Mustansiriya Medical Journal

Background: Tibial and/or fibular shaft fractures accounted is a common problem, the incidence is approximately 25% of all fracture of lower limb. Majority of these fractures are successfully managed with interlocking nail (ILN) or plate & screws, which has become the mainstay of treatment of diaphyseal injuries with less complications in comparism to other methods of treatment Aim of the study: This study is to evaluate and to compare the effectiveness of treatment of patients with fractures of tibial shafts using interlocking nail or plate & screws fixation. Study design; case control Methods: From January 2010 to july2014, forty six patients with fractures shaft of tibia were treated surgically in Al-Yarmouk Teaching Hospital. Evaluation using functional score of Karlstrom& Olerud [20]. All patients were followed up regularly for an average 12 months with. The patients were divided into two groups, depends on the method of treatment. The ILN group group (1) included 21 patients with an average age of 35years. The Plating group (2) included 25 patients with an average age of 40.0 years. Results: In our study, both groups were similar in the location of fractures, mean age, mechanism of the injury, type of fracture and gender (all P values were approximately 0.38). The wound size is smaller in the ILN group (2-4cm) group when compared to the Plating group (10-14) cm (P<0.001). The rate of union , time of healing and rate of malunion were not significantly different between the two groups (P>0.05).Evaluation of the consecutive postoperative roentgenograms for assessment adequacy of reduction were recorded. The rates of malunion between the ILN group (14.6%) and the Plating group (5%) showed no significant difference (P=0.36). Conclusion: using interlocked nailing for treatment of tibial shaft fractures is effective, simple and assures maintenance of the reduction. Plate & screws gives rigid fixation without cast immobilization except in distal third in both group needs either fixation of distal fibular fracture or cast immobilization, after surgery, most patients return to their previous jobs about 6 months.

Background and Objectives: MEBO is a Chinese burn ointment has been introduced recently for local management of burn injuries with a USA patented formulation since 1995. In this study we try to prove that MEBO is more effective if applied vaginally after electrocautery than electrocautery alone in treating cervical erosion. Method: This study performed from 1st of May 2013 to the end of April 2014 in private clinic in Baghdad, a clinical comparative study was done on 100 patients who had cervical erosion(by clinical examination), group1(50 patients) were treated with electro cautery once time alone. group 2 treated with electrocautery once time followed by MEBO application vaginally once daily for 20 days, all patients in both groups seen weekly to assess the start and completion of healing of erosion and any sign of infection and improvement of any symptom especially vaginal discharge. Results: The mean time required for start and completion of healing was significantly shorter for group2(1.5 ± 0.5)weeks,(2.2 ± 0.6)weeks, respectively than group1 which was(3.5 ± 1.0)weeks, (4.2 ± 1.0)respectively and it was statistically significant(P value less 0.001). More patients in group2 had decreased vaginal discharge(44)than group1(33) and it was statistically significant difference. Also the incidence of vaginal infection was less in group2(6%)than group1(24%),it was significant statistical difference. More patients in group 2 healed completely(45) than group 1(38) but the difference was statistically not significant. Conclusion: MEBO is very efficacious in treating cervical erosion and is superior to electocautery alone.

Background: Studies indicated that IBD-related tissue damage results from a dynamic interplay between immune and non-immune cells, in which cytokines are crucial mediators. Aim: To determine serum level of eight cytokines (IL-2, IL-4, IL-8, IL-10, IL-12, IL-17A, IP-10 and IFN-γ) in inflammatory bowel disease (IBD) Iraqi patients. Patients and Methods: The IBD patients (54 ulcerative colitis; UC and 25 Crohn's disease; CD) attended the Gastrointestinal Teaching Hospital in Baghdad for diagnosis and treatment during the period March-August 2012. Serum level of cytokines was determined by ELISA method. Results: Four cytokines showed significant variations between UC patients and controls. Levels of IL-8 (2.47 ± 0.35 vs. 0.48 ± 0.19 pg/ml), IL-12 (5.06 ± 0.47 vs. 1.58 ± 0.79 pg/ml) and IP-10 (6.96 ± 1.02 vs. 1.98 ± 0.76 pg/ml) were increased in patients, while level of IL-10 (2.72 ± 0.44 vs. 7.33 ± 2.32 pg/ml) was decreased. In CD patients, levels of IL-8 (3.26 ± 0.56 vs. 0.48 ± 0.19 pg/ml), IL-12 (4.71 ± 0.79 vs. 1.58 ± 0.79 pg/ml) and IP-10 (5.03 ± 1.50 vs. 1.98 ± 0.76 pg/ml) were also significantly increased in patients compared to controls. Comparing UC and CD patients revealed that IL-10 level was significantly decreased in UC patients (2.72 ± 0.44 vs. 5.79 ± 1.10 pg/ml), while IFN-γ was significantly increased (5.99 ± 0.49 vs. 3.78 ± 0.61 pg/ml). Conclusion: These findings highlight a pathogenic role of these cytokines in UC and CD patients.

Background: Systemic lupus erythematosus is a systemic autoimmune disease or autoimmune connective tissue disease in which the body’s immune system incorrectly attacks healthy tissue. Cytokine imbalance has been demonstrated in systemic lupus erythematosus patients. Objective: The aim of this study was to clarify the cytokine genetic polymorphisms of interleukin-10, interlukin-12, and systemic lupus erythematosus. Patients and Methods: This study was conducted in Medical City Hospital through the period from June 2013 until the end of October 2014. Fourty six female patients with systemic lupus erythematous were enrolled in this study; their age range was (18-45) years and they were compared with 44 healthy controls. About 5 ml of blood sample was obtained from every systemic lupus erythematosus patient and control. The separated serum was used for measurements of interleukin-10, interleukin-12, and cytokine genetic polymorphism. Results: Interleukin10 and interlukin-12 showed a significant increased level in patients as compared to the controls (P ≤ 0.001). Genetic polymorphisms of tow cytokine genes (interleukin-10 and interleukin-12) at 4 positions (interleukin 10-1082, interleukin 10-819, interleukin 10-592 and interleukin 121188) were determined in patients and the control. Conclusions: It can be concluded that serum interleukin-10 and interleukin-12 was increased in patients as compared to the control group, so the declining its concentration would help prevention of systemic lupus erythematosus disease.

Background: Abnormal thyroid function test is generally associated with polycystic ovarian syndrome (PCOS). Objective: To detect the prevalence of hypothyroidism modalities in patients with PCOS and to evaluate the role of thyroid hormone changes in association with PCOS. Study design and setting: A cross sectional study carried out at the Department of Gynecology and Obstetrics at Al-Yarmouk Teaching Hospital for a period of one year from January 2013 to January 2014. Patients and Methods: One hundred females with polycystic ovarian syndrome were taken. From each patient, blood sample was taken for thyroid function test (triiodothyronine (T3), thyroxine (T4), thyroid stimulating hormone (TSH)), anti-thyroid antibodies (anti-thyroid peroxidase antibodies (anti TPO)) and anti-thyroglobulin antibodies (anti-TG). Results: The current study revealed that the prevalence of thyroid dysfunction in the participant females with PCOS was 29% (9% had subclinical hypothyroidism, 5% had clinical hypothyroidism and 15% had autoimmune thyroiditis). Thyroid stimulating hormone had shown to be significantly higher (p<0.001) among the PCOS female group with thyroid dysfunction (being the highest in clinical hypothyroid, while it’s increased level shows no significant difference between the subclinical hypothyroid group and autoimmune thyroiditis group) as compared to euthyroid females with PCOS. Higher levels of thyroid auto-antibodies were present in the sera of PCOS patients diagnosed with autoimmune thyroiditis (46.7%). Conclusion: The current study showed that clinical, subclinical hypothyroidism and autoimmune thyroiditis were found in a significant number of patients with polycystic ovarian syndrome. We recommend assessment of the thyroid function routinely in patients with PCOS and offer thyroid hormone replacement therapy if necessary.

Background: Thalassemia is among the most common genetic disorders worldwide. Detection of hypochromic and microcytosis by the measurement of red blood cell indices is a preliminary step. Objectives: To enlighten the importance of analysis of Red Blood Cell indices as a proactive step before ordering Hb electrophoresis. Patients and Methods: Retrospective analysis of Complete Blood Count (CBC) and Hemoglobin (Hb) electrophoresis of 378 patients who were sent to the hematology laboratory of Al-Karama Teaching Hospital in the period from 1st of January 2009 to 31st of December 2011. For those patients, CBC and Hb electrophoresis results were reviewed. Patient data were tabulated and processed using SPSS software. P value of less than 0.05 was considered as significant. Results: Of the 378 patients referred to hematology laboratory in AlKarama Teaching Hospital in Wasit Governorate, 199 (52.6%) were females. Male to female ratio was 0.8:1. Pallor was the predominant cause of referral for Hb electrophoresis (187 patients, 49.5%).The mean age was (21.5 ± 15.22 years) with a range of (1-73 years). The Hb level was ranging from 4.5g/dl to 18.0 g/dl with a mean of (11.1 ± 2.7 g/d). Red cell volume level was ranging from 49.1 to 103.0 (fL), the mean was (73.4 ± 11.4 fL). Red cells distribution width (RDW) level showed the minimal reading of (25.6 fL) to a maximum one of (89.0 fL) with a mean of (43.60 ± 8.0 fL). About fifty eight percent (218 cases) were having normal Hb electrophoresis results. Thalassemia trait was detected in 37.3% of referred cases (141 cases). P value was less than (0.05) in the measurements of mean of both normal and thalassemia trait patients in regard to Mean cell volume (MCV), Red blood cells (RBC) count, Mean cell hemoglobin (MCH) and Mean cell hemoglobin concentration (MCHC) (0.0001 for MCV, RBCs, RDW and MCH, while 0.042 for MCHC). The mean Hb level for both normal and thalassemia trait cases were almost similar (both were 11.2 g/dl). Conclusion: Illogical ordering of Hb electrophoresis might lead to overloading of diagnostic services and over expenditure.

Background:- Beta-thalassemia is a genetically inherited disorder characterized by reduced synthesis of the beta chain hemoglobin. Treatment consists of blood transfusion and chelating therapy in a form of paranteral deferoxamine (DFO) and oral deferasirox (DFX). Aim of the study: - to compare the quality of life, patient satisfactory adherence to the three different modalities of treatment. Objectives:- To compare three groups of patients receiving different modalities of treatment and the effect on their daily activities . Patients and methods:- A total of 270 patients (118)male and (152) female enrolled in the study ,their age ranging from(10.5year)till(17year), for the period from( May 2013—till May 2014) , A special Questionnaire was arranged including three parts, First was on demographic data, the second part included Wallstons health locus of control scale and the third part included the patients satisfaction. Results:- The ratio of male to female were (1—1.3).The most common drug used was (DFX) (55.5%).Life style scale regarding ability to perform daily activity showed (90.6%) of patients on (DFX). About patient adherence to treatment (45.3%) of (DFX) group of patients. Conclusion:- It is concluded that optimal chelating therapy should be individualized for each patient to enhance their adherence and improve the quality of their life .

Background: Nasal obstruction is known to be associated with a major decrease in disease-specific quality of life, for which a considerable role is played by nasal valve obstruction. There are many procedures for treating such type of nasal obstruction. Evaluation of treatment results in relieving obstruction with special regard to the type of the surgery is therefore of increasing importance. Objective: The evaluation of the effectiveness of minimal invasive valve repair (MIVR) for the treatment of nasal valve obstruction in comparison with the reduction of the size of inferior turbinate by coblation and submucosal diathermy. Patients and Methods: This is a cross sectional study conducted from the 20th Nov 2011 to the 19th of Sept 2013. The study included 43 patients suffering from nasal obstruction for more than 6 months. The patients were divided into three groups according to the type of surgery carried out (minimal invasive valve repair, coblation and submucosal diathermy of inferior turbinate), the patients were followed up for 3 months, and the data were statistically analyzed. Results: Patients treated with minimal invasive valve repair showed highly significant differences between the pre-operative and the 1st, 30th and 90th days post-operative total NOSE scale scores (p=.0001). And the differences between the 1st, 30th and 90th days total scores were also significant. While patients treated by coblation and submucosal diathermy showed no significant difference in the mean nose score between pre and immediate postoperative period (p=.705 and p=.2), however there was significant changes in the 30th and 90th days score from the baseline (p=.011 and p=.011) and (p=.001 and p=.001), the postoperative morbidity was less in the minimal invasive valve repair group in comparison with coblation and submucosal diathermy groups. Conclusion: All the three types of the included surgeries provided good outcome in treating nasal valve obstruction. However, more rapid onset of improvement and lesser postoperative morbidity were reported by minimal invasive valve repair.

Background: MIPO technique is one of the best methods of treatment for comminuted diaphyseal tibial fractures which preserve the endosteal blood supply with minimal interference with muscle attachment and periosteal blood supply for the bone fragments. Aim of the study: to compare between using MIPO technique in the treatment of compound comminuted tibial diaphyseal fractures after application of external fixators and using the external fixators for treatment alone. Materials and Methods: 41 patients with 49 compound diaphyseal tibial fractures treated by external fixators, 28 (57.1 %) fractures of them were exchanged into internal fixation after 15-35 days (n=28) mean (29.4 days) by MIPO technique (group I), and the rest (21, 42.9 %) were left with their external fixators to the end of the study (group II). Thirty-six patients were male, and 5 were female. The 4 parameters of final comparison were infection (superficial, pin tract, and deep), nonunion, malunion and time to union. Results: Seventeen (34.8%) fractures developed superficial and pin tract infection and only 8 (16.3%) fractures developed deep infection. Only 7 (14.3%) fractures developed non-union, 4 (8.1%) in group I, and 3 (6.2%) in group II. Thirteen (26.5%) fractures developed malunion, from them 10 (20.4%) in group II and only 3 (6.2%) in group I. In group I, 14 (50%) fractures were united after 3 months of follow-up, 21(75%) after 6 months, 23 (82%) after 1 year, and 24 (85.7%) fractures after 1.5 year (24/28). Mean union time was (20.6) weeks. In group II, 6 (28.5%) fractures were united after 3 months, 10 (47.6%) after 6 months, 13 (61.9%) after 1 year, and 18 (71.4%) after 1.5 year (18/21). Mean union time was 12.5 months (50 weeks). Group I with MIPO technique showed good and early union at 3, 6 months and 1 year follow-up (P-value < 0.05) in comparison to group II. Conclusion: The MIPO technique is a reliable fixation approach to fractures of the diaphysis of tibia, preserving most of the osseous vascularity and fracture haematoma and thus providing for a more biological repair.

Background: Preterm birth is a major health concern. It is the leading cause of perinatal mortality and morbidity. bacterial vaginosis(BV) is the most common infection worldwide, the presence of bacterial vaginosis is claimed to cause preterm labour. Aims: To assess the prevalence of bacterial vaginosis in preterm labour. Patients and Methods: A case- control study was carried out in a Department of Gynecology and Obstetrics of Al-Yarmouk Teaching Hospital for a period of one year from May 2013 to May 2014. 100 pregnant women with singleton fetuses were divided into two groups: first group included 50 pregnant women diagnosed to have preterm labour with a gestational age < 37 weeks were taken as a study group and second group included 50 term pregnant women with a gestatioal age ≥ 37 weeks were taken as control group, vaginal swab was taken from each pregnant women in the above groups and the swab was sent for microbiological examination looking for the presence of Amsel′s criteria .Bacterial vaginosis was diagnosed when at least three of the four criteria were positive . Results: Bacterial vaginosis was more prevalent in patients with preterm labour (32%) in comparison with patients with term labour (14%) and the difference was statistically significant since the P-value (0.032).bacterial vaginosis among preterm labor is about three times higher than that among term labor Conclusion: The prevalence of bacterial vaginosis in preterm labour women is higher than that in term labour group.

Background: Since August 2010 WHO announced that the H1N1 influenza virus has moved into the post-pandemic period. However, localized outbreaks of various magnitudes are likely to continue. Methods: A hospital based descriptive study of patients with a diagnosis of epidemic influenza admitted to Al-Yarmouk teaching hospital. Sixtyfive adult in-patients with a primary diagnosis of epidemic flue were enrolled in this study. Results: The mean age was 40.7±13.7 year. Only 9.2% of them were admitted to the RCU. Tachypnoea, dyspnoea, and auscultatory findings were the main presenting picture. Pneumonia was the most common complication occurring at a frequency of 44(67.7%). Positive cases for epidemic flu virus were 11 patients at a rate of 16.9% of all admitted patients. Conclusion: Most admitted cases during H1N1 outbreak presented with the usual symptoms of flu. The course, complications, and the outcome of the disease have no direct relation with the positivity of nasal swabs for H1N1.

Background: Adiponectin is an adipokines secreted by adipose cells and found to be lower in obese subjects than in lean subjects. Aim: To examine potential anti-inflammatory effects of adiponectin on adipose tissue of animals on methionine-choline deficient diet. Materials&Methods: 25 adult male albino mice were used in the study. The animals were divided into three groups: Group M1 animals (10 mice) were fed methionine-choline deficient diet for three weeks. On the third week, they were treated with intraperitoneal adiponectin injections (1.5 mg/kg/day. Group M2 animals (10 mice) were fed the same diet for three weeks. On the third week, they were treated with intraperitoneal 0.9% saline placebo injections. Control animals (5 mice) were fed regular chow for 3 weeks. The epididymal fat pad was bluntly dissected and transferred to fixative. It was prepared for routine paraffin sectioning and stained with H&E. The number of cells per mm2, adipocyte diameter and surface area were assessed using Image J Adipocytes Tool Macros. Results: Adipocyte measurements were significantly reduced in both groups M1 and M2 in comparison to control animals. Fat sections from group M1 showed a marked reduction in fat cell size and tissue surface area with enlarged and congested blood vessels were surrounded by small rounded adipocytes and preadipocytes. Fat sections from group M2 animals showed an unusual picture of fatty microsyst formation, enlarged congested blood vessels surrounded by thick connective tissue cells mantle and in between the cysts, small fat cells and inflammatory infiltrate were observed. Some large cysts surrounded areas loaded with macrophages and preadipocytes at different stages of maturation. Conclusion: The less amount of inflammation and absence of fatty microcysts in adiponectin treated animals suggests that adiponectin may have anti-inflammatory effects in rapidly remodeling adipose tissue.

Objectives: The application of auditory brainstem response in the hearing evaluation of patients with suspected non-organic hearing loss. Patients & Methods: At Al-Rasheed military hospital (from May 1985 to Oct 1986), 137 patients with suspected non-organic hearing loss (NOHL) were referred for auditory brainstem response test, only 32 patients (aged 18-35 years) were selected on criteria that indicated the absence of middle ear problem and they have marked exaggeration by pure tone audiogram with pure tone average (PTA) of 70 db or more in 500-2000 Hz. Results: The results revealed that only 25 % of the suspected cases have a genuine organic hearing losses, while the rest of the cases (75 %) either have a pure NOHL (about 16 %) or overlapping an organic hearing loss (about 59 %). Conclusion: For diagnosis of non-organic hearing loss, dependence on pure tone audiometry and acoustic reflex threshold (ART) are unreliable procedures and they should be supplemented by neurophysiological tests of which ABR is one of the powerful tests in this respect.

The maternal and neonatal data of 76 infants of diabetic mothers were studied to determine the frequency of possible complications in these infants. The study was carried out in the maternity and children hospital in Basra for the period from May 2000 till June 2001. Diabetic mothers were classified according to White's classification and most of them belong to gestational diabetes (32.8%) and class C (34.2%). Macrosomia with hypoglycemia , respiratory distress syndrome and jaundice were the most common complications occur in infants of diabetic mothers, whose mothers were poorly controlled (78.1%, 71.8%, 56.25) respectively and only 6.2% were without complications, while (38.6%)of diabetic mother with good control were without complications. There was significant difference between both groups in relation to complications (p ˂ 0.01), but no significant difference related to the type of diabetes (p ˃ 0.05). So attempts to maintain diabetic control as close to euglycemic level to prevent these complications.

Acute intussusceptions in adults is a rare condition. In children, intussusceptions is often idiopathic in nature, while in adults, a cause is identified in up to 90% of cases. Malignant tumors are reported to be the cause of colon intussusceptions in 65% to 87% of cases. The caecum and sigmoid colon can be regarded as mobile organs which are affected more by intussusceptions than the descending colon due to its attachment to the retroperitoneum. Symptoms at presentation are usually nonspecific. Computed tomography is considered to be the most reliable investigation in making a preoperative diagnosis. A 60year-old man presented with a two months history of recurrent attacks of severe colicky abdominal pain. A caecal tumor was diagnosed by CT-scan of the abdomen. The intussusception was diagnosed by barium enema. The patient was managed surgically. The presentation, diagnosis and treatment are discussed with review of the literature