adiponectin, and A/L ratio; as well as, there was a significant
increase in serum leptin, insulin, and HOMA-IR in poorly controlled compared to
good-controlled diabetes group. On the other hand, the correlation coefficient
investigated to show the relation between both (A/L ratio, and HOMA-IR) and
other variables in each group of glycemic control; and observed that A/L ratio
has a strong significant correlation with other parameter than HOMA-IR in both
groups.
Conclusions: the results suggested that the A/L ratio was more linked with
insulin resistance parameters than HOMA-IR. In addition to that, A/L ratio is a
good predictor for insulin resistance in good and poorly controlled diabetes
mellitus. Accordingly, an A/L ratio is likely to become a new laboratory
biomarker of insulin resistance.

Aims: To detect the frequency of TMD, analyzing its symptoms, and to
determine its otological manifestations as otalgia, tinnitus, ear fullness,
and hearing impairment. Patients and Methods: During 4 months period, 350 patients visiting ENT
department for their ear complaints, only 72 patients were selected and
submitted to this study by filling the questionnaire regarding their
symptoms of TMD and their otological complaints, followed by full ENT
examination (there is normal otoscopic finding) and clinical examination
of the temporomandibular joint (TMJ) and adjacent area.
Results: Among 350 patients, 72 patients had TMD (20.5%), 44 male
(61.1%) and 28 female (38.9%). Regarding the most common TMD
symptom TMJ pain (48.6%) was commonest, followed by joint clicking
sounds (23.6%), pain on masticatory muscles (18.1%), and limitation of jaw
movement with or without jaw deviation (9.7%), while the most common
ear symptom was otalgia (52.7%),followed by ear fullness (23.6%), tinnitus
(22.2%), and hearing impairment (1.3%).
Conclusions: High frequency rate of TMD, the most common TMD
symptom was TMJ pain and the most common ear symptom was otalgia.

Aims: The present study is conducted to evaluate the level of Leptin,
Insulin like growth factor -1 (IGF-1) and Albumin (Alb) in heamodialyzed
patients pre- and post-dialysis compared with healthy control.Patients and Method: A study was made on 25 dialyzed patients
attending the dialysis unit in AL-Yarmook teaching hospital from the
period between May and August 2009 (male only) with age range (25-55)
years, and their duration time with dialysis was more than one year.
Serum Leptin, IGF-1 was measured by ELISA method, Albumin level was
measured by kit.
Results: The mean serum Leptin level was significantly lower in post
dialysis patients when compared with pre-dialysis, but still higher than
healthy control. While insulin like growth factor-1 was higher in post
dialysis than pre-dialysis but the difference was not significant, and both
of them were significantly lower than healthy control.
Conclusions: The present study shows that Leptin level has been proved
to be elevated in patients with pre- dialysis, due to renal failure that may
be impairs either its synthesis or clearance. We have also demonstrated
an increase in the level of IGF-1 in post-dialysis when compared with pre-
dialysis, but the level still lower than healthy control, thus early decrease
in serum IGF-1 may allow early detection of malnutrition in
haemodialyzed patients.

Background: Healthy eating is vital for teens' health and well-being. The nutritional needs of teens vary accordingly, but generally increased due to the rapid growth and changes in body during puberty. A poor diet may cause health problems later in life such as obesity, heart disease, or diabetes.
Aims: To assess the attitude and practice of students in Babel governorate secondary schools about factors affecting their nutritional status and the relation of some of these factors with demographic characteristics.
Methods: A cross-sectional survey by using self-administered questionnaire about the attitude and practices (including feeling hungry in presence of food at home, eating breakfast daily, consumption of different food items according to number of servings daily of fruits, fresh vegetables, milk and dairy products, sweetener and soda drinks, fruit juice, fast food and high fat diets) to be filled in 15-20 minutes distributed to a sample of 2848 students from randomly selected secondary schools in Babel governorate, during the period from 1stJanuary to the last of February 2011.
Results: The study showed that 3% of the sampled students always feel hungry and 54.2% always not skipping breakfast. Female skipping breakfast more than male and the difference was statistically significantly but the skipping rate difference was not significant between urban and rural areas. The consumption of food items including fruits about 31.1% in three serving and more daily, about 21% eating vegetables in more than three serving daily, more than 28% drinking sweetener soft drink or soda more than three times daily, 77.8% eating high fats diet three times and less daily and about 25.9% were not consuming milk and dairy products daily.
Conclusions: There were unhealthy eating habits including less than normal number of servings for most of food items (fruits, vegetables, dairy products and fruit juices) and high usage of sweetener soft drink and unhealthy snack food.

Background: Maternal perception of fetal movement is one of the first signs of fetal life and is regarded as a manifestation of fetal wellbeing. Aims: To evaluate reduced fetal movement as an effective predictor for the assessment of fetal condition and to improve fetal outcome by early detection of fetal hypoxia. Study Design and setting: A Co relational study carried out for a period of two years from Dec. 2010 - Dec. 2012 at Obstetrics and Gynecology Department of Al Yarmouk teaching hospital Baghdad Iraq. Patients and Methods: 200 patients with history of sluggish fetal movements from 32-41weeks gestation were admitted to the Obstetric ward during the study time for clinical evaluation and their biophysical profile score was recorded and were followed till delivery, the mode of delivery and neonatal outcome were recorded including APGAR score of newborn which was noted at one and five minutes and those having poor APGAR score were resuscitated and admitted to neonatal care unit. Results: During this study 200 patients were evaluated, 58 patients were primigravidas and 142 were multigravidas. Among 200 patients non reactive fetal heart was found in 64 cases. 120 patients had a biophysical profile score of 10/10, 44 patients had a score of 8/10 and 32 patients had a score of 6/10. In 4 patients with 4/10 score emergency caesarean section led to the delivery of neonates with low APGAR score. Majority of patients with normal biophysical profile score of 8-10/10 had good APGAR score. The rate of caesarean section was 34%. Concerning fetal outcome 70% of cases with good outcome, low APGAR score at five minutes (<610) in 14% of cases, meconium staining in 9% of cases, birth asphyxia in 6% and endotracheal intubation in 1% of cases. Conclusions: reduced fetal movement appears to be a serious complaint that should be further evaluated and is associated with a significant fetal compromise.

Background: Laparoscopic Cholecystectomy (L.C) is now considered the gold standard in gallbladder surgery. However, Open Cholecystectomy (O.C) is still being performed widely in Iraq. Both types of surgeries have unique problems in the early post-operative period which need to be recognized and dealt with properly. Even with better experience in laparoscopic surgery, complications in the early post-operative period should be expected and addressed promptly and efficiently. Aims: To observe and compare the clinical events in the early post-operative period (the first 48 hours) following L.C and O.C, and to recognize the special problems arising during this period. Also, to document and compare the early post-operative complications in both types of surgeries and the methods applied to deal with these complications.
Patients and Methods: All patients admitted for cholecystectomy (open and laparoscopic) to the 2nd surgical team at Al-Yarmouk Teaching Hospital for one year were included in the study. They were evaluated pre-operatively and followed post-operatively with full documentation of the surgical procedures, findings and intra-operative complications. Early post-operative course starting from anesthetic recovery till discharge from hospital was followed very closely and documented. General and specific complications in the early post-operative period were studied and their management observed in details.
Results: The number of patients operated upon was 110, 58 laparoscopicaly and 52 by open surgery. In the L.C group , the average pain score in the first 24 hours was 1 compared to 3 in the O.C group patients with L.C were given analgesia on day zero only, while 25% of patients with O.C received analgesia on day one also. Early nausea was present in 90% of patients in L.C group VS. 90% in O.C group, the L.C group 10.4 % had respiratory symptoms vs. 23.1% with O.C patients with L.C had earlier return of bowel function. In the LC group, there were 17 episodes of bleeding vs 4 episodes in the O.C group. In the L.C group 2.8% had common bile duct injury vs 4.6% in O.C group. Post-operative bile leak was 2.8% in L.C vs 1.9% in O.C, while spillage of gallstones was higher in L.C(65.6% vs. 9.7%). Conclusions: The early post-operative course is smoother in the L.C group although with better anesthetic techniques and good post-operative care, the course following O.C is improving. Vascular complications related to trocar site, blood vessels and solid organs mainly liver were more in the L.C group. Bile leakage and gallstone spillage were more with L.C but bile duct injuries more with O.C. Better training of surgeons is needed to improve the learning curve and decrease the incidence of complications.

Background: Today, the hospital admission and surgical management for peptic ulcer disease is largely restricted to the treatment of its complications.
Aims: To study the risk factors of perforated peptic ulcer.
Patients and Methods: A prospective study of 118 patients presented with perforated peptic ulcers between January 2009 and December 2011 at Al- Yarmouk Teaching Hospital. A detailed history was documented including the proposed risk factors of age, gender, occupation, social habits and associated medical illnesses.
Results: The total number of patients was 118 patients. Out of these, 101 were males (86%) and 17 were females (14%); with the male: female ratio being 6:1. Patients in the fourth decade constituted the highest proportion of cases (38%); 78% non-professional employers; 43.2% used ulcerogenic drugs; 72.9% were smokers and 14.4% consumed alcohol. Negative history of peptic ulcer diseases were documented in 64.4%; 19.5% had associated medical; 44% had blood group O and H. pylori infection was positive in 75% of cases. Regarding the risk factors, H. pylori and smoking were more related.
Conclusions: Nonprofessional employer males in the fourth decade of life were the commonest in this collection. Combined risk factors of H. pylori and the use of NSAID formed the highest risk. Negative past history, those with group O and smoking were important risk factors in this study. Regarding the relation of risk factors to morbidity and mortality, medical co-morbidities & smoking had significant relation