Issue 2

Drugs Use for Diarrhoea In Children At Home

Luay Al-Nouri

Iraqi Postgraduate Medical Journal, 2006, Volume 5, Issue 2, Pages 122-127

Children's acute diarrhea is an extensive global problem .It has increased in Iraq seventeen fold after
wars and economic sanctions. Proper management is important in saving lives and prevention of
complications. We wanted to see what drugs were used, how often and how it compared with oral
rehydration use.
The mothers of 175 children who presented with diarrhoea of acute onset and admitted to the
Children Welfare Hospital, Baghdad, over a period of 8 months were interviewed.
Apart from 39 children, who had parenteral infections, two had celiac disease and one accidentally
ingested a laxative, the others were diagnosed as gastroenteritis at hospital. Of the 102 children
diagnosed as gastroenteritis before admission, 29(28%) had their stools microscopically examined
and a parasite was found in 12. Seventy- three (75%) of those who did not have stools examined, and
(59%) of those who had no parasites demonstrated in stool were given antibacterials (metronidazole,
gentamicin, amoxycilin, +/- cloxacilin, co-trimoxazole). Many had antiemetics and anti spasmodics.
Oral rehydration solution (ORS- WHO) was given to (46%) of patients.
Seventy-Four (73%) of children with gastroenteritis were given anti bacterials at home and less than
half had ORS.

L-1α and IL-8 levels in leukopenic leukemic patients with bacteremia

Sevan N. A. Abdallah

Iraqi Postgraduate Medical Journal, 2006, Volume 5, Issue 2, Pages 128-131

Interleukin-1α and Interleukin-8 are an inflammatory cytokines. They are a heterogeneous group of
humeral mediators of the inflammatory response. In leukemic patient's leukopenia developed as a
result of cytotoxic chemotherapy and/ or disease itself. Therefore, those patients were suffering from
low number of leukocytes in addition to defects in the function of these cells. Normally leukocytes
are the main source of cytokines production.
IL-1α and IL-8 were studied in (84) adult patients, males and females and more than 15 years old.
The leukemic patients were suffering from leukopenia and bacteremia. The study including (20)
healthy. Interleukin-1α and interleukin-8 concentrations were measured by using a commercially
available enzyme-linked immunosorbent assay (ELISA).
Statistical analysis shows significant increase in the levels of IL-1α and IL-8 between leukopenic
leukemic patients with bacteremia and healthy control group.
Leukopenic leukemia patients strikingly show distinct increases in plasma IL-1α and IL-8 levels
during bacteremia.

Clinical Profile and OutComeOf Respiratory Failure In Iraqi Children

Muhi Al-Janabi

Iraqi Postgraduate Medical Journal, 2006, Volume 5, Issue 2, Pages 132-137

The frequency of acute respiratory failure is higher in infants and young children than in adults.Acute
respiratory failure remains a significant cause of morbidity and mortality for children .
One hundred and twenty children under the age of 15 years presented with respiratory failure and
admitted to RICU in Children Welfare Teaching Hospital and Surgical Specialty Hospital in Medical
City - Baghdad in the period from the 1st of May -2003 to the 30th of June 2005 were enrolled in a
descriptive study.
Seventy nine (65.83%) cases were males and 41 (34.17%) were females. Male / female ratio was
1.93:1.The mean age was 30.21 months, 35 (29.16%) cases were neonates. Sixty eight (56.7%) cases
were from urban areas and 52 (43.3%) were from rural areas. Seventy eight (65%) children were
admitted for medical diseases and 42 (35%) were admitted for surgical problems. The most common
medical causes were respiratory (50%) followed by neurological (37. 17%).The most common
respiratory cases were bronchiolitis (28.2%) and most common neurological cases were Guillain- Barre
Syndrome (58.6%).The majority (90.47%) of surgical cases were admitted post-operatively. The
average duration of stay in RICU was 9.71 days. Fifty three patients (44.17%) survived and 67
(55.83%) died.
The most common age group admitted to RICU is infancy, medical cases are more commonly admitted
than surgical cases, the most common medical causes of admission are respiratory followed by
neurological causes, the most common respiratory cause of admission is acute bronchiolitis.

Spiral Computed Tomography Findings In Clinically Suspected ACute Pulmonary Embolism

Nazar B. Elhassani

Iraqi Postgraduate Medical Journal, 2006, Volume 5, Issue 2, Pages 138-145

To show the role of enhanced spiral computed tomography in clinically suspected acute pulmonary
embolism(PE) patients .
From October 2003 to October 2004, Fourty two patients with clinically suspected acute pulmonary
embolism ,were examined by thin slices contrast enhanced spiral computed tomography as the primary
diagnostic test to role out or confirm the diagnosis of pulmonary embolism. Patients were examined in
the Radiology Departments of (Al-Kadymia, Al-Yarmook & Ibn Al-Bittar Teaching Hospitals).
Pulmonary embolism diagnosed in 43% of the patients by showing clot within pulmonary arteries with
or without non specific signs like effusion , wedge infarct & dilated pulmonary artery .CT was normal
or gave an alternative diagnosis that could explain the patient’s signs & symptoms in 52%.
Inconclusive findings were seen in 5%.
Computed tomography can be used safely as the primary diagnostic tool in clinically suspected acute
pulmonary embolism patients, to confirm or role out the diagnosis.

The Prevalence of Silent Gall Stones And Its Relation To Some Risk Factors in Iraq

Safa M. M. AL-Obaidi

Iraqi Postgraduate Medical Journal, 2006, Volume 5, Issue 2, Pages 146-150

Gallstone disease is a common condition all over the world as well as in Iraq. Symptomatic gallstones
definitely need surgical or medical treatment . To remove or treat silent gallstones is still a debatable
subject. Gallstones are about twice as common in women than in men and their incidence vary
according to some physical fasters
1016 adult volunteers from both sexes and of different age groups were examined by ultrasound in
Medical city teaching hospital between January 2004 and August 2005, for the estimation of the
prevalence of silent gallstones among Iraqi people and it's relation to some physical and familial
factors was studied .
The incidence of silent gallstones in both sexes was 3.3%. It is more common in women 4.09% than in
men 2.2% and it increases with age, parity, and the use of contraceptive pills, and high intake of black
tea The size of most of the stones was less than 20 mm and they were less than three in number, the
gall bladder was with a normal wall thickness, no associated mass , or gallbladder wall calcifications,
and no association with specific blood group or obesity was found.
Silent gallstones were found in 3.3% of healthy Iraqi individuals, and they are associated with the same
risk factors of symptomatic gall stones such as age , parity , familial contraceptive except that obesity
and blood groups are not a major risk factor.

Evaluation of Amino acid Homocysteine in Hypertensive Patients

Ali Taqi. Al-Baldawi

Iraqi Postgraduate Medical Journal, 2006, Volume 5, Issue 2, Pages 151-154

Hypertension is a world wide disease and in 90% of cases the cause is unknown . Its early detection
and treatment can prevent serious complications such as ischemic heart disease (IHD) . Furthermore
the association of lipids with IHD is a well-known fact . However abnormally high levels of
homocysteine were found to be strongly linked to an increase risk of coronary artery disease .
To evaluate the total plasma homocysteine concentration in hypertensive patients.
Total plasma homocystein concentrations were measured using High Performance Liquid
Chromatography(HPLC) with Ultraviolet( UV) detector in 60 hypertensive patients (27 male and 33
female) aged 35 years and more . Cholesterol , triglyceride , HDL-cholesterol , LDL-cholesterol ,
VLDL-cholesterol were determined .The prevalence of high total homocysteine values were determined
by comparison with normal reference population.
Total plasma homocysteine levels were significantly higher in patients than in normal population. Total
serum cholesterol and triglyceride concentrations were also significantly higher in patients than in
normal population with no association to the level of homocysteine which is regarded as a special
independent vascular risk factor.
The study involves the evaluation of homocysteine in hypertensive patients plasma homocysteine
levels were significantly higher in patients than in control groups. There were no significant differences
between male and female patients.

Role of Color Doppler Ultra Sound Versus Histopathology in Differentiating Malignant From Benign Breast Masses

Hassan H. Zaini

Iraqi Postgraduate Medical Journal, 2006, Volume 5, Issue 2, Pages 155-159

Cancer of breast is by far one of the most important clinical problems that concerns the surgeon. It is
the commonest form of cancer in females, when detected early and given the proper treatment can be
cured. Color Doppler imaging is modern technique that can be used in preoperative assessment of
breast lumps.
To asses the role of color doppler imaging in differentiating malignant from benign breast lumps in
comparison with the histopathology in AL- Najaf teaching hospital.
Total number of patients was 80 female of different age groups were assessed during the period from
first of February 2004 to the first of February 2006 , presented with variable palpable breast masses.
After clinical assessment, all our patients underwent , color doppler imaging and then subjected to the
excisional biopsy and histopathology for confirmation of the diagnosis.
The results of color doppler imaging for all our patients were found as follow, benign lumps in 54
cases (67.5%),malignant lumps in 26 cases (32.5%),two cases diagnosed as benign by color doppler
imaging proved to be malignant by histopathology
giving ( 2.5%),false negative rate. All obtained results of sensitivity, specificity and over all
accuracy of color doppler imaging respectively as follow (92.85%),(100%),and(97.5%).
Color doppler imaging is highly sensitive and specific method in evaluating malignant breast masses
and is painless, non-invasive and time saving procedure, so we can reduce the rate of unnecessary
surgery for histopathology.

The Pattern Of Indications, Complications Of Splenectomy Personal Experience

Nooraddin Ismail Allaqolli

Iraqi Postgraduate Medical Journal, 2006, Volume 5, Issue 2, Pages 160-164

A prospective study of Splenectomy personal experience,with changing pattern of indications.
During the study period (Feb, 1990-Jan, 2006), a total of 411 splenectomies performed in erbil
governate for different indications.
The study included 411 patients, the age rang were 4– 65 years. Out of 411 cases 201 cases were due
to trauma (48.9%).
Trauma of different types remains the most common indication for splenic surgery & complications
like gastric or pancreatic fistula is historical complications.

Random Abdominal Flaps for Reconstruction of Upper Limb War Injuries: A Good Option for a Bad Time

Harith Abdul Jabbar Al Ani

Iraqi Postgraduate Medical Journal, 2006, Volume 5, Issue 2, Pages 165-171

Soft tissue war injuries of the upper limb are usually extensive and multiple . Plastic surgeons face
the challenge of reconstructing these injuries in patients who are multiply injured ,and in a time when
facilities for free flap surgery are not available.
To demonstrate the efficacy of random abdominal flaps in reconstructing soft tissue defects of the
upper limb.
From May 2003 to September 2005, 55 war injury patients with deep soft tissue loss in the upper
limb were managed by random abdominal flaps of different shapes and directions, 13 of them had
other soft tissue injuries affecting other areas in the body. The surgeries were done in busy general
hospitals during war where time, personnel and facilities are limited.
In 53 patients, the flaps had completely survived without complications, 2 flaps developed partial tip
necrosis and healed later by secondary intention. Donor areas were covered by split thickness skin
grafts in 52 cases, and directly closed in 3 cases. The largest flap dimension was 18 cm length and 15
cm width. The main disadvantages of the flap are donor site scar, bulk of the flap, and the need for a
second stage for flap separation.
Random abdominal flaps are easy, safe, versatile and operative time saving option for coverage of
upper limb injuries. It can be designed in any direction to cover different soft tissue defects. These
flaps still continue to be an excellent alternative for free tissue transfers during war time.

Post Stroke Shoulder Pain Problem

Zeki Nooh Hassan

Iraqi Postgraduate Medical Journal, 2006, Volume 5, Issue 2, Pages 172-176

Shoulder pain is one of the complications that happened in patient suffered of hemiplagia our aim is to
study this problem in hemiplegics patients due to stroke
56 patients affected by different types of stroke were enrolled in this study , each patient was
examined by neurologist , CT scan then done and referred to a consultant rheumatologist at alkindi
hospital for assessment of his shoulder area , the patient then investigated thoroughly for his or her
shoulder pain
The study showed high correlation between shoulder pain and older age patients, aphasia, cortical
sensory defects
The study showed that the frozen shoulder is the commonest cause of post stroke shoulder pain

Distally Based Fasciocutaneous Flaps In the Management of Soft Tissue War Injuries of the Lower Half of the Leg

Tariq Abdul Qadir

Iraqi Postgraduate Medical Journal, 2006, Volume 5, Issue 2, Pages 177-190

Soft tissue war injuries affecting the lower half of the leg are a major challenge facing plastic
surgeons .Distally based fasciocutaneous flaps have an important role in the management of these
To demonstrate the role of distally based fasciocutaneous flaps as an alternative to free tissue transfer
in the management of lower leg soft tissue defects.
Thirty seven war injury patients with soft tissue loss in the lower half of the leg were managed by
distally based septocutaneous flaps (19 cases),and distally based superficial sural artery flap (18
cases) , donor areas were closed by partial thickness skin grafts in all of the cases.
All of the 37 flaps survived and healed uneventfully except in 4 cases in whom partial necrosis of the
flap occurred at the tip. Two cases of distally based superficial sural artery island flaps developed
venous congestion and edema .
Distally based fasciocutaneous flaps are an important alternative to microvascular tissue transfer in
treating lower leg war injuries. The versatility and arc of rotation of the distally based superficial
sural artery flap were better than in distally based septocutaneous flaps.

The Effect of the Aqueous Extract of Peganum harmala Seeds on the Mammary Glands of Virgin, Pregnant, and Lactating Rats

Wasan Al- Saidi

Iraqi Postgraduate Medical Journal, 2006, Volume 5, Issue 2, Pages 191-198

Penganum harmala is a well known herb that is used by different societies. It is used as a medical
herb in treating various diseases and disorders .There was no earlier published work on the effects of
the aqueous extract of Peganum harmala . Therefore, we designed this study to investigate the effect
of the aqueous extract of Peganum harmala seeds on the mammary gland at the various physiological
states (virgin, pregnancy and lactation) making use of the available histological, histochemical, and
immunohistochemical means.
Aqueous extract of Peganum harmala was given for two weeks by an orogastric tube on single regular
daily dosage to Norway albino female rats. Animals were subdivided into subgroups according to
their physiological states. Mammary glands of these animals were routinely processed for histological,
immunohistochemical and histochemical studies using formalin fixative ,paraffin embedded sections
in the first two studies and formal calcium, frozen sections in the third study. Experimental specimens
were compared with that of control subgroups.
Harmal induced mammogenesis in the mammary glands of virgin rats. It's aqueous extract was able to
initiate lactogenesis in a well-prepared mammary gland (i. e. during pregnancy) and finally this
aqueous extract promotes lactogenesis when administrated during lactation.
Peganum harmala is a mmammogenic herb .
KEYWORDS: Peganum harmala, mammary

Differentiation Between Two Isolates Of Entamoeba histolytica Isolated From Different Clinical cases After Intraceacal Inoculation In Hamsters

a.AL -.Alousi; Raja

Iraqi Postgraduate Medical Journal, 2006, Volume 5, Issue 2, Pages 199-203

The aim of this study is to differentiate between virulence of two isolates ,one was isolated from
severe clinical symptoms of amebiasis isolate (A) the other was from asymptomatic carriers isolate
12 male hamsters were employed in this study , they were divided into 3 groups . 1st group (5
hamsters), inoculated intracecally with isolate isolate (A) from human case of severe amebiasis . 2nd
group (5 hamsters) inculated with isolate (B) from asymptomatic carriers .3rd group (2
hamsters)inoculated with saline solution as control group .
1st group of hamsters showed a flask shaped ulcer with sever inflammation of cecum with liver
abscesses , after four weeks of infection The 2nd group showed only mild inflammation of cecum
without ulceration and liver abscess. While 3rd group were normal control group.
Our study may be Considered as a step for Characterization of Entamoeba histolytica that cause the
invasive intestinal and extraintestinal amebiasis and E.dispar an intestinal commensal parasit in Iraq.

Epstein- Barr Virus In Iraqi Patients With Nasopharangeal Carcinoma

Batool Mutar Mahdi

Iraqi Postgraduate Medical Journal, 2006, Volume 5, Issue 2, Pages 204-208

Epstein-Barr virus (EBV) was ubiquitous Herpes virus that had a role in the development of
undifferentiated carcinoma of the nasopharynx, Burkett’s lymphoma, acute infectious mononucleosis
and other lymphoprolifrative disorders.
Thirty Iraqi patients with nasopharangeal carcinoma were referred to Oncology Unit in Al-Kadhemia
Teaching Hospital from 1992-1994. Sera of those patients were tested for the presence of antibodies
against Epstein-Barr virus nuclear and early antigens using indirect immunoflourescence test.
Cellular immunity for those patients was tested for the CD4+, CD8+, CD4/CD8 ratio, T-cells % and
B -cells %. Their results were compared with twenty-two normal apparently normal individuals.
Antibodies to Epstein-Barr virus nuclear and early antigens were detected in nasopharangeal
carcinoma Iraqi patients and not in the control group. There was significant difference between two
groups in CD8+ cells, T- cells % and B- cells % and there was no significant differences between two
groups in CD4+ cells, CD4/CD8 ratio.
EBV infection was stopped by T- cells immune response that was capable of eliminating virus
infected cells and virus neutralizing antibodies against nuclear and early antigens which prevent the
spread of infection. Lymphocytes were predominantly CD8+ cytotoxic T lymphocytes, which
recognize and destroy EBV infected cells.
Other antibodies to viral capsid antigens (IgG, IgA and IgM). Other methods must be used other than
indirect immunoflourescense test like western blot method and enzyme linked immune sorbent assay

Evaluation of EBV serum and salivary IgA antibodies level in head and neck cancer patients

Ahmed Sahib Abdulamir

Iraqi Postgraduate Medical Journal, 2006, Volume 5, Issue 2, Pages 209-212

Many previous studies revealed that salivary and serum IgA response to infectious agents such as
EBV-coded antigens in patients with nasopharyngeal carcinoma (NPC) had a vital role in the
combat against tumorigenesis. Moreover, it could be considered as a reliable index for the humoral
limb of anti-cancer immunological action.
One hundred twenty two head and neck cancer (HNCA) patients were selected randomly from two
main hospitals, Alkadhimya hospital and radiotherapy center in Baghdad. Also 100 apparently
healthy control subjects (HC) underwent the same examinations and tests. Enzyme-linked
immunosorbent assay (ELISA) test was applied on all HNCA patients sera and saliva, in order to
measure anti-EBV IgA antibodies .
Revealed that NPC patients were the only group that showed a sero-positive ELISA readings of anti-
EBV serum IgA. No saliva EBV antibodies were detected in the studied groups .
S.IgA level seems to be an applicable index for evaluating EBV burden originated from
nasopharyngeal cancerous cells. Such index might help in diagnosing early and specifically the
carcinogenesis of NPC, moreover, might help in evaluating the progress of the disease.

Prevalence of Autoantibodies to Various Tissue Antigens Before and During S2 – Complex Immunotherapy in Head and Neck Cancer Patients

Batool M. Mahdi

Iraqi Postgraduate Medical Journal, 2006, Volume 5, Issue 2, Pages 213-222

A total of 63 terminal untreatable stage IV head and neck cancer patients were investigated for clinical
responses and presence of autoantibodies to various tissue antigens before and during S2- complex
S2 –complex is a new low molecular weight biological response modifier (BRM) with a potant
immunostimulating and anti tumor activities.
Autoantibodies detected at pretreatment period were those directed towards the following antigens :
nuclear, thyroid microsomal, epithelial cells, gastric parietal cells, smooth muscles, peripheral
leukocytes, T-lymphocytes, B-lymphocytes, monocytes, thymus reticular epithelial cells and Hassall’s
corpuscles. Beside, autoantibodies with specificities to glomerular basement membrane and vascular
endothelial cells were present at low incidence. Short term use of S2- complex induced a transient
increase of the following autoantibodies: nuclear, thyroid microsomal, epithelial, parietal cells, smooth
muscle, thymus reticuloepithelial cells, Hassal’s corpuscles, thymocytes, peripheral blood leukocytes,
T, B-lymphocytes, monocytes, as well as kidney glomerular basement membrane and vasculr
endothelial cells.
In the later follow up period i.e. 2-6 months most of these autoantibodies responses returned to normal
healthy control levels. Moreover, two exceptions were demonstrated which were the incidences of the
antiglomerular basement membrane and vascular endothelial antibodies which remianed higher than the
pretreatment frequencies. In addition, autoantibodies specific to mitochondria , thyroglobulin and red
blood cells were only occasionally seen in our head and neck cancer patients both before and during S2-
complex therapy.

The Location of Aerobactin Determinants of Uropathogenic E. coli in Association with Hemolysin Production Antibiotic Resistance and Patient Characteristics.

Ibtesam Ghadban Auda

Iraqi Postgraduate Medical Journal, 2006, Volume 5, Issue 2, Pages 223-229

Aerobactin, Hemolysin and the resistance to some antibiotics axe important Features of
Uropathogenic E. coli (UPEC). The characteristics of patients from which we isolate the
UPEC have associate with these Features and their determinants location.
We determined the phenotypic expression and gene location of Aerobactin and phenotypic
expression of Hemolysin among 60 UPEC isolates. We correlated the presence of Aerobactin system
with antibacterial agents resistance. The expression of Hemolysin and the characteristics of patients.
Two methods of plasmid curin, sodium dodecyl sulfate and elevated temperature plasmid curing, are
used then plasmid extraction and agarose gel electrophoresis are performed to determine the
location of Aerobactin determinants and the size of Aerobactin plasmids, as well as the location of
the determinants of some antibiotics resistance which were ampicillin (Am), Tetracycline (Tc),
gentamicin (GM), Chloramphenicol (C) and co- trimazole (Co).
Aerobactin and hemolysin expression among UPEC isolates were 93.3% and 35% respectively. The
isolates of non compromised patients produce statistically higher rate of expressed hemolysin (90.5%
, p<0.01). Plasmid- borne Aerobactin was absent in UPEC isolates of non compromised patients
(89.5%, p<0.01). On the contrary compromised patient isolates express plasmid Aerobactin of 59.5%
(p<0.02). We also found that Aerobactin determinants are located on a plasmid in compromised
patient isolates and associated with the absence of chromosomal Hemolysin production (82.9%,
p<0.01). Yet, The chromosomal aerobactin is associated with hemolysin production (61.9%,
p<0.02). Furthermore, UPEC isolates of compromised patients carry relatively large plasmid of
Aerobactin (85.7%. p<0.05) and these large plasmids carry either chloramphenicol (83.3%.p<0.02) or
gentamicin determinants (100%. P<0.01) but not co- trimazole, tetracycline or ampicillin.
The isolates of non compromised patients carry chromosomal Aerobactin and hemolysin. While the
isolates of compromised patients express plasmid Aerobactin and do not express chromosomal
hemolysin. Aeobactin plasmids are relatively large plasmids and carry either chloramphenicol or
gentamicin resistance determinants.

The Laryngeal Mask Airway: technical guidelines and use in special situations

Ahmed Abdulameer SALIH

Iraqi Postgraduate Medical Journal, 2006, Volume 5, Issue 2, Pages 230-239

Recent advances in airway management have changed the practice of anesthesia. Among these changes
has been the introduction and increasing use of the Laryngeal Mask Airway (LMA). The laryngeal mask
airway (LMA) is a novel device that fills the gap in airway management between tracheal intubation and
use of the face mask.
This study describes the LMA, different methods of LMA insertion, uses, advantages, problems,
complications and contraindications of LMA.
During eight years of LMA use in Al-Yarmook teaching hospital in Baghdad, the device was used for
wide spectrum of surgical procedures successfully. We report some special series of cases were LMAs
were used in providing a patent airway include LMA use with IPPV (intermittent positive pressure
ventilation), for patient with history of failed intubation, for children who require general anesthesia for
ultrasonic shock wave lithotripsy, the use of reinforce flexible LMA for nasal surgery and the use of total
intravenous anaesthesia with LMA. Also we describe two methods of blind endotracheal intubation
through LMA.

Adult Ebstein Anomaly with Right Atrial Myxoma

Hameed Al Ani

Iraqi Postgraduate Medical Journal, 2006, Volume 5, Issue 2, Pages 240-245

Ebstein Anomaly is rare in adults; a combination of
this disease with cardiac myxoma has not been
reported previously.
Surgery was performed by removal of the myxoma
and replacement of the tricuspid valve and
correction of the abnormal atrialization of the right
The patient had a smooth postoperative recovery
and improved dramatically after wards.
We have dealt with this rare condition successfully
and the patient had good outcome.