Volume 5, Issue 1, Winter and Spring 2005

Trends in the diagnosis and follow up of hypertension in elderly population in samara and Al-Ramadi cities

Salah N. Dalli Ali

Al- Anbar Medical Journal, 2005, Volume 5, Issue 1, Pages 1-4

Objective : To study the trends of diagnosis and follow up hypertension in elderly subjects in Samara and Al – Ramadi city .
Patients and methods: Between 1994 – 2002 , 1782 elderly hypertensive patients , their age ≥ 65 year, in Samara and Al- Ramadi cities were interviewed about the way of diagnosis and follow up of their hypertension .
Results : The study shows that 84.9% of patients were diagnosed in the 1 '' visit and received a prescription for it, 6.3% were diagnosed and treated initially by internist, while the remaining patients were ( 94.7 %) diagnosed and treated by non – internist (only 0.9% of them were referred to internist ). None of the above patients had their blood pressure checked in standing position at diagnosis . Only 1.1% have an investigation done at diagnosis Only 13.1% were followed by a internist after diagnosis , and only 27.1% of patients were attending regularly for checking their blood pressure .
Conclusion : None of the elderly hypertensive was scientifically diagnosed and only a minority of them were followed up in an acceptable way .

Association of HLA – I and HLA – II molecules with Mycobacterium Tuberculosis Infection.

Farook K. Hassan; Haitham Khasim; Nidhal A. Al-mohymen

Al- Anbar Medical Journal, 2005, Volume 5, Issue 1, Pages 5-9

Aim: To study the association of HLA-I and HLA-II molecules in lymphocytes suspension obtained from tuberculosis patients .
Material and Methods : Patients : 105 positively diagnosed patients as having tuberculosis and 40 healthy control subjects. Blood from all subjects tested were exposed to micro assay and a panel of monoclonal antibodies (McAbs) to HLA-I and HLA-II antigens .
Results : Lymphocytes suspension showed that there is an association between HLA-A30(19), DQ6, DR1, B18, whereas negative association recorded when HLA-B13, DR8, DQ4, is seen .

Blood lead level Among Children in Al-Anbar Governorate, Iraq

Jawad K.A. Al-Diwan; Adnan M.H. Al-Hamwandi

Al- Anbar Medical Journal, 2005, Volume 5, Issue 1, Pages 10-13

Background: Several cases with lead poisoning were admitted to Al- Anbar maternity and children hospital during last decades . This study was carried out , therefore , to study lead poisoning among children in Al-Anbar governerate .
Materials and Methods: Two districts (AL-Hathba and Al- Matheeq ) were included in the study . 128 blood samples were collected from children and their mothers . 44samples from water , soil and kuhil were, also, taken . Lead was estimate in the samples .
Results: Lead toxicity was noticed in 93.8% and 100% of children from Al- Hathba and Al-Matheeq , respectively . Age of children was significantly associated with blood lead levels Pica , also, was associated with blood lead levels .
Conclusion : There is a high prevalence of lead toxicity among children in Al-Anbar governerate .

Liver function test among workers in Petrochemical and Fertilizers production Factory in Basrah, Iraq

Jamal Ahmed Abdul Al-Bari

Al- Anbar Medical Journal, 2005, Volume 5, Issue 1, Pages 14-18

Objective : A study was conduct to determine whether hepatic function changes in workers occupationally exposed to mixture of agents , were due to the exposure or confusing .
Methods: a total of 311 workers of petrochemical industry and fertilizer production factory in Basrah city . Their mean age 39+6 years , and at least one year of exposure to organic agent . This sample was compared with a group of 154 non industrial control subjects, with a mean age 39+5.7 years and similar anthropometric characteristics . serum samples were obtained to determine the activities of aspirate amino transferase (AST) , alanine amino transferase (ALT) , alkaline phosphatase (AP) and total serum bilirubin (S.BIL ) .
Results : there were significant elevation in the activities of AP, AST, ALT and the level of total S.BIL . among industrial workers whose age > 40 years compared to those younger than 40 years ( P < 0.05 ) and to non- industrial control subjects ( P < 0.05 ) . The values of all above parameters studied were significantly elevated with increasing the period of exposure in both factories as compared to the control group ( P < 0.05 ) .
Conclusion : On the basis of this study , it can be concluded that a substantial difference in these enzymes and total S.BIL between exposed and non-exposed was fund. These results might be related to organic agent exposure and might have effect liver .

Adenoids in Adults : A Rare Cause of Nasal Obstruction

Ahmed Nasrat Al-Juboori

Al- Anbar Medical Journal, 2005, Volume 5, Issue 1, Pages 19-21

adults .
Patients and methods : Retrospective study of six adult patients suffering from nasal obstruction found to have enlarged adenoids . The diagnosis were made in different ways . some were diagnosed preliminary by complete ear , nose and throat examination and lateral skull radiography , others by accidental finding during operations for septal and sinuses pathology , the above patients adenoidectomy was performed . the remaining one patient, excisional biopsy was done for postnasal space mass provisionally diagnosed angiofibroma by computed tomography and magnetic resonance imaging of the nasopharynx .
There was an allergic rhinitis in some patients proved by skin test .
Results : Out of six patients aged between 18 – 35 years with enlarged adenoids, two patients diagnosed preoperatively, another three patients with enlarged adenoids found accidentally during operations for septal and sinuses pathology . The remaining one patient, excisional biopsy was performed for the postnasal space mass provisionally diagnosed angiofibroma. Four patients out of the total number had evidence of allergic rhinitis .
Conclusion : Although it is rare, enlarged should be considered in the differ entail diagnosis of adult suffering from nasal obstruction .

Effectiveness and safety of inferior turbinectomy : a comparison between anterior and radical trimming

Ahmed Nasrat Al-Juboori

Al- Anbar Medical Journal, 2005, Volume 5, Issue 1, Pages 22-25

Objective : To determine whether the turbinectomy techniques used(anterior and radical trimming of inferior turbinate ) influenced the rate of outcome and complications .
Patients and methods : In prospective, comparative study sixty patients admitted to Saddam General Hospital in Ramadi were diagnosed as having allergic rhinitis with bilateral inferior turbinates hypertrophy by history, clinical examination and skin test . Thirty patients underwent radical inferior turbinectomy (RT) and the other thirty, trimming of the inferior turbinates (AT) was done . The indication for the operation was persisted nasal obstruction despite medical treatment . Postoperative follow up persisted for one year, Chi-squared test used to evaluate the outcome and complications of both procedures .
Results : The most common postoperative complications were infection (20% for the RT group and 10% for the AT group), synechiae (16.6% for the RT group and 10% for the AT group) And hemorrhage (10% for the RT group and 3.3% for the AT group) . Atrophic rhinitis were not observed in any of the patients. Relief of nasal obstruction was reported in 90% for the RT group and 73% for the AT group (p<0.05) .
Conclusion: The radical inferior turbinectomy provides the advantage of significant improvement of nasal airway patency as compared to trimming of the anterior end of the inferior turbinates, while confining excision to the anterior end of the inferior turbinate offers the advantage of a lower incidence of complications like infection, synechiae and hemorrhage which may be massive and requires blood transfusion

Transfer Factor : Immunotherapeutic Potential in typhoid fever

Khalifa; A. Kalifa; Aswar J.Al-Marsumi

Al- Anbar Medical Journal, 2005, Volume 5, Issue 1, Pages 26-29

Objective: The purpose of the experiment described in the present study was to extract and evaluate specific transfer factor from sensitized guinea pigs against typhoid infection and use it as an immunotherapeutic agent .
Methods: Guinea pigs sensitized with S.typhi were serving as donors for specific transfer factor (TFs). Normal nonstimulated animals served as controls . Humoral immunity was evaluated by ELISA test . Cell-mediated immunity was evaluated by delayed-type hypersensitivity test and macrophage migration inhibitory test. Rosette test was also evaluated. Dose-dependent study was done. Fractionation of the prepared transfer factor was done using sephadex G-25 column .
Results : Guinea pigs were used as a model to study specific transfer factor . Immunity both humoral and cell-mediated were specifically produced. Transfer factor was highly effective in transferring specific immunity to S. typhi . The immunity was dose-dependent . Protection ranged between 10 – 70% . The best time for administration of TF was one day before challenge . Macrophage migration inhibition factor (MIF) expressed as migration indices gave good results. Mean migration index in TFs recipient was 0.3780.008 This is in comparison with 0.9280.013 in control . More than one dose of TFs is required .
Conclusion : Transfer factor probably used as immunotherapeutic agent in S. typhi infection . More work has to be done in this subject before giving conclusion .

Hemoglobin status During pregnancy in Ramadi Maternity & Child hospital

Shawnem A. W. Al-Jaff; Raja J. K. Al-Hadithi; Majid A. K. Lafi

Al- Anbar Medical Journal, 2005, Volume 5, Issue 1, Pages 30-33

A sample of 998 pregnant women admitted to the Maternity and Children hospital in Ramadi, for the period from Jan. to Jul. 1996. Routine history, physical examination, and routine hematological investigations were performed, 32.1% of cases were found to be anemic (hemoglobin, Hb, level below 11 g/dl with mean value of 8.9g/dl (SD = 0.84), while the non-anemic cases had mean Hb value of 12.2 g/dl (SD=6.7). Age group 16-20 (n=67), 21 - 30 (n= 513), 31-40 (n=368), 40+ (n=50) years exhibited mean Hb value of 10.93 g/dl (SD=1.8), 11.42 g/dl (SD=1.5), 10.75 g/dl (SD=1.7), and 11.16 g/dl (SD=1.7) respectively. The 31 – 40 age group exhibited a significantly (P=0.000) louver value than the 21 – 30 age group . Both gravidity and parity of 4 plus exhibited a significant (P=0.000) drop in mean Hb value women who received iron supplement showed a significantly (P=0.002) higher Hb value . It is concluded that pregnant women of fourth decade age group, with gravidity 4 plus and parity 4 plus are the most vulnerable to develop anemia. Thus, iron supplementation for this group of pregnant women can reduce morbidity and mortality of both mother and fetus . Some recommendations are presented.

Urinary tract infection : Significant bacteruria and candiduria in diabetics and non-diabetic patients

Mushtak T.S. AL-ouqaili; Evan L.K. Al-Kaki

Al- Anbar Medical Journal, 2005, Volume 5, Issue 1, Pages 34-39

and their susceptibility tests to selected antimicrobials in both diabetics and non-diabetic patients.
Methods : A total of 134 urine specimens, 66(49.3%) were obtained from patient admitted to Ramadi General Hospital in Ramadi and 68(50.7%) from the community setting during the period from April to September 2002. General Urine Analysis and semi-quantitative culture technique of urine were performed .
Result : Out of 134 urine cultures, 121(90.3%) showed significant bacteruria . Thirty nine out of 56(69.5%) of hospitalized patients and 13 out of 65(20%) of non- hospitalized patients were diabetics while the remaining were non-diabetics . Further, in diabetic community acquired infection (CA) , Escherichia coli was the most common 10(76.9%) while Klebsiella spp . 15(38.5%) was the most common isolate in hospital acquired infection (HA) . In non-diabetics, Escherichia coli was the most common in both CA and HA, 24(38.0%) and 4(20%) respectively. Furthermore, significant candiduria was found in diabetic HA 11(28.2%) and 9(81.8%) of them harboring urinary catheter in contrast with non-diabetic HA, 6(30%). The isolated bacteria in both groups showed resistance to ampicillin, and sensitivity to aminoglycosides and ciprofloxacin .
Conclusion : In diabetic patients, Escherichia coli was the most common organism isolated in CA while Klebsiella spp . was the commonest isolate in HA. In non-diabetics, Escherichia coli was the most common organism isolate from both CA and HA. Candida albicans was the commonest cause of candiduria in diabetic HA. Further, aminoglycosides and ciprofloxacin can be used empirically to treat both types of infection in diabetics and non-diabetics .

Genetic aspects of Ambler class C, extended spectrum and metallo-beta-lactamases among beta-lactam resistant Escherichia coli and Klebsiellae pneumonia

Mushtak T. S. AL-Ouqaili

Al- Anbar Medical Journal, 2005, Volume 5, Issue 1, Pages 40-47

Objective : To detect the role of Ambler class C(AmpC), Extended Spectrum (ESBL) and metallo-B-lactamases in the resistance of Escherichia coli and Klebsiellae pneumonia to P-lactams and whether the genetic expression of these enzymes are encoded by conjugative plasmids DNA or chromosomal DNA .Method : The National Committee for Clinical Laboratory standard AmpC and ESBLs screening and phenotypic confirmatory tests were performed for 25 isolates of Escherichia coli and 18 isolates of Klebsiellae pneumonia . Plasmid profile analysis and curing experiments were performed . Plasmid DNA recombination for resistant genes was carried out by conjugation . Results : Initially, 17(68.0%), 11(61.1%) isolates off coli and K pneumonia respectively demonstrated a clavulanic acid (CA) effect by double disk synergy and 15(60.0%), 10(55.6%) isolates of Escherichia coli and Klebsiellae pneumonia respectively demonstrated a CA effect by broth microdilution technique . The genes encoding for ESBL in 13 (86.7%), 9(90.0%) isolates of ESBL producing Escherichia coli and Klebsiellae pneumonia respectively were carried by conjugative plasmids while this genetic elements were encoded for 3(30.0%), 3(37.5%) of AmpC plasmids isolates of Escherichia coli and Klebsiellae pneumonia respectively . Further, the resistant genes encoding for metallo-p-lactamase in one isolate of Escherichia coli was carried by conjugative plasmid.
Conclusions: The study concluded that ESBLs and AmpC cephalosporinases play an essential role in the resistance of Escherichia coli and Klebsiellae pneumonia to P-lactams and in the lesser extent metallo-p-lactamase. Further, isolation of plasmid DNA revealed that most of the isolates examined harbored more than one plasmid Furthermore, conjugative plasmids were found to be the main genetic elements encoding for ESBLs produced by Escherichia coli followed by Klebsiellae pneumonia and the lesser extent to AmpC producing strains of the same bacteria respectively while the B-lactamases production for the remaining isolates is suggested to be under non-conjugative plasmids or chromosomal control .

Microbiological aspects of chronic suppurative otitis media in Ramadi city

Ahmed Nasrat Al-Juboori; Mushtak T. S. AL-Ouqaili

Al- Anbar Medical Journal, 2005, Volume 5, Issue 1, Pages 48-52

Objective : To determine the microbiological causative agents of chronic suppurative otitis media (CSOM ) AMONG PATIENTS IN Ramadi city and antimicrobial susceptibility surveillance pattern to the most frequently used antimicrobial agents . Patients and Methods : Seventy-two patients visited E.N.T. Unit of Saddam General Hospital in Ramadi were clinically diagnosed with CSOM. The specimens were obtained directly from the ear under direct vision and cultured under aerobic, facultative anaerobic , and anaerobic condition. Antimicrobial susceptibility tests were performed by using standardized Kirbey-Bauer disk diffusion test. Pseudomonas aeruginosa ATCC 27853, Staphylococcus aureus ATCC 25923 were used as internal quality control isolates .
Results: Out of 87 isolates, A bacterial isolates obtained in 78(89.7) isolates . Among the bacterial causative agents, the most common bacteria isolated were Pseudomonas aeruginosa in 30% , followed by Staphylococcus aureus in 21.8% , anaerobic Bacteroides fragilis in 13.8% , Klebsiellae pneumonia in 9.2% , Proteus vulgaris in 4.6% and others . A total of 9(10.3%) fugal isolates , Aspergilus niger was 5.7%, and Candida albicans in 4.6% The above cultured isolates were found either single or in mixed culture from, no growth was obtained in 4(5.5%) cases . Ciprofloxacin sensitivity ratio was the highest among other antimicrobial agents.
Conclusions: Pseudomonas aeruginosa was the predominant bacteria isolated from patients with CSOM followed by Staphylococcus aureus , anaerobic Bacteroides fragilis and the fungi respectively . Ciprofloxacin was the potent antimicrobial In vitro, through the high inhibition ratio to most of the bacteria followed by third generation cephalosporins and aminoglycosides . The use of systemic anti-anaerobic drugs combined with an anti-anaerobic drugs combined with an anti-aerobic drugs is worthy of a clinical trial, on the other hand the addition of an antifungal to the preparation of local antibiotics may by beneficial .

Clinician Laboratory relationship

Salman K. Ajlaan; Yasin A. Baker

Al- Anbar Medical Journal, 2005, Volume 5, Issue 1, Pages 53-56

Objective : To evaluate the Clinician – Laboratory Relationship (CLP) from various aspects.
Subjects and methods: 40 Clinicians and 39 laboratory specialists were included in a questionnaire-based study . Two questionnaire forms were prepared, one of clinicians and the other for laboratory specialists . Each form contains several questions covering various aspects of the CLP .
Results: Among laboratory specialists, only 15.4% were frequently asked by clinicians for laboratory advice, 65.1% have frequent contact with clinicians upon facing unusual or abnormal results , and 66.7% reported satisfactory clinicians response . Among clinicians, 50% asked laboratory specialists frequently for advice, and 80% stated satisfactory laboratory specialists response . Adequate CLR was reported by 23.1% of laboratory specialists and 62.5% of clinicians .
Conclusion :The study concluded that CLR is somewhat favorable for histopathologists and to a lesser extent haematologists unlike clinical biochemists and microbiologists.

Hyperuricemia, is it a cause or an effect of hypertension? A study in Ramadi city, Iraq

Mahmood M. Atia

Al- Anbar Medical Journal, 2005, Volume 5, Issue 1, Pages 57-60

Objective : To evaluate the relationship between Hyperuricemia and hypertension .
Patients and methods : 5Q hypertensive patients(30 males and 20 females ) and 24 normal individuals (11 males 13 females ) as control group were investigated at the clinical pathology unit in Ramadi, for the following parameters:- Body mass index (BMI), blood pressure (BP), serum cholesterol (S.Ch), and serum uric acid (S.U.A.) .
Results: The four parameters were found elevated in 26(52%) . serum uric acid and S.Ch were elevated in 13 (26%) of them , while S.U.A. and BP elevated in seven (14%) Patients. In the other four patients (8%) BP, elevated only . Correlation studies of demographic variables showed that age was positively correlated with BMI and S.Ch . while S.U.A. showed a higher relationship with blood pressure in males than in females .
Conclusion : It can be concluded that the association between hypertension and hyperuricemia is clinically significant , but seem to be over looked .

Some serological tests In diagnosing cystic hydatidosis

Mahmood; M. Atia; Ismail A. Al-Hadithi; Mahmood Al-Mahdawi; Mina S. Al-Jeboori

Al- Anbar Medical Journal, 2005, Volume 5, Issue 1, Pages 61-64

Background : Cystic hydatidosis (CH) caused by Echinococcus granulosus is an important zoonosis world wide . several test are currently used for screening and for diagnosis .
Objective : To show the possibility of diagnosis via the presence of specific antibody for CH in serum of patients infected with this disease .
Methods: Passive hemagglutination test (PHA), double immunodiffusion test(DD5) and counter immunelectrophoresis (CIEP) were used for diagnosis .
Results: The results showed that the antigen of whole HC has a high antibody titer than filtrate and protoscoleses . PHA test gave sensitivity (83%) when the whole antigen used. And gave from 66-80% when protoscoleses antigen was used while 50-70% was detected when the filtrate was used, and CIEP gave a high sensitivity than DD5 .
Conclusion : PHA test a higher diagnostic sensitivity than CIEP and DD5 test .
Key words : Hydatidosis , Double immunodiffusion test, Immunelectrophoresis

Treatment of The Dental Anxious Patients Using Nitrous Oxide Oxygen Sedation

Ali Muayad Al-Hayali

Al- Anbar Medical Journal, 2005, Volume 5, Issue 1, Pages 65-68

Objective : The objective of this study is to obtain a better compliance of patients by using N20/O relative analgesia in the dental treatment of highly anxious patients or dental phobic patients .
Patients and method : The sample of this study was consisted of 37 subjects (22 female , and 15 male) their age ranged between 8 to20 years ,when we use the dental anxiety scale , all of them were considered as a highly anxious patients towards any dental treatment , A special apparatus was used to give a measured amount of both nitrous oxide and oxygen in a gradual scale to those patients directly before and during the dental treatment in order to find the effect of this method in decreasing the anxiety and fear. The comparison was done in the results of dental anxiety scale before and after using this method in the treatment for all the subjects in this study.
Results: A highly significant differences were recorded between the result of the first and second questionnaire of dental anxiety scale, which revealed a decrease in the anxiety and fear for these patient after using the nitrous oxide/oxygen mixture during the treatment .
Conclusion : From this study , - we concluded that using nitrous oxide /oxygen mixture (relative analgesia ) through the procedure of dental treatment , is a very practical method in treatment and management of highly anxious patient.
Key words: Relative analgesia . Inhalation sedation, nitrous oxide , anxious patient .

Rotavirus in gastroenteritis of infants and children under three years of age hospitalized in Al-Ramadi Maternity and Children Hospital , Al-Anbar , Iraq .

Zaid R. Al-Ani

Al- Anbar Medical Journal, 2005, Volume 5, Issue 1, Pages 69-71

Objective : To determine the incidence of rotavirus infection and some of its epidemiological criteria in Ramadi Maternity and children hospital .
Materials and methods : Stool sample were obtained from 369 infants and children with acute diarrhea and from 115 infants and children with diseases other than diarrhea, admitted to Al-Ramadi Maternity and Children Hospital during1st Dec. 2001 to 1st June 2002 . Latex agglutination test was used for detection human rotavirus using commercially available kits .
Results : human rotavirus was detected in 24.4% of infants and children with acute diarrhea. The rotavirus infection was predominate in females . 96% of patients with rotavirus infection were less than 2 years of age . The peak of rotavirus infection was noticed in Dec ., Jan. and Feb.
Conclusion : Rotavirus is a common enteropathogen in infants and children with diarrhea. However , further studies are needed to explore the role of crowding , unsanitary and poor socioeconomic conditions and life style in transmission of rotavirus infection

Incidence of organic injuries in penetrating abdominal wounds

Ibrahim SA; Hadi AM AL-Aubaidi

Al- Anbar Medical Journal, 2005, Volume 5, Issue 1, Pages 72-74

An analysis is reported of 53 cases of penetrating abdominal injuries operated on in AL-Ramadi General hospital , Al- Anbar governorate in the period of May 1995 to July 1996. The commonest wounds were due to bullet injury (64%), stab injuries (28%) and other causes were just 8% Male: female ratio was 15:1. The patients age was 3-70 years with a peak age incidence at 16- 30 years . The distribution of injured organ was as : small bowel (36%) , liver (30%), stomach (28%), large bowel (24%), spleen(12%), diaphragm (12%), gall bladder (2%), and mesentery (2%) . No pancreatic and vascular injuries were found . The analysis was reported single abdominal organ injury (52%), two organs (40%) while multiple organ injuries only (8%) .The ratio of urban to rural patients was 3.5:1 . The mortality rate was 4% occurred in multiple organ injuries and caused by bullet injury.

Detection of major risk factors in patients with acute myocardial infarction in Al-Ramadi city

Khalid Al-Rawi; Hameed A. Al-Zagroot; Abdulla L. Jassim; Amar Y. Abdullan

Al- Anbar Medical Journal, 2005, Volume 5, Issue 1, Pages 75-77

Objective : To study the prevalence of major risk factors like age , hypertension , and diabetes mellitus and smoking in acute myocardial infarction and their effect on the development of complication.
Methods : A 207 patients with acute myocardial infarction admitted to the cardiac care unit in Al-Ramadi general hospital were included in the study from May 2001 to May 2002. A questionnaire form including : age, sex, presence of hypertension , diabetes mellitus, smoking , and presence of any complication like arrhythmia, heart failure….etc.
Results : There was an increase in the prevalence of myocardial infarction with increasing age . The mean percentage of hypertensive patients was 44% while for diabetes mellitus and smoking were 27% and 40% , respectively . About 53% of hypertensive patients and smokers developed complications of MI, while 35% of diabetes had complications .
Conclusion: There are an increase in the incidence of myocardial infarction and its complications in the presence of one or more major risk factors.
Key words : Myocardial infarction, complications, risk factors