Print ISSN: 2706-6207

Online ISSN: 2664-3154

Volume 10, Issue 1

Volume 10, Issue 1, Winter and Spring 2012


Common Rota Virus Gastroenteritis in Children under 5 Years in Maternity and Children Teaching Hospital, western Iraq

Qaiss .A. Alani

Al- Anbar Medical Journal, 2012, Volume 10, Issue 1, Pages 1-7
DOI: 10.33091//amj.2012.54060

Objective: This study was designed to find out the incidence of rotavirus as an etiological agent in diarrheal patients under 5 years of age admitted to Al-Ramadi Maternity and Children Teaching Hospital.
Methods: Over a period of one year, from the 1st of January 2009 to the 1st of January 2010. 420 stool samples were collected from patients with diarrhea and sent directly to the hospital laboratory for detection of rotavirus antigen using rapid immunochromatographic assay.
Results: Out of 420 stool samples, rotavirus was detected in 165 (39.26%).The majorities of cases were reported in first year of age.
Conclusion: It appears that artificial feeding, living in rural areas and low mother education all are important factors that increase percentage of infection with this virus. Also it appears that the infection can happen in all seasons but mostly in summer. The study conclude that Gastroenteritis due to rotavirus is an important problem of diarrhea in Al-Ramadi city and recommended that the mothers need to be encouraged for breast feeding as a prophylactic measures for all types of diarrhea and also sterilization of water.
factors that increase the percentage of infection by this virus. Infection occurred in all seasons but predominantly in summer.
Key Words: Gasteroenteritis, Children, Rotavirs, Ramadi.

Management of Pediatric Facial Trauma by Pyriform Suspension

Tahrir N. N. Aldelaimi

Al- Anbar Medical Journal, 2012, Volume 10, Issue 1, Pages 8-12
DOI: 10.33091//amj.2012.54061

Background: Surgical treatment of pediatric maxillofacial region is a complex and challenging task to maxillofacial surgeons. Incorrect and inappropriate treatment of trauma will end with secondary deformity that is very difficult to correct.
Objectives: This study discusses types of pediatric maxillofacial injuries and evaluates the management of child patients with injuries to the maxillofacial region using pyriform suspension in Anbar Province, Iraq.
Materials & Methods: Twenty-eight child patients with maxillofacial trauma were seen at Maxillofacial Surgery Department at Ramadi Teaching Hospital during the period from December 2009 till November 2010; including 21(75%) boys and 7(25%) girls. Age, sex, etiology, associated injuries, pattern of fractures and treatments were reviewed.
Results: Road traffic accident was the most common cause for pediatric facial trauma, mandibular trauma was found in 13 children while Midfacial trauma was found in 15 children.
Conclusions: Significant advances have been made in the management of these injuries, decreasing the incidence of secondary deformities.

Honey depots phagocytosis in vitro

Shehab Ahmed Lafi

Al- Anbar Medical Journal, 2012, Volume 10, Issue 1, Pages 13-17
DOI: 10.33091//amj.2012.54062

Background and Objectives: Honey is an important unique food product containing bioactive compounds derived from bees and plants. The medicinal properties of honey were known since ancients, it was mentioned by different nations and cultures and there is renewed interest in honey therapeutics . This study aimed to show the effect of honey on phagocytic activity in vitro.
Methods: The phagocytic activity of isolated human neutrophils was studied in vitro using Nitro Blue Tetrazolium test (NBT ). These cells were exposed to different concentrations of crude Eucalyptus local Iraqi honey (0%, 5%, 10%, and 15% honey concentrations in normal saline) for 15 minutes at 37C before challenging with yeast cells .
Results: It was found that, 70% of tested cells showed positive NBT on exposure to 5% honey and 85% on exposure to 10% honey . While cells incubated with 15% honey showed 20% positive reaction which was less than the control group results.
Within the control treatments , cells were not exposed to honey concentrations and 55% of cells were showing positive NBT.
Conclusion: The study concluded that honey prexposure of Neutrophils can depot or increase phagocytic activity of isolated Neutrophils at certain concentrations in vitro.

A Spectrum Estimation and Clinical Evaluation of Low Back Pain in General Practice

Hammodi F J Al-Jumaily

Al- Anbar Medical Journal, 2012, Volume 10, Issue 1, Pages 18-27
DOI: 10.33091//amj.2012.54063

Objectives: The primary purpose of this study is to look for the magnitude of the low back pain {LBP} amongst the referred cases and to identify its relation to the underlying conditions in patients presenting to Rheumatology Outpatient Clinic.
Methods: One thousand patients who were complaining of LBP were enrolled in this cross-sectional study they consulted Rheumatology outpatient Clinic of Al-Ramadi Teaching Hospital ,Ramadi City, Iraq , from 2 January 2009 to 1 August 2009 . Pregnant women, Patients below 18 years of age and Fibromyalgia syndrome were excluded from the study. When primary diagnosis of LBP of any duration {acute ,subacute and chronic} was confirmed by historical and physical examination ,clinical decision was made to request either conventional X-Ray(for spondylolysis/spondylolisthesis, lumber spondylosis , Ankylosing spondylitis ,Psoriasis and Sacralization ) or MR Imaging (for Intervertebral disc prolapse, spinal canal stenosis , infectious discitis , spondylitis or infiltrative disorders ) .Data obtained from plain X-Ray and MRI were interpreted by consultant Radiologists .The radiological findings and clinical evaluations were assessed ,investigated and analyzed .
Results : Out of 1000 patients enrolled in this study with mean age 46 +16 year ,738 (73.8%) were females and 262 (26.2%) were males .Female gender is significantly higher than males with predominance of 40-61 age groups . LBP of Inflammatory causes was reported in 518 (51.8%) patients with predominance of 29-39 (29.9%) ,40-50 (27.9%) age groups , while 482 (48.2%) patients were of mechanical causes predominated in 51-61(29%) and 29-39(17.2%) age groups .inflammatory subtype of LBP was experienced in higher rate among 438 (84.5%) female individuals than that of male individuals 80 (15.4%) ,while mechanical subtype occurred in male patients more than in female patients ,300 (62.3%) and 182 (37.7%) respectively .As mentioned, the commonest causes were disc prolapse and spinal stenosis in 105 males(43.3%) ,90 females (37.9%) ,followed by muscular spasm affecting 70 males(29.1%) and 70 females(28.9%) . The causes of Inflammatory subtype of LBP were distributed in 300 females (74%) due to Reactive arthritis and Pelvic Inflammatory Diseases { PID} , 80 females(19.7%) and 75 males(64.6%) due to Rheumatic disorders (Ankylosing spondylitis ,Psoriasis ) ,40 males(35.3%) and 25 females(6.17%) due to infectious agents (Brucellosis ,T B) .Our data illustrate the relation between Reactive arthritis and PID with Birth control method used females ,out of 300 diseased females, 200 were reported to use of Birth control .Intrauterine device(IUD) in 120 females(60%) ,contraception's (oral and injectable) in 40 females(13.3%) ,and tubal ligation in 40 females(13.3%) .The difference was statistically significant (p<0.05) .
Conclusion : Our findings demonstrate that LBP is a common problem results from the reviews can be considered relevant for general population . There were inconsistent findings with respect to categories of LBP ,Inflammatory subtype reported significantly more in female individuals of 40-61 years of age .The issue of Birth control methods are clearly relevant to the concept of LBP which were implicated as potent risk factors .Although no acceptable evidence was found for therapeutic aspects ,misuse of systemic corticosteroids was reported in 144 cases with advers effects and osteoporotic features ,mostly were of iatrogenic in nature .

Cranioplasty: Comparison Between Utilizing Titanium Mesh, Prefabricated Polymethyl methacrylate and Autograft Bone.

Hisham Maddah Al-Alousi

Al- Anbar Medical Journal, 2012, Volume 10, Issue 1, Pages 28-34
DOI: 10.33091//amj.2012.54064

Background: A Cranioplasty is the term for any operation in which a defect of the skull bone is repaired. A traumatic injury is often the reason , but there are other reasons including previous tumour surgery or surgery for some forms of stroke.
Aim Of Study: The aim of this study is to compare between the using of titanium mish, polymethylmethacrylate (PMMA), and Autograft bone in cranioplasty.
Material And Method: In our study 20 patients , 12 males (60%) and 8 females (40%), ages ranged for 15-45 years, were subjected to cranioplasty that were performed to achieve morphological and functional rehabilitation of the cranial vault using ;polymethylmethacrylate ,titanium mish and autograft bone. Our patients underwent elective delayed cranioplasty in Al-Ramadi Teaching Hospital during the period from December 2006 to December 2010.
Results: Although the use of titanium may cause artifact on computed tomography (CT scans) ,which can limit follow –up imaging studies, but our study proved that the use of titanium is remarkable. Prefabricated PMMA prostheses are effective for cranioplasty, so reduced surgical time, reduced surgical blood loss and technical simplicity. The infection rate associated with use of prefabricated PMMA prostheses is lower than that for autograft bone flaps. All patients were highly satisfied with the cosmetic appearance ,Cranioplasty was carried out with no major complication except in two cases.
Conclusion: The use of titanium mesh for cranioplasty is a good alternative in spite of the disadvantages, causing an artifact on CT and magnetic resonance imaging (MRI) , and it's expensiveness. Prefabricated PMMA prostheses are effective for cranioplasty in respect to reduced surgical time, reduced surgical blood loss and technical simplicity. The infection rate associated with use of prefabricated PMMA prostheses is lower than that for autograft bone flaps.

Dental Anxiety and it's Relation to Serum Cortisol Level Before

Dunia W. Alfayad

Al- Anbar Medical Journal, 2012, Volume 10, Issue 1, Pages 35-40
DOI: 10.33091//amj.2012.54575

Background: Dental anxiety is still prevalent, despite advances in treatment methods, and it affects the utilization of health does not only decrease the pain threshold, but actually leads to the perception of painless stimuli as painful. services. Cortisol is an important hormone in the body, secreted by the adrenal glands and involved in many functions.
Objectives: To evaluate the relation between the level of serum cortisol and increase anxiety in dental patients before minor oral surgery.
Materials and Method: Sixty patients were included in this study were attended Alkatana Specialized Dental Center from October/4/2010 till December/1/2010, their age ranged from (16-54 years) 27 patients were females and 33 were males. They were divided into two groups, 30 of them as controls (they didn't need any dental surgery) who match the other 30 patients study group in age, sex and their general health status but they needed minor oral surgery. Blood samples were collected from all patients between 10-11 Am., and about 5 minutes before surgery to the patients of the study group. Serum cortisol level was measured by using radioimmunoassay analysis.
Results: A total of 60 patients were enrolled in this study. Regarding the control group 15 were females and 15 were males while for the study group patients12 were females and 18 were males. Serum cortisol level was significantly different between two groups the mean was13.05 ±6.51 for control patients and 23.62 ±10.12 respectively and the Coefficient correlation (r)between serum cortisol level and pulse rate in both groups were 0.16 (p>0.05) for the control patients and 0.58 (p<0.01) for the study group patients. When serum cortisol concentrations in study group were distributed according to the age of the sample, there was a highly significant positive correlation between these variables (r=0.36, p< 0.05). Also pulse rat in study group was found highly positive association with age (r=0.55, p < 0.01).
Conclusions: It is concluded that the study group patients exhibited significantly higher levels of serum cortisol and pulse rate than that of the control group. This deference is suggested to be due to phobia from dental surgical work. As recommendation we suggest giving patient 5 mg of diazepam at the night before the operation.

Kala-azar in Al-Anbar Governorate, Western Iraq

Zaid R Al-Ani

Al- Anbar Medical Journal, 2012, Volume 10, Issue 1, Pages 41-49
DOI: 10.33091//amj.2012.54578

Objectives : To study the clinical presentation, epidemiology, and the therapeutic response of visceral leishmaniasis (Kala-azar) in Al-Anbar Governorate, western Iraq.
Methods : All cases suspected of Kala-azar admitted to AL-Ramadi Maternity and Children Hospital from the 1stof November 2001 to the 1stof April 2002 were investigated to look for Kala-azar disease. The diagnosis depended on the clinical presentation, immunofluorescent antibody test (IFAT) and the bone marrow examination (BM) test. The collected data includes the patient’s name, age, sex, residence, presence of water irrigation areas, sand flies (Hermes), dogs & Jackals, and the poultry farms in their residence areas. Data was analyzed and compared with other studies.
Results : The majority (75%) of the cases were found under 2 years age, more in males than females, and in rural than urban areas. More than 68% of the recorded cases were from Al-Fallujah district peripheries. The major presenting clinical manifestations were; fever (100%), hepatosplenomegaly (100%), anemia (96.9%), abdominal distention and anorexia (84.4%). The IFAT test results were positive in 93.8% and the BM examination in 51.1% of the studied cases. All cases (except one) responded to Pentostam (Sodium Stibogluconate) treatment in a dose of 15mg/kg/day for 21 days.
Conclusion : Kala-azar was found as a public health problem in Al-Fallujah and Al-Ramadi, the largest two districts of Al-Anbar governorate, affecting mainly the infants and children below 3 years age. The use of insecticides, Larvicides and reservoir control, the use of fine window sieves, and the medico-social education about the mode of transmission and role of sand flies, Jackals, dogs, slaughters and poultry farms in the transmission of the disease and their control are important measures for the reduction of the prevalence of this treatable morbid and mortal disease.

Outcome of Surgical intervention in vascular injuries inAl-Fallujah General Hospital 2010

Mohammed Tafash Dagash

Al- Anbar Medical Journal, 2012, Volume 10, Issue 1, Pages 50-58
DOI: 10.33091//amj.2012.54581

Background: Vascular trauma is one of the most challenging aspects in the care of the injured patient, presenting a unique array of problems in diagnosis , decision – making & surgical technique (1).The focus of contemporary trauma surgery is the need to maintain correct priorities , the first of which is to save the patient's life ( 1 ).
Objective & Aim: To focus on the incident, mechanism of injury, management & outcome of vascular injury.
Materials & Methods: This is a descriptive study of 56 cases presented with vascular trauma referred to thoracic & vascular ward in Al-Fallujah General Hospital (FGH), over a period of one year (1st of January 2010- last day of same year). In the diagnosis of vascular injury we depended mostly on physical examination because the site of injury was usually obvious, and in doubtful cases, specific investigations were not available. Some of the patients were stable at presentation, and others were presented with severe bleeding and in shock state .All of patients were resuscitated in the casualty unit that includes control of hemorrhage and volume replacement. All of them were explored at the operative theatre, when vascular injury was dealt with, either by simple or complicated procedures.
Results: Out of the 56 patients operated upon. The most common mechanism of injury seen was penetrating in 51 (90.9%). Non-penetrating in 5 (9.1%) patients. The surgical intervention within 6 hrs in 41 (73.21%) patients. 43 ( 68.25 %) cases were associated with extremities vessel as 24 ( 38.09%) cases with upper limbs including radial artery most vessel injured ,then brachial & ulnar artery. 19 (30.15%) cases with lower limbs were the femoral artery most vessel injured. While truncal vessel in 20 (31.74%) cases & intercostal vessel more injured. The vascular intervention includes ligation in 34 procedures (53.96%) to save life rather than to save limb as a priority especially in non-end artery , end to end anastomosis in 14(22.22%) , graft interposition in 8 (12.69%) cases & lateral repair in 7(11.11%) cases (7 patients had 2 vascular injuries) . The results of surgical intervention were good. Thoracotomy was needed in 7 (12.5%) patients , Intercostal arteries injury was found in all .Only 2 ( 3.57%) patient dead. Two (3.57%) cases ended with above knee amputation due to delay presentation after injury.

Inhibition of Uropathogenic Citrobacter Adhesion by Biosurfactants Extracted from Vaginal Lactobacillus acidophilus

Omar Abd Ulkareem Ali

Al- Anbar Medical Journal, 2012, Volume 10, Issue 1, Pages 59-67
DOI: 10.33091//amj.2012.54584

Background and Objective: A study was conducted to determine the role of biosurfactants solution that was extracted from Lactobacillus acidophilus in the adhesion of uropathogenic Citrobacter on uroepithelial cells.
Methods: A total of 53 isolates of uropathogenic Citrobacter were isolated from female inpatients in Ramadi Maternity and Children Hospital, suffering from urinary tract infections. The age of patients ranges from 15 to 45 years. Lactobacillus acidophilus was isolated from healthy woman by vaginal swab and the biosurfactants were extracted from it. The adhesion of uropathogenic Citrobacter on uroepithelial cells were made as control. Another adhesion experiments was made in presence of biosurfactants solution or Lactobacillus acidophilus whole cells in the test tubes.
Results: The mean of uropathogenic Citrobacter adherent on uroepithelial cells in control tubes was 255.2 per 10 urpepithelial cells while the mean of uropathogenic Citrobacter adherent on uroepithelial cells in presence of L. acidophilus was 145.067 per 10 urpepithelial cells and the mean of uropathogenic Citrobacter adherent on uroepithelial cells in presence of Biosurfactants solution was 70.778 per 10 urpepithelial cells.
There was significant decreasing in numbers of uropathogenic Citrobacter which adhere on uroepithelial cells in presence of biosurfactants in the test solution, and the Lactobacillus acidophilus as whole bacteria can decrease the adhering number of uropathogenic Citrobacter in the test tubes
Conclusion: The biosurfactants solution has a potential effect to prevent the adhesion of uropathogenic Citrobacter on uroepithelial cells.
Key words: Biosurfactants, Lactobacillus acidophilus, Citrobacter, Adhesion

Prevalence of Oesophago - Gastroduodenal Illnesses Among Dyspeptic Children in Al-Anbar Governorate

Abdulla Eltaif Jassim

Al- Anbar Medical Journal, 2012, Volume 10, Issue 1, Pages 68-74
DOI: 10.33091//amj.2012.54780

Objective: To determine the prevalence of Oesophago-gastroduodenal diseases among dyspeptic children in Al-Anbar Governorate.

Patients and Methods: A cross-sectional study conducted at Gastroendoscopy Unit of Al-Ramadi Teaching Hospital from 1 May 2002 -30 August 2007, and included two hundred seventy dyspeptic children subjected to Oesophago-gastroduodenoscopy (OGD) after direct complete medical history and clinical examination was taken from each child or from his parents.

Results: According to OGD findings, a higher significant prevalence of negative endoscoping findings (normal dyspeptic children) (62.2%) than those with positive cases (37.8%) were detected (p

A Comparison of Arch Width in Adults with Normal Class I Occlusion and Adults with Class II Division1 Malocclusion in Ramadi City

Zena Hekmat Al-Taee

Al- Anbar Medical Journal, 2012, Volume 10, Issue 1, Pages 75-80
DOI: 10.33091//amj.2012.54781

Aim: The purpose of this study is to compare the arch width between normal class I occlusion and class II div 1 malocclusion in males and females in Ramadi city
Methods and Materials: Fifty-six pairs of study models samples were selected from Ramadi secondary school. The mean age of this group is 18.3±0.7 years. The 56pairs of study are divided into two groups. The first group consists of 28 study models of Class I occlusion.
The samples were divided evenly between the genders (14 females and 14 males). The second group consists of 28 study models of Class lI division1 malocclusion who were equally divided between the genders (14 males and 14 females) Measurements were made directly on upper and lower dental casts with an electronic digital caliper with sharpened tips. The dental arch width was recorded by measure intercanine width, intermolar width and interalveolar width to compare the two groups, the student’s t-test was used with 95% confidence interval.
Results: The present study showed the maxillary intercanine and intermolar width were significant narrower in Class II Division 1 than that in Class I normal occlusion. The maxillary interalveolar widths showed no difference between the two groups. These results suggested that transverse discrepancy in Class II division 1 patients originated from upper posterior teeth and not from the maxillary alveolar base. On the other hand, the mandibular intercanine width was significant larger in Class II, Division 1 than that in Class I normal occlusion . The mandibular intermolar and Interalveolar width were significant larger in Class I normal occlusion subjects.
Conclusion: The arch widths were smaller in Class II, Division 1 malocclusion compared to Class I normal occlusion except mandibular intercanine width and the arch widths were larger in males than that of females.

Case Report: Scrotal Gigantism

Niema H. Al-Heeti

Al- Anbar Medical Journal, 2012, Volume 10, Issue 1, Pages 81-85
DOI: 10.33091//amj.2012.54782

Background: Scrotal lymph edema is rare outside endemic filariasis regions in Africa and Asia, and of variable causes.
Case presentation: In this report we describe a rare case of penoscrotal lymphedema in Iraq , and surgical technique for correction. We discuss also its etiology and therapeutic approaches. Radical excision of elephantoid tissues and reconstruction with scrotal flaps was performed. Good cosmetic and functional results were obtained with one stage procedure.
Conclusion: Surgery can be successful even in giant scrotal elephantiasis with good cosmetic and functional outcome.