Al-Kindy College Medical Journal

Electrosurgery is the application of a high radio frequency of alternating polarity, electrical current to biological tissue as a means among many functions like cut, coagulate, desiccate, or fulgurate tissue in surgical practice . Many surgeons have faced during their lifetime one or more of the complications of these devices . It is either electrical, laser, ultrasonic and mechanical.

Background: Osteoporosis is a skeletal defect manifested by a reduction of bone strength as a result of reduced bone mass to the extent that there is a higher risk of fracture even on minor trauma. Hysterectomy in a premenopausal woman is a well known cause of ovarian failure resulting in an increased risk of osteoporosis.

Objective : To clarify bisphosphonate's preventive effect on osteopenia and osteoporosis in premenopausal women after hysterectomy.

Type of the study: Cross –sectional study.

Method: 84 premenopausal females post hysterectomy aged between 40 – 50 years, were enrolled in this randomized controlled double blinded trail at Al Yarmouk teaching hospital and private clinic in Baghdad for a period of two years from Augest 2011 till July 2013. Participants were assigned as: 1stgroup (study group 42 women): received risedronate treatment "over a period of one year" with calcium and vitamin D; and 2ndgroup (control group 42 women) were taken as a matched group for:"age, body mass index (BMI) and fracture history", received only calcium and vitamin D as a placebo. Bone density had been assayed at the end of the year for all participants and evaluated for osteopenia and osteoporosis.

Results: Osteopenia and osteoporosis were significantly lower in the risedronate arm as compared to those not received the drug "14.3% & 11.9% versus 26.1% & 19% respectively".

Conclusion: The bone mineral density results were significantly better in those who received risedronate than those not received the drug.

Background: Modifications of life style are often critically important to adequately control excising hypertension.

Objective: :to determine the source of information regarding hypertension and lifestyle modification practices in the management of hypertension in a sample of Iraqi hypertensive patients.

Type of the study: Across-sectional study.:

Methods: The study was conducted over a period of two months during November and December 2015 at Primary Health Care center of Baghdad Al-GidedaAwaland Bab Al Mudhum primary health care centers. The sample included 219 hypertensive patients (102 females and 117males). They were subjected to a structured questionnaire consist of socio-demographic characteristics, duration of disease and source of information and different questions related to life style modification practices in the management of hypertension, also all participants were subjected to height and weight and blood pressure measurement. Data analysis by using SPSS programme vertion18.Frequeny, percentage for each question responses was calculated andpercent score was measured .

Results:The main source of information regarding lifestyle modifications was the health workers (37.8%). The included patients were in the 5th decade, mean duration of disease was 5.55±5.12year, with mean systolic/diastolic blood pressure 142.6/ 89.3mmHg, obese with mean BMI 32.14±5.19 kg/m2.The dietary and drug intakelifestyle modification practices of patients were with higherpercent score (90% , 88% and 84%) regarding decrease alcohol intake ,intake of healthy oils,stop smoking and intake of fresh fruits and vegetablesrespectively while the lower percent score56% for intake of folic acid .

Conclusions: The lifestyle modification practices regarding body fitness was highest 82% for enough rest while for regular physical exercise was 68%.

Background: The recognized procedures that have been used to treat gynecomastia are said to have relatively a long operative time, less patient satisfaction rate, they are merely used, in mild to moderate gynecomastia, leaves a mild bulging over the nipple areola complex, resulting in aesthetically unsatisfactory results. The more the grade of gynecomastia, the more complicated the used surgical techniques. This study evaluates the success rate of these simplest surgical technique in higher grades of gynecomastia.

Objectives: to present the experiences with use of Modification of Combined Vibrated Power Assisted Liposuction with Periareolar Gland Excision in management of in different type Gynecomastia

Type of the study: This is a retrospective study

Methods: The study includes the use of a modification of combine vibrated power-assisted liposuction with periareolar gland excision applied for managing different types of gynecomastia. In 23 consecutive patients (46 breasts) treated between February of 2011 and March of 2016.

Results: 23 patients (46 breasts) were successfully treated using this technique. Volume aspirated in both breast was 792 ml (range, 450 to 1600 ml). Using the periareolar excision technique, the mean operative time was 55 minutes (range, 45 to 90 minute). Complications were minimal (1.5 % per breasts), and no revisions were required.

Conclusions: The modified Combined vibrated power assisted liposuction and the periareolartechnique have demonstrated to be a less time consuming versatileapproach, for the treatment of gynecomastia and consistently produces a smoothcontoured male breast, it is promising method to achieve good aesthetic results in gynecomastia surgerywhile resulting in an inconspicuous scar.

Background: The treatment of articular cartilage defects is one of the most clinical challeng for orthopedic surgeons. Articular cartilage is a highly organized tissue with complex biomechanical properties and substantial durability. However, it has a poor ability for healing, and damage from trauma or degeneration can result in morbidity and functional impairment. debilitating joint pain, dysfunction, and degenerative arthritis Objectives: The purpose of study is to show effectiveness of micro fracture arthroscopy as a method of treatment for such problem .

Type of the study: Cross-sectional study. Methods: Arthroscopic surgery was done to 52 patients who complain of knee pain limping and show clinical or radiological evidence of cartilaginous injury and we used arthroscopic micro fracture technique for those patient who have injury of no more than4cm2 then we instruct patient to not put any weight over knee for 2-3 months and followed clinically according to Lyshlom scor and by MRI and some of them by second look arthroscopy to assess the healing.

Results: Fifty two patients under go micro fracture arthroscopy . Thirty four patients (65.4%) reported good or excellent subjective results , thirteen patients (25%) had fair knee function, and only five patients (9.6%) reported poor result

Conclusions: Micro fracture arthroscopy is a cheap effective method for repairing cartilaginous lesion .

Background: The world health organization estimates that worldwide 2 billion people still have iodine deficiency Objectives: Is to make comparison between the effect of identification of recurrent laryngeal nerve (RLN) and non-identification of the nerve on incidence of recurrent laryngeal nerve injury (RLNI) in different thyroidectomy procedures.

Type of the study: cross –sectional study.

Methods: 132 patients with goiters underwent thyroidectomy .Identification of RLN visually by exposure were done for agroup of them and non-identification of the nerves for the other group. The outcomes of RLNI in the two groupsanalyzed statistically for the effect of Identification of RLN on decreasing the incidence of the nerveinjury .The benefits of identification of RLN evaluated in each procedure ofthyroidectomy which were total thyroidectomy (TT), near totalthyroidectomy (NTT), and subtotal thyroidectomy (STT).Patients were followed up monthly for 6 months by indirect laryngoscopy for mobility of the vocal cords.

Results: 132 patients underwent thyroidectomy,258 RLNswere at risk, 124 nerves were identified and134 nerves were not identified,1 RLN was injured in identified group, and 8 RLN were injured in non-identified group. The pvalue was (0.0393) which was significant. TT were performed for 56 patients (42.4%) and total hemi thyroidectomy(THT) for 6patients(4.5%), there were 118 RLNs at risk, 64RLNs were identified and 54 RLNs were not identified.1RLN was injured in identified group, and 7RLNs were injured in non-identifiedgroup, the pvalue was(0.023)which was significant.NTT procedure were performed for 38 patients(28.8%) , 76 RLNs were at risk. 30 RLNswere identified and none of themwas injured, 46 RLNswere not identified, 1 RLN was injured the p value was(1)which was not significant.STT were performed for 32patients(24.4%),64 RLNs were at risk. 30 RLNs were identified and 34 RLNs not identified,there was no nerve injury in both groups .

Conclusions: identification of RLN decrease incidence of RLNI in TT, while there was no significant increase of RLNI in NTT and STT when the nerve was not identified

Background: Several studies suggested that skeletal system is adversely affected by diabetes and is associated with increased risk of osteoporosis and fragility fractures

Objectives: The study was a case-control study that designed to assess the level of bone turnover markers (BTMs) among patients with type 2 diabetes mellitus (T2DM) and to investigate the effect of body weight and diabetic control on the level of bone turnover

Type of the study: Cross- sectional study.

Methods: The present study included 100 postmenopausal women with type 2 diabetes mellitus. Sixty-six non-diabetic postmenopausal women were enrolled as a control. Fasting blood samples were collected to measure Alkaline phosphatase (ALP),stoeocalcin(OC), fasting blood sugar (FBS)and glycated hemoglobin (HbA1c). Urine samples were collected to measure deoxypyridinolin(DPD). The results were expressed as a ratio to urine creatinine

Results: The mean level of serum osteocalcin was significantly lower in the diabetic group than in the control group,while the level of urinary deoxypyridinolin was significantly higher in the diabetic group than in the control group . There was no significant difference in the level of Alkaline phosphatase between diabetic patients and control. An inverse association was found between osteocalcin with body mass index(BMI), glycated hemoglobin and fasting blood sugar. On the other hand appositive association was found between the level of deoxypyridinolin with body mass index

Conclusions: Altered bone metabolic markers in patients with T2DM with more significant alterations in those who hsd poor glycemic control . Decrease in formation marker osteocalcin and increased resorption markers such as (DPD) has been found

Background: Tear of MCL of the knee is a frequent problem among knee ligaments injuries.Injuries to the MCL are usually caused by contact on the outside of the knee and are accompanied by sharp pain on the inside of the knee. Contrary to most other knee ligaments the medial collateral ligament (MCL) has an excellent ability to heal, being fairly large and well vascularised structure. The vast majority of isolated medial ligament injuries heal without significant long-term problems

Objectives: is to compare between the early clinical examination, and assessment under general anesthesia (GA), and to find out the best methods to assess the MCL tear especially in suspected cases.

Type of the study:Cross- sectional study.

Methods: Fifty patients are collected from casualty & outpatient units from November/2014 to October/2016 with MCL injury in AL-Kindy teaching hospital.We decided to evaluate them under general anesthesia by valgus stress test at 30 degrees & 0 degrees to estimate the integrity of MCL, in addition to anterior &posterior Drawer test to evaluate anterior &posterior cruciate ligaments

Results: : From the 50 patients we select, there were 21 patients seen in the examination to have MCL tear.1 of them were Grade I ( 4.8% ),14 of them were Grade II (66.7% ),&6 of them were Grade III (28.5%)Associated injuries with ACL injury were 5 patients, with PCL injury were 1 patient and with medial capsular injury were 2 patients. Follow up of case range from (2-10) weeks with an average of 6 weeks combined with physiotherapy programs.

Conclusions: Diagnosis of MCL tear by valgus stress test under GA is the best method for the assessment of MCL tear in suspected cases.

Background: Thalassemias are a group of heterogeneous genetic disorders, in which the rate of production of hemoglobin is partially or completely suppressed due to reduced rate of synthesis of α or β- chain

Objectives: to estimate the prevalence of Hepatitis C infection among B thalassemia patients attending Ibn-AL-Baladi center of blood diseases in AL-Sader city, in AL-Resafa Quarter of Baghdad and to determine the possible risk factors.

Type of the study: Cross- sectional study.

Methods: A cross sectional study conducted on B Thalassemia patients attending the blood diseases center in Ibn-AL-Baladi hospital during the period from 1st of July till the 31st of December 2015.

Results: All of 400 eligible patients, who were recruited to be included in this study, were accepted to participate in the study giving an overall response rate 100%. The prevalence rate of Hepatitis C according to anti HCV antibody test among the study group was 26%.

Conclusions: we conclude that about quarter of Iraqi thalassemic patients visiting the thalassemia center in Ibn-AL-Baladi hospital have HCV infection

Background: Despite the fact that the exact architecture and orientation of ventricular myocardium are critical to cardiac functions either in health or disease, it is still debated.

Objectives: Anatomical demonstration of the ventricle myocardium (VM)as a single, long and continuous muscular sheet and this muscular sheet can be dived into 3-segments. As a new anatomical concept the left ventricle is a triple layers wall; whether the right ventricle is a single layer wall.Histological demonstration of different directions of muscle-fibers at each layer of ventricular myocardium.

Type of the study: Cross- sectional study.

Methods: In this study 100-heart (fish, chicken, goat, sheep and cow) were dissected and analyzed. Dental lacrona and wax knife used majorly in the dissection, boiling of the hearts with distilled water and finally opening them by the “opening-technique”.

Results: Ventricular myocardium is a single, long and continuous muscular sheet in 100-samples of different species which had been included in the study (passing from the fish toward the cow). VMS can be divided into 3-segments in (100% of cow, 95% of goat and 85% of sheep). The left ventricle is a triple layers wall; whether the right ventricle is single layer wall, this result observed in (100% of cow, 95% of goat and 85% of sheep).Finally different directions of muscle fibers observed at each layer of ventricular myocardium where the subendocardial layer shows transverse running pattern of muscle fibers, mesocardial layer shows longitudinal running pattern of muscle fibers and subepicardial layer shows mixed running patterns of muscle fibers.

Conclusion: Ventricular myocardium is single, long and continuous muscular sheet. This sheet consists of 3-segments. These segments coils in spiral track and form the triple layers left ventricular wall and the single layer right ventricular wall. By histological examination of ventricular myocardial layers different directions of muscle fibers observed at each layer.

Background: Normal Left Ventricular systolic function is present in nearly 50% of patients with congestive heart failure, the majority of such patients have systemic hypertension. Recent studies have demonstrated Left Ventricular dyssynchrony among patients with heart failure and normal systolic function. The co-existence between Left Ventricular dyssynchrony and hypertension with normal systolic function (with no clinical evidence of heart failure) is less well understood.

Objective:

To assess the Left Ventricular dyssynchrony among hypertensive patients with normal systolic function by using Tissue doppler imaging.To find out the associations between the LV dyssynchrony and other global echocardiographic findings like (LA volume index, LVmassindex , LV sephericity and LV filling pressure E/E`)

Type of the study: Prospective case- control study

Methods: The study conducted in Baghdad Teaching Hospital from 1st of June 2015 to 30th of May 2016 .Study included two groups of people, 40 patients, age_ matched healthy (control) group (group1) and 60 patients with established hypertension (group 2). A Complete 2-D and TDI echocardiography studies with simultaneous ECG were performed for all patients. Examination involved LV septal and posterior wall thicknesses, internal dimensions, left atrial size, ejection fraction and tissue doppler derived waves velocities E', E/E.' Dyssynchrony was determined by measuring T-P max ( the maximal time difference from the onset of QRS to peak systolic velocity on TDI between any opposing LV wall in 3 apical views) .

Results: The study included 40 age –matched control people, 27males (67.5%) and 13 females (32.5%) with a male to female ratio was 1.8 :1, ranging from (42.4-58y) with mean age was (50.2 ±7.8y ) (group 1) and 60 hypertensive patients, 38 males (63.3%) and 22 females (36.7%) with a male to female ratio was 1.7 :1, ranging from (48.5- 66.5y) with mean age of (57.5± 9.0 y) (group 2) . Left Ventricular dyssynchrony was identified in 20 of 60 patients (33.3%) .Dyssynchrony had no significant association with age and BSA. But it was significantly associated with LA volume index (r = 0.61, p=0.001), LV mass index(r=0.52 ,p=0.001) , LV sphericity index (r= 0.5, p = 0.003) ) and LV filling pressure(r=0.6 , p value=0.001) . Dyssynchrony had significant negative correlation with ( E`) velocity (r= - 0.7 ,P =0.001) .

Conclusion: Left Ventricular dyssynchrony is frequent among hypertensive patients with normal LV systolic function .The Left Ventricular dyssynchrony is significantly related to LA volume, LV mass, LV sphericity and LV filling pressure.

Background: Intestinal infections are frequently occur among children with cancer who receive chemotherapy. On the other hand, diarrhea is especially common and severe among cancer patients that develop neutropenia, either due to the disease itself or due to the intensive chemotherapy. There are many causes of diarrhea among those patients, but intestinal infections still an important etiology among them.

Objectives: to study the frequency of diarrhea among neutropenic children, with its infectious etiologies, especially the bacterial, fungal and parasitic causes.

Type of the study:Cross-sectional study.

Methods: the study was done in the Oncology Department of Nanakali Hospital for Haematological diseases and malignanciesin Erbil City, on pediatric age group. One hundred six children with cancer were followed up during the period between January – May 2017, of them only 50 patients who full fill the criteria of being (neutropenic, diarrheic, and age < 14 years), and those were regarded as the study group, compared to 20 patients who had the same criteria (diarrheic, and age < 14 years) but notneutropenic.They were investigated for the infectious causes of diarrhea especially bacterial, parasitic, and fungal agents. Data were analyzed statistically using SPSS program and Correlation test was also used. The results were regarded significant with p < 0.05.

Results: A total of 70 diarrheal episodes in 106 cancer children were detected, 50 of them were neutropenic while 20 were not. Intestinal infections were detected in 62% of the 1st group and in 45% of the 2nd one, while the causes in the remaining cases of diarrhea (38%) cannot be identified. Bacterial pathogens were the main agents that causes diarrhea followed by fungi then parasites with an infectious rates of (28%, 20%, and 14% respectively).

Conclusions: Diarrhea commonly developed among cancer children with neutropenia. Bacteria are the most incriminated pathogens followed by Candida and parasites. This study noticed the presence of other etiologies for diarrhea beside infectious causes that should be considered and investigated in the future researches and during management of diarrhea in those patients

Background: There is a strong desire of adolescent to have a peer group and to be appreciated and also to become a member of this group which can affect one each other. There for; encourage, adapting,and imitating of friends and group consider as the main reasons behind starting of smoking among youngsters. Smoking habits in the family were found tobe acause of smoking pressure among adolescentas peer pressure. Smoking habit may be started before 18 years of age in most adult smokers.

Objectives: To study the effect of peer pressure and family smoking habiton the prevalence of smoking among secondary school students.

Type of the study: A cross sectional study .

Methods: the study done with cluster sampling method; was conducted between 1st of March to 30th of May 2016. By clustering schools and randomly 7 schools were selected;3secondary schools, 3 intermediate schools and 1 professional secondary school these schools were from second Al- Kurkh education directorate /Baghdad.A total of (1993)boy students were included. An anonymous self-completion questionnaire was used..The questionnaire was essure and family smoking habiton the smoking status of students.

Results: The results of the study showed an increasing prevalence of smoking habits among students both forcigarette23.6% -41.4%, and shisha4.1% - 38.8%by increasing the class grade, and also by existing smoking parents(cigarette30.1%,and shisha 32.7%). The prevalence of nonsmoking habit among students decreases by increase smoking family members (63.4% -3.9 %).

Conclusion: The effects of peer pressure and family smoking habit were obvious among students with statistically highly significant association. Education and awareness for anti-tobacco programs should be adopted in the curriculum of all secondary schools.

Keywords: peer pressure, family smoking habit, cigarette, shisha, secondary schools, students.

Background: The emergence and spread of multidrug-resistant Gram-negative bacilliin burn wound infections related to biofilm formation, which lend to challenge in treatment with conventional antibiotics andprompting to search for novel antimicrobial agents to control the infections.Silver nanoparticles (AgNPs) have wide spectrum biological properties with different mechanisms of action and less toxicity towards human cells.

Objective:The goal of this study was to evaluated the anti-bacterial and anti-biofilm activities of AgNPs alone and in combination with aminoglycoside (Amikacin) and β-lactam (Ampicillin) antibiotics against multidrug resistant Gram-negative bacilli (Pseudomonas aeruginosa, Escherichia coli, klebsiellapneumoniae) isolated from burn wound infections. Type of the study: Cross –sectional study.

Methods: 70 clinical isolates of GNBtested for susceptibility tests by disk diffusion method against 10 antibiotics. The minimum inhibitory concentrations (MICs) of AgNPs and antibiotics were carried out according to the standard broth microdilution method, while synergistic interactions were evaluated by time kill-kinetic assays. Calgary method was applied for anti-biofilm activity.

Results:Pseudomonas aeruginosa represented the majority of GNBisolated from burn wound infections 34 (48.5 %)followed by Klebsiella pneumonia 21 (30 %) and Escherichia coli 15 (21.5 %). Silver nanoparticles showed remarkable antibacterial activity against GNB that isolated from burn wound infections with the MICs between 25- 75 µg/ml. Aztreonam, amikacin and cefepime were the most effective antimicrobial drugagainst GNB isolates.Synergistic bactericidal effects were observed in two-drug combinations of AgNPswith broad-spectrum aminoglycoside (Amikacin) and β-lactam (Ampicillin) antibiotics against multidrug resistant GNB. In addition,AgNPsalone or in combination with ampicillin inhibited biofilm activity about 60 % – 75 % ofGNB,while combination of AgNPs withamikacin exhibited a powerful anti-biofilm activity and inhibition biofilm formation by 75% to 80%.

Conclusion: The results confirmed a synergistic bactericidal effects and significant enhancing of anti-biofilm activity of AgNPs in combination with antibiotics (amikacin and ampicillin) against multidrug resistant GNB isolated from burn wound infections. These data suggest that AgNPs could beapplied as nanodrug for treatment of burn wound infections

Background: Osteoarthritis OA is the most common joint disorder in the world. Injection of high molecular weight hyaluronic acid intra-articular with steroid is a one of the used therapeutic option for patients with (OA)knee.

Objectives: Objective of this study was the evaluation the efficacy, safety, pluse duration of action of viscosupplementation of the HMWHA( high molecular weight hyluranic acid ).

Type of the study: Cross-sectional study.

Methods: From 81 patients with sever knee pain due to OA (grades 3–4) were recruited from Al-Yarmouk teaching hospital & a private clinic during the period from January 2014 till July 2016. The patients were (24 males - 57 females) with mean age 57.14 years( range from 45y -64 y). Visual Analog Scale (VAS) questionnaire for pain, morning stiffness calculated by minuets and physical function were used to assess treatment efficacy after intra-articular HMWHA injection.

Results: The study included 81 patients who gave the examination data and complete the vital baseline and follow-up data necessary to check for the safety and efficacy .Major improvement was seen after 6 months from injection, as pain, stiffness and physical activity data decreased to 20.32, 1.42 and 4.44 respectively. Such achievement continue for 9 months after injection, as the pain marks was 28.3, the stiffness marks was 3.15,while the physical activity marks was 5.

Conclusions: injection of HMWHA with steroid intr articular is effective, safe for the period of 9 months for those patients who complain from moderate and severe OA knee joint.

Leigh's syndrome, or sub acute necrotizing encephalomyelopathy, is a rare inherited neurometabolic disease of infancy and early childhood with variable course and prognosis. Rarely, it occurs in juveniles and adults. The diagnosis is difficult and still remains to challenge the clinicians on the basis of history; hence the role of imaging is very essential. It is the neuroimaging, chiefly the Magnetic Resonance Imaging showing characteristic symmetrical necrotic lesions in the basal ganglia and/or brain stem that leads to the diagnosis. Late-onset varieties are rare and only few cases were reported all over the world. Here, I report a case of late onset (juvenile) Leigh syndrome presenting with an acute polyneuropathy. Neuroimaging confirmed it to be a case of Leigh syndrome.