Al-Kindy College Medical Journal

Blastocystosis is symptomatic infection caused by the protozoal parasite Blastocystis , which resides in the intestinal tract of its hosts and it is one of the most common parasites reported in humans. It’s prevalence ranges between (30 - 50%) of the population in developing countries. This genus has a worldwide distribution and often the most commonly reported human intestinal protozoan in children and adults, even infect infants

Background: Breast cancer still a major cause of disability and mortality among women throughout the world. Lack of awareness and early detection programs in developing countries is a main reason for escalating the mortality.

Objectives: to assess level of awareness about breast cancer among university female students in Baghdad focusing on knowledge of breast cancer risk factors, warning symptoms and signs and knowledge about the screening method specially breast self-examination.

Methods: A cross-sectional study conducted over two months from first of march through April 2015 and included (240) female students in non- medical colleges at Al-Rusafa and Al-Karkh districts who completed a comprehensive self-structured questionnaire covering socio-demographic characteristics and (27) questions covering the knowledge of risk factors; warning symptoms and signs of breast cancer and the breast self- examination. Participants’ responses were analyzed statistically and percent score of knowledge level was calculated.

Results: The mean age of students was (22.8 ± 3.4) years with range (19-30) years, single (75.8%), and those with no family history of breast cancer (85.42%); the internet was the most common source of students’ information (34.7%).

Conclusion: The overall percent score of all students’ knowledge about risk factors, warning symptoms and signs and breast self-examination was poor (<60%).

Background:-Osteoarthritis (OA) is the most common form of arthritis and the leading source of physical disability in elderly people. The Prevalence of OA is increasing and will continue to do so as the population gets older. The OA is predominantly managed in primary care centers by primary health care physicians and much can be done to alleviate symptoms from osteoarthritis by combinations of therapeutic options including pharmacological and non-pharmacological treatments.

Objectives of study :- To assess the knowledge, attitude and practice of Iraqi PHCC physicians in Baghdad, AL-Rusafa, regarding the management of osteoarthritis patient, and it's association with sociodemographic data.

Methods:- A descriptive cross sectional study with some analytic elements has been conducted from the 1st of January to 1st of June 2017, in primary health care centers of six sectors selected randomly from Al Rusafa health directorate; in Baghdad. The data was collected by self-administered questionnaire regarding demographic characteristics, knowledge, attitude, and practices of physicians regarding



management of osteoarthritis. Data analysis was done by (frequency, percentage), Chi square test (Fisher exact test). P value less than 0.05 was considered significant .

Results: The total study sample was 204 enrolled physicians, their age ranged from (25-58) years, The correct answers regarding etiology, diagnosis, imaging findings etc. ranged from 64.2-83.3% which reflect good knowledge of physicians regarding OA disease as well as that highly qualified physician showed good knowledge, about half of enrolled physicians showed good attitude and their practices regarding osteoarthritis and its management are good in general.

Conclusion; -The knowledge, attitude and practice regarding osteoarthritis managent among primary health care physicians are good in general.

Objective: the objective of this study was to compare the intraoperative blood loss, intraoperative time, postoperative pain and secondary hemorrhage between electrodissection and cold steel dissection tonsillectomy.

Methods: One hundred and six patients were enrolled in this study, the patients were randomly allocated into electrodissection group A (n=51) and cold steel dissection tonsillectomy group B (n=53). All patients are above 7 years and had history of recurrent tonsillitis and/or tonsillar hypertrophy with obstructive symptoms. Intraoperative parameters and postoperative outcome were assessed.

Results: In group A patients had statically significant less operative time and blood loss than group B early postoperative pain was not differ significantly between the two groups, however late onset pain (pain on the 7th day) was significantly higher in group A. There was no significant difference between the groups regarding secondary hemorrhage.

Conclusion: Electrodissection tonsillectomy is rapid, safe and effective method of tonsillectomy with obvious advantage of minimum perioperative blood loss, lower operative time and without early post-operative pain difference when compared to cold steel dissection tonsillectomy. Although it has some disadvantage of late postoperative pain.

Background: Tumor associated tissue eosinophilia (TATE) has been described in a variety of neoplasms. In regard to squamous cell carcinoma, some studies worldwide done to assess stromal eosinophilia in oral and cervical squamous cell carcinoma. The objectives of this study is to evaluate the association of stromal eosinophilic infiltration of cutaneous squamous cell carcinoma and to detect the significance of this association.

Aim of the study

The aim of our study is to establish the relationship between the degree of stromal eosinophilia and the level of invasion and the histological grade in cutaneous squamous cell carcinoma.

Methods: In this retrospective study done at the histopathology department of al Wasity teaching hospital for orthopedic and plastic surgery in Baghdad, all paraffin embedded blocks for excisional biopsies diagnosed as primary cutaneous squamous cell carcinoma from December 2015 to January 2017 were retrieved. Incisional biopsies and those with margin positive tumor cells were excluded. After a careful evaluation for histological grading and assessment of level of invasion according to an established histological criteria , the assessment of tissue eosinophils was done by three pathologist through counting eosinophils in tumor stroma in 10 high power field using a light microscope and categorized as none (0,),low (1-4),medium (5-19)and high (more than 20).

Results : of 56 cases of primary cutaneous squamous cell carcinoma 48(85.7%) cases were conventional .The mean age was 43.14 ± 1.76 .Regarding conventional squamous cell carcinoma ,of 48 cases 30(62.5) were well differentiated,16(33.3%) had clarck level III,18(37.5%) had clarck level IV and 14(29.1%) had Clark level V .There is a significant statistical relationship between histological grading of tissue eosinophilia and level of invasion with p value 0.044 and a non-significant relationship with degree of differentiation.

Conclusion :The majority of cutaneous squamous cell carcinomas were conventional well differentiated with a mean age in the fifth decade of life ,a male predominance and often had a degree of stromal eosinophilia that is strongly associated with the level of invasion .Thus more Intense tissue eosinophilia is correlated with a higher level of stromal invasion. The significance of such an association should be regarded as either a potential predictive tool for stromal invasion in small incisional biopsy or as a prognostic indicator that could be included in the pathology report for conventional squamous cell carcinoma

Background: Knee osteoarthritis (KOA) is a common joint disorder leading to considerable pain and locomotor disability in lower limb function. Locomotor disability, which is difficulty in activities of daily living related to lower limb function, can be the consequence of KOA, so early diagnosis and management may improve quality of life.

Objective: To assess the contribution of radiological osteoarthritis of the knees to disability in the activities of daily living related to lower limb function.

Methods: One hundred twenty Iraqi KOA patients (104 females and 16 males) who were attending to Rheumatology Unit, Full history was taken and complete clinical examination was done for all patients. Wight-bearing X-rays of both knees (anteroposterior and lateral view) were taken for patients and were graded according to Kellgren and Lawrence scale.

Results: The frequency of locomotor disability, was 62.50% for men and 72.11% for women (p=0.431). The frequency of radiological osteoarthritis of the knee was 50% for men and 40.37% for women (p=0.651). There was significant statistical differences between; locomotor disability, and increased age, morning stiffness, muscle wasting & BMI (p=0.000, p=0.003, p=0.002 and p=0.028 respectively). There was no statistical significant association between; KOA radiological grading, and gender, morning stiffness, BMI & lower limb locomotor functions disability (p=0.651, p=0.357 and p=0.972 respectively).

Conclusion: Radiological osteoarthritis of the knee is only weak independent predictors of locomotor disability. Patient's age, pain of the knees, muscle wasting, morning stiffness and obesity seem to be the most important independent determinants of locomotor disability.

Background: Neonatal period is a very vulnerable period of life due to many problems, In spite of advances in perinatal and neonatal care still, the mortality rate of neonate high especially in developing country The World Health Organization estimates that globally four million neonatal deaths per year, Developing countries account for around 99% of the neonatal mortality in the world, In Iraq. Neonatal mortality rate about 19 per 1000 live births which represent 56% of child death below 5 years age in 2012. The hospital in the study represents the larger pediatric hospital in Iraq. It contains 400 children's beds and 24 neonatal incubators.

Aims of the study: are to determine the institutional new-born case fatality rate and the cause of death in the neonatal care unit.

Method; The study is cross-section study of the population sample of neonatal care unit of central teaching hospital of pediatric in Baghdad Al-krakh health directorate

Result: Study appear total neonate admission during 2015 was 1977 neonates mortality rate 9% Four main causes of death were Respiratory related condition, Bacterial sepsis, Disorder related to short gestational and low birth weight not relayed to elsewhere classification and congenital malformation 37.5%, 33.3%, 7.1% and 7.1% respectively while the main primary cause of morbidity were Neonatal jaundice, Respiratory related condition, Bacterial sepsis and 37.5%, 35.2%. 14.1% respectively Conclusions: The majority of morbidity and mortality can prevent by appropriate intervention

Background: This study is to evaluate the necessity of prescribing prophylactic antibiotics for nasal packing in spontaneous epistaxis. There are few published papers of infective complications in such patients.

Methods: This prospective study analysed 149 consecutive patients admitted to AL-Kindy teaching hospital with spontaneous, epistaxis, who underwent nasal packing over 2 years period . in the first year, 78 patients received prophylactic antibiotics , In the second year 71 patients were not given prophylatic antibiotics. Exclusion criteria included antibiotics prescribed for unrelated pathology and post-operative epistaxis. Signs and symptoms of acute otitis media, sinusitis and toxic shock syndrome were assessed using clinical examination and a questionnaire.

Results: :Fourteen out of 149 patients experienced otalgia, mostly following posterior nasal packing. No patient in both groups had evidence of any infective complication.

Conclusion: we do not recommend the use of prophylactic antibiotics for patients undergoing nasal packing for spontaineous epistaxis.

Background: low back pain is one of the most common public health problems and of the most common musculoskeletal complaint. Many risk factors have been considered for developing low back pain include smoking, obesity and sedentary lifestyle.

Aim of study: To evaluate smoking, obesity, and sedentary lifestyle associations with low back pain in young adults aged (18 – 39 years).

Methods: a comparative cross sectional study for young adults aged 18 – 39 years, participants with low back pain as a symptom constitutes the first group, others free of this symptom considered as the control group. Age and gender matched in both groups. Smoking, obesity and sedentary life style variables collected and analyzed statistically using odd ratio and chi-square

Results: One hundred patients were enrolled in the study after 12 patients being removed due to our exclusion criteria. 45 patients were with low back pain, 2:1 male to female ratio, For LBP group; data show 30:15 obese to none obese ratio, 23:22 smokers to none smoker ratio, and ratio of 35:10 with sedentary lifestyle compared to active one. While in the control group, data show 22:33 obese to none obese ratio, 16:39 smokers to none smoker ratio, and ratio of 23:32 with sedentary lifestyle compared to active one. Using Chi-square test, the P- value was of 0.0079, 0.025 and 0.0003 for obesity, smoking, and sedentary lifestyle, respectively. The odds ratio was 3, 2.55 and 4.86 for obesity, smoking, and sedentary lifestyle, respectively. All above results were statistically significant.

Conclusion: Each of smoking, obesity and sedentary lifestyle is statistically correlated with low back pain in young adults' age group.

Background: breast cancer is commonest cancer globally and the 1st cancer in Iraq among females, its management and prognosis depend on early diagnosis, the traditional method was excisional biopsy which is expensive and invasive leading to delayed diagnosis, FNAB is cheap nom invasive more acceptable to women, Aim of the study: to test the reliability of FNAB in preoperative diagnosis of breast lump.

Methodology: This is a retrospective study of 204 cases, 102 breast cancer cases and 102 benign breast lesions, taken between Jan. 2017 – Nov. 2017. The sample taken from the breast cancer early detection center in Al-Alwiyaa maternity teaching hospital, during the year 2017

Results: Invasive ductal carcinoma (IDC) was found among 82(80.4%) of malignant cases, ILC was 14(13.7%) , fibroadenoma was the most common benign lesions 51(50%), The absolute sensitivity was 96% , specificity 100%, with 4% false negative the accuracy was 98%. The complete sensitivity was 96%, and specificity was 83%, with 4% false negative and 17% false positive cases, the accuracy was 90%,

Conclusion and recommendation: fine-needle aspiration biopsy (FNAB) is accurate for breast lump diagnosis. With high sensitivity and specificity. FNAB is a good screening method and help in an improvement of treatment planning

Background:. Children with spina bifida occulta require early surgery to prevent neurological deficits. The treatment of patients with a congenitally tethered cord who present in adulthood remains controversial.

Objective: The aim of this study is to describe the outcome obtained in 61 adult patients with congenital TCS and no prior surgical treatment who underwent surgical untethering.

Methods: This prospective study was conducted on 61 adult patients who underwent surgical untethering for spina bifida occulta at four neurosurgical centers in Baghdad / Iraq between March 2000 and January 2018. Patients who had undergone prior myelomeningocele repair or tethered cord release surgery were excluded.

The most common intraoperative findings were lipomyelomeningocele (41%) and a tight terminal filum (36%). The follow-up duration ranged from 10.8 to 149.5 months (mean 20.9 months). Of the 34 patients with back pain, status improved in 65%, worsened in 3%, remained unchanged in 18%, and improved and later recurred in 15%. Lower-extremity pain improved in 16 patients (53%), remained unchanged in 23%, improved and then recurred in 17%, and worsened in 7%. Lower-extremity weakness improved in 47%, remained unchanged in 47%, and improved and then recurred in 5%. Finally, of the 17 patients with lower-extremity sensory changes,

status improved in 35%, remained unchanged in 35%, and the information on five patients was unavailable. Surgical complications included three wound infections, one cerebrospinal fluid leak, and two pseudomeningoceles requiring surgical revision. One patient developed acute respiratory distress syndrome and sepsis postoperatively and died several days later.

Conclusions: Adult-age presentation of a congenital tethered cord is unusual. Despite a slight increase in postoperative neurological injury in adults, surgery has relatively low risk and offers good potential for neurological improvement or stabilization. As in children, we recommend early surgery in adults with this disorder. The decision to undertake surgery, however, should be modulated by other factors such as a patient’s general medical condition and risk posed by anesthesia.

Background Median sternotomy is the gold standard incision for most cardiac operations. However, with the advent of minimal invasive surgery, a new approach emerged in cardiac surgery named mini-sternotomy and has been successfully used to perform a variety of operations.

The aim of this paper is to present our experience of using mini-sternotomy to harvest the left internal mammary artery (LIMA) for off-pump revascularization of the left anterior descending artery (LAD)

Methodology Over a 2-year period (October 2012-October 2014), 100 patients underwent coronary artery bypass grafting (CABG) via conventional median sternotomy (CMS) (n=80) and mini-sternotomy (MS) (n=20). The 2 groups were compared regarding length and difficulty of surgery, postoperative pain and respiratory function, stay in the intensive care unit (ICU), wound infection, shoulder stability and other variables.

Results One patient (5%) with LMS was converted into CMS due to inadequate exposure. The blood loss was less in LMS patients. Lung atelectasis and pleural effusions were less in group 2. A higher PaO2, lower PaCO2 and a shorter assisted-ventilation time were observed in LMS group. Early postoperative pain score & analgesic requirements were less in LMS patients and their hospital stay was shorter (4-5 days) than CMS. Moreover, LMS patients could return to their jobs and drove cars earlier than group 2 patients. There were 9 deaths (11.3%) in CMS group vs. one death (5%) in LMS group; however, this difference was not statistically significant (p˂0.05)

Conclusions This study shows that off-pump coronary surgery through mini-sternotomy incision is feasible and safe.

Background: Insulin resistance is present in 50% or more of patients with primary hypothyroidism. Metformin can decrease TSH levels in these patients by a complex matter, this can be of great help in clinical practice.

Objective: This study was designed to evaluate the effect of metformin in reducing TSH levels in patients with primary hypothyroidism.

Methods: Hundred patients with primary hypothyroidism, 82 females, 18 males were included in this study, everyone was followed up for two months after adding metformin 850 mg twice daily in addition to thyroxin.

Results: 36 patients (36%) have a normal baseline TSH and no change after 2 months, 64 patients (64%)have a change in TSH either a decrease(49 patients ,79.56%) or an increase (15 patients , 23.44 % ).

Conclusion: Metformin therapy is highly effective in reducing TSH levels in patients with primary hypothyroidism.

Background: Calcaneus is a spongy cancellous bone with rich blood supply , its fracture heals more rapidly providing no occurrence of infection and soft tissue injury around ,no gross malposition of fragments. The associated pain leads to a major impairment in life quality. The aim of treatment for calcaneal fractures is the decrease of pain and rebuilding of walking ability for patients with normal foot shape and the ability to wear normal foot wear. To reduce complications, a minimally invasive technique for the treatment of displaced intra-articular fractures of the calcaneus was preferred to use.

The purpose of this study was to determine whether the closed reduction and percutaneous K. wire fixation of displaced intra-articular calcaneal fractures results in better functional outcome at a minimum one year follow up after the injury compared with those after non-operative management.

Methods: One hundred and eleven displaced closed intra-articular calcaneal fracture in 105 patients (six were bilateral) were seen at the orthopedic department of Al-Kindy teaching hospital and Shaih Zaid hospital , only 45 cases included in this study and prospectively evaluated with an average follow-up time of minimum of one year (1–3years follow-up). For radiographic evaluation, plain radiographs and CT scans were obtained. The Maryland Foot Score was used for clinical estimate. Sanders type II, III and IV fractures were diagnosed.

Results: The incidence of subtalar arthritis was correlated with the severity of fracture. Böhler’s angle was restored in 70.1% (47 of 67) of the cases. The majority (77.7%) of patients were content with their treatment result. The rate of significant complications was 6.5%.

Discussion: Percutaneous K. wire fixation of displaced intra-articular calcaneal fractures presented minimally invasive technique which showed comparable results with a low rate of serious complications and is a viable alternative for the treatment of intra-articular, dislocated calcaneal fractures.

Conclusions: the functional results after K. wires fixation of displaced intra-articular calcaneal fractures were better than those after non-operative care.

Background: Surgery is one and may be the most effective method to treat obesity. In the last decade, Laparoscopic Sleeve Gastrectomy is perceived to be less invasive, technically simple, less morbid and more popular form of bariatric surgery.

Objectives: This study aims to assess the effect of Laparoscopic Sleeve Gastrectomy on Fasting Blood Glucose Levels and Blood Pressure.

Methods: A prospective controlled study in which 50 obese patients were involved, 36 of patients have hypertension and type 2 diabetes mellitus , 7 patients have type 2 diabetes mellitus only, and 7 patients don’t have hypertension or type 2 diabetes. All patients were submitted to Laparoscopic Sleeve Gastrectomy at Al-Kindy Teaching Hospital between October 2014 and October 2016.

Results: Forty five of patients were females, while five were males . Mean age was 34 years, mean height 159 cm mean pre Laparoscopic Sleeve Gastrectomy weight was 121kg. Mean post- Laparoscopic Sleeve Gastrectomy weight was 82kg. Mean weight loss outcome at 1 year follow-up is 32.23% of total body weight. . Preoperative initial mean value of fasting blood glucose was 157.4 mg/dL and the declining occurred at 12 months after Laparoscopic Sleeve Gastrectomy was 97 mg/dL . The hypertension remission rates 1 year after Laparoscopic Sleeve Gastrectomy ranges up to 54% of total number of patients and 75% of those with Hypertension.

Conclusions: Laparoscopic Sleeve Gastrectomy has an effect in improving Fasting Blood Glucose Levels and Blood Pressure.

Background: Polycystic ovarian syndrome is a common endocrine disorder affecting 6-10% of women of reproductive age and the most common cause of anovulatory infertility.

Objective: The aim of the study was to compare the effectiveness, side effects and outcomes of step-up gonadotrophin protocol versus laparoscopic ovarian diathermy (LOD) in infertile patients with clomiphene citrate resistant polycystic ovary syndrome.

Methods: The sample included women who attended our infertility clinic at Al-Elwiya Maternity Teaching Hospital and Kamal Al-Samarraee for Infertility and IVF Hospital in Baghdad/ Iraq from November 2013 to November 2014. Eighty cases of infertile women with polycystic ovarian syndrome who failed to ovulate with clomiphene citrate for six months where collected, forty women treated with step-up protocol with low dose recombinant FSH gonadotrophin which increased gradually according to ovulation response, another forty women treated with LOD. Ovulation monitoring in each group was done with transvaginal ultrasound to exclude monofollicullar, bifollicular ovulation, ovarian hyperstimulation syndrome, multiple pregnancy and pregnancy rate in each cycle for 6 cycles.

Results: Higher unifollicular ovulation and pregnancy rate in LOD than step-up protocol (91.4% & 25% versus 75% & 10%) respectively, while multifollicular and hyperstimulation rate were higher in gonadotrophin group (24.3% & 0.1% versus 8.50% & nil) respectively.

Conclusion: Ovulation induction and pregnancy rate per cycle was higher with LOD group, not time consuming, also there was no risk of hyperstimulation of the ovary or twin pregnancy as compared to the step-up protocol with gonadotrophin

Background: Acne vulgaris is one of the top three most commonly encountered dermatological problems worldwide in both primary and secondary care. Human keratinocytes express functional TLR2 heterodimers. An increased expression of TLR2 was detected in the epidermis of inflammatory acne lesions, as observed in normal skin; the expression level increased with the degree of differentiation of the keratinocytes. TLR2 expression is upregulated in inflammatory acne lesions and induced by C. acnes. The current study conducted to assess the oral isotretinion treatment effect on the acne vulgaris patients by evaluated the Toll Like Receptor 2 as a major immune system marker in Acne vulgaris immune response.

Methods: 50 patients with acne vulgaris seen in outpatient clinic of dermatology centre(Al-Baidhaa out clinic center) in Baghdad during the period 1/9/2017 to 1/8/2018. The diagnosis of patients were done by the specialist dermatologist only sever and moderate acne cases were chosen. Fifty serum samples were collected before oral isotretinion therapy, only forty-five serum samples were collected after 8 weeks of oral isotretinion therapy. All patients have received 0.5mg-1mg/kg/day of oral isotretinoin. The mean ages was 22 years(range, 16-36 years). A total of 50 patients, 36(72%) of patients were females and 14(28%) were males. Furthermore 43(86%) of cases have heredity history. Also control serum samples were collected from people without acne and they chose with the same mean ages. The serum samples were stored at -70°C for up to six months. ELISA test for quantitative determination of TLR2 human was done. Statistical analysis was done using T-test.

Results: Highly significant statistical difference were noticed (p<0.001) when we compare study group after therapy with control group, also highly significant statistical difference was noticed (p<0.01) when we compare study group before therapy with control group.

Conclusion: Significant decrease of TLR-2 level was noticed in study group after isotretinoin therapy in comparison with same group before therapy and also with the control group. Pronouncedly the effects of oral isotretinion suggest a path towards importance of this therapy as an anti-acne agent

Background : Xanthomatosis is a disease in which large tendon tumors can occur, especially in the Achilles tendon. This disease is a rare interesting orthopaedic condition.

Case Report:A case of a twenty eight year old girl patient with giant bilateral Achilles tendon xanthomas in which both tumors were resected.

There was no ulceration on the both sides. The patient was treated by total resection of the lesion and reconstruction using tendon transfer of the Peroneus brevis and Flexor hallusis longus. Postoperative treatment consisted of six weeks lower leg cast immobilization followed by partial weight bearing. After 4 months the patient was able to walk pain free without any difficulties. It has been suggested that total resection with augmentation had associated with fewer complication of recurrent as compare with a subtotal resection. 10 months after surgery our patient had no signs of recurrence of Achilles tendon swelling.

Conclusion: Complete excision of the lesion is needed to reduce recurrence. Reconstruction of the defect is a challenge due to the large defect. Tendon transfer augmentation results in good functional outcome of the patient even in large defects.

Background : The aim of this work is to assess the role of breast sonography and ductography in the evaluation of different causes of nipple discharge.

Methods : The study will be carried out on twenty-five female patients referred to the Radiodiagnosis department at Alexandria Main University Hospital presenting with nipple discharge.

They were divided into two groups:

Group I include 10 patients (40%) with surgically significant nipple discharge who were the patients with unilateral, uniorificial surgically significant colour type nipple discharge .They were investigated by mammography, sonography, and ductography.

Group II include 15 patients (60%) with surgically insignificant nipple discharge. They were further subdivided into 9 patients (36%) with unilateral multiorificial and 6 patients (24%) with bilateral nipple discharge. They were subjected to mammography ,sonography without ductography.

Results Nipple discharge is the release of fluid from the nipple. It is the third most common breast complaint for women seek medical attention, after lumps and breast pain. It is a symptomatic problem that causes many women both discomfort and anxiety.

Conclusion : The current study showed certain diagnostic sonographic features for patients of multiple papillomatosis was agreed with studies carried out

ABSTRACTBackground : Acne vulgaris is a
common skin disease, affecting more than 85% of
adolescents and often continuing into adulthood.
People between 11 and 30 years of age and up to
5% of older adults. For most patients acne remains
a nuisance with occasional flares of unsightly
comedones, pustules and nodules. For other less
fortunate persons, the sever inflammatory response
to Propionibacterium acnes (P.acnes) results in
permanent
Methods: Disfiguring scars. (1, 2) Stigmata of sever
acne cane lead to social ostracism, withdrawal
from society and severe psychologic
depression (1-4).
Result Pathogenesis of acne Traditionally, acne
has been thought of as a multifactorial disease of
the folliculosebaceous unit, involving excess
sebum production, abnormal follicular
hyperkeratinization, overgrowth of
Propionibacterium acnes, and inflammation (Fig
2). Recent laboratory and clinical investigations
into the roles of the innate immune system and
extracellular matrix remodeling proteins have shed
additional light on this pathogenetic process (5-7).
Role of androgens: Activity of type 1 5areductase
enzyme was shown to predominate in
human sebaceous glands and epidermis. This
enzyme is responsible for the conversion of
testosterone to the more potent androgen,
dihydrotestosterone (DHT). DHT in turn is thought
to mediate androgen dependent skin diseases such
as acne, hirsutism and androgenetic alopecia (13)
The enzyme 5a-reductase type 1 has been studied
in those with and without acne and it has been
hypothesized that those with acne might have more
active 5a-reductase type 1 .(2)
Conclusion : The prominent role of hormones in
the pathophysiology of acne has long been
recognized and corroborated by clinical and
experimental observations and therapeutic
experience (14). Although acne is not considered a
primary endocrine disorder, androgens, such as
dihydrotestosterone, dehydroepiandrosterone
sulfate, and testosterone, and growth hormone and
insulin-like growth factors, have all been
implicated in the pathogenesis of acne (15).
Corresponding address to :
Dr. Yasir Mansour Mohamed Al-Ani
Islam Mohammad Nabil El Helou