Print ISSN: 2706-6207

Online ISSN: 2664-3154

Volume 10, Issue 2

Volume 10, Issue 2, Summer and Autumn 2012

Latanoprost Therapy In Primary Open-Angle Glaucoma Patients: A Three-Month Study In Al-Anbar Province

Majid A. K. Lafi

Al- Anbar Medical Journal, 2012, Volume 10, Issue 2, Pages 1-10

Background: Primary open angle glaucoma (POAG) is the most common form of glaucoma throughout world, accounting for about two-thirds of cases. Latanoprost is a prostaglandin (PG) F2α derivative and has a strong effect on lowering the intraocular pressure (IOP) in patients with POAG and in normal eyes.
Objectives: The aim of this study is to evaluate the IOP lowering effect and safety of latanoprost in POAG naïve patients and in patients on timolol exhibited insufficient response, in Al-Ramadi Teaching Hospital.
Patients and Methods: Forty-seven Iraqi patients (47 eyes) with POAG were enrolled in a single center (Al-Ramadi Teaching Hospital) in prospective uncontrolled observational cohort study. The mean age (± S.D) was 57.09±2.04. The baseline IOP of 38 naïve patients stratified into ≥ 21 ≤30 vs. ˃30mmHg. Nine patients who had been treated with timolol but exhibited insufficient response, they were shifted to latanoprost and enrolled in this study. All participants were treated with 0.005% latanoprost once daily (evening) for 3 months. IOP levels were measured at baseline and after 1, 2 and 3 months. The efficacy outcome was mean change and mean percent change in IOP from baseline to month 1, 2 and 3.
Results: At all follow-up visits there was a significant reduction in IOP compared with the baseline value in naïve patients treated by latanoprost as 1st line (P<0.0001) and in patients shifted from timolol to latanoprost (P<0.001). The baseline IOP was 26.69±3.22 (mean±SD) mmHg, 36.43 ±3.67 mmHg and 22.00 ±4.15 mmHg in ≥ 21 ≤30 mmHg group, ˃30mmHg group and in patients shifted from timolol to latanoprost respectively. After 3 months, the IOP was reduced by 12.31±3.22 mmHg (45.63±8.26%), 21.43±4.16 mmHg (58.40±6.33%) and 8.00±3.74 mmHg (34.88±10.02%) respectively. No evidence of an upward drift in the IOP was observed during the treatment period. The most frequently reported adverse ocular effects were mild conjunctival hyperemia. No adverse systemic effects were observed. Timolol has been added to latanoprost in five naïve patients (14.2%) to achieve the desired therapeutic objective. Three naïve patients were lost to follow up. None of the patients needed shifting from medical to surgical treatment.
Conclusion: It is highly justified to use latanoprost as 1st line monotherapy in POAG naive patients and in patients whose IOP is insufficiently controlled on β-blocker monotherapy (timolol) by shifting them to latanoprost.

Loss of Tetracycline Resistant Gene from pBR322 by Direct Repeat Spontaneous Homologous Recombination

Evan L. Khaleef

Al- Anbar Medical Journal, 2012, Volume 10, Issue 2, Pages 11-18

Objectives: It's well known that tetracycline resistant gene in pBR322 is about 1190bp clockwise in direction and tetracycline antibiotic inhibits bacterial protein synthesis. Resistant cells are able to grow in the presence of tetracycline because of efflux system. In this study, we try to delete tetracycline resistant gene from pBR322 by spontaneous homologous recombination between direct homology flanked regions.
Subject and Methods: There is direct repetitions Direct repeat between flank regions of tetrgene of pBR322 yield loss of tetrgene (Tetracycline Resistant Gene) by spontaneous homologous recombination. Restriction enzyme and T4 DNA ligation from NEB Phusion High Fidelity PCR Kit from NEB was used for PCR amplification. The measurement of rate of loss of tetrgene from pBR322 by homologous recombination was made using fluctuation test.
Results: After construction of new derivative from pBR322 which includes200bp flank region upper to tetrgene homology with downstream region in same direction, the measurement of rate of loss of tetrgene by fluctuation test was 64%.
Conclusion: The high rate of loss of tetrgene from pBR322 by direct repeat spontaneous homologous recombination indicated that homologous recombination between 200bp flank region for gene like tetrwhich it is about 1190bp consider as active method to delete the wanted gene.

Pattern of Skin Disorders Among Female Secondary School in Fallujah City

Asma I Alajeel

Al- Anbar Medical Journal, 2012, Volume 10, Issue 2, Pages 19-25

Introduction: Adolescence is the transitional stage of physical and mental human development that occurs between childhood and adulthood. The pattern of skin disease in general varies in frequency and severity in different age groups and it differ with geographical locations due to environmental, race factors, sex and age.
Objective: To determine the pattern and severity of skin disease among adolescent female students in Fallujah city in order to understand the effect and the impact of skin diseases at this stage of life.
Patients and Methods: This is a cross sectional study of 400 adolescent female students with skin diseases in Fallujah secondary schools. The study was performed during the period from November 2009 - May 2010. The students were examined for the type of skin disorder and its severity.
Results: The majority of the patients had one skin disorder 62%; the remainder had 2 or more disorders. The most common skin diseases and conditions were the disease of skin appendages (with the acne being the most common one) followed by dermatitis and related conditions and then skin infections.
Acne was noticed in (30%) of students, affecting the face (95.5%) and trunk (4.5%). The next common disorder was hirsutism (25%), atopic dermatitis, (15%), diffuse hair loss (10%), dandruff (7.5%), warts (7. 5%) and (scabies 7%).
A large number of acne patients had also hirsutism and to lesser extent dandruff and Androgenetic alopecia and these patients were found to have high free testosterone level and ultrasound appearance of polycystic ovary (PCO) which pointed to the diagnosis of Polycystic ovary syndrome (PCOS).
Conclusion: Skin diseases are common among adolescent female students in Fallujah city. The most common skin disorders at this age were acne and hirsutism which is of cosmetic importance, so early and proper management of these disorders is important to prevent the late disfiguring sequel and psychological problems.

The Effect of Tamsulosin and Combination of Terpenes (Rowatinex) on the Clearance of Renal Stone Gravels After Single Session of Extracorporeal Shock Wave Lithotripsy (ESWL)

Waleed Nassar Jaffal

Al- Anbar Medical Journal, 2012, Volume 10, Issue 2, Pages 26-33

Background: Extracorporeal shock wave lithotripsy (ESWL) is currently considered one of the main lines of treatments for urolithiasis. The effectiveness of pharmacologic therapies in facilitating stones expulsion after ESWL has been reported.
Objectives: To evaluate the effect of Tamsulosin and terpenes combination (Rowatinex) on the clearance of stone gravels after extracorporeal shock wave lithotripsy (ESWL) of renal stone.
Methods: From May 2010 to June 2011 (84) patients with single radio opaque renal stone presented to urologic consultation department at Al-Ramadi teaching hospital/Iraq were included in this prospective, case-control study. All patients were examined by ultrasonography, and intravenous urography. Their age ranged from 19 to 62 years. All patients underwent ESWL and randomly divided into three groups, group A, of 28 patients, received conservative medical therapy alone and served as the control group, group B, of 28 patients, received tamsulosin 0.4 mg once daily in addition to conservative medical treatment and group C, of 28 patients, received Rowatinex capsules, 1 capsule before food 3 times daily in addition to conservative medical therapy. All patients were followed up by clinical examination, urine analysis, ulrasonography and abdominal radiograph (KUB) at 4 and 8 weeks and the number of patients with clinical success was recorded. Clinical success defined as stone-free status or clinically insignificant stone.
Results: The age of patients ranged from 19 to 60 years in group A (mean 35.7±6), 20-62 years in group B (mean 36.6±13.25) and 20-61 years in group C (mean 36.2±13.02), there was no significant statistical difference between the age, gender and site and size of renal stones among the three groups (p value > 0.05). The percentage of patients with clinical success after ESWL at 4 weeks was 23% in group A, 44% in group B and 40% in group C and increased to 46%, 80% and 76% in group A, B and C respectively at 8 weeks. The clinical success was statistically more significant in group B and C compared to group A at both 4 and 8 weeks ( p value < 0.05). There was no statistically significant difference in the clinical success between group B and C (p value > 0.05). Although the incidence of drugs side effects in group B and C occurred more than in group A, but no significant side-effect was detected so as to require exclusion of a patient from the study and medical intervention was not performed in any of the patients because of side-effects.
Conclusion: The use of medical expulsion in this study by tamsulosin or terpenes combination (Rowatinex) was well tolerated and it demonstrated that it is clinically meaningful and statistically it has significant improvement in the clearance of stone fragments after ESWL of renal stone. The effect on tamsulosin and terpenes combination (Rowatinex) is comparable.

The Effect of Vancomycin and Some ion Chelators on the Formation of L-forms Bacteria in Gram-Positive Cocci

Sawsan Qahtan Taha Al-Quhli

Al- Anbar Medical Journal, 2012, Volume 10, Issue 2, Pages 34-45

Background: L-phase variants or cell wall deficient bacteria are strains of bacteria that lack cell wall temporally. They are pleomorphic, a term that refers to change in size and shape. Recently, unusual antibiotic result was observed in such bacteria.
Objective: To investigate the role of vancomycin and some ion chelators like calcium and magnesium on the induction of gram-positive cocci (Streptococcus faecalis, milleri Streptococci, Staphylococcus aureus and Streptococcus pneumoniae) to produce L-forms bacteria.
patients and methods: In this study, the bacterial isolates were bacteriologically identified , the MIC and sub-MIC of vancomycin were determined of these isolates by using the technique of micro-broth dilution method , hypertonic special culture media designed for induction of L-forms bacteria with different concentrations of CaCl2 and MgSO4
Results: The results indicated that the species Streptococcus faecalis was the most affected one especially at the concentration of vancomycin 12.5 mg/l, where this bacterium was affected with this concentration of antibiotic and CaCl2 at the concentration of 12 g/l and 6 g/l respectively and MgSO4 at the concentration of 4g/l and provided that at the concentrations of (12+4) g/l and (6+2) g/l of CaCl2 and MgSO4. The milleri Streptococci, Staphylococcus aureus and Streptococcus pneumoniae also were affected at the same concentration of vancomycin (12.5mg/l) and at the concentration of 12 g/l of CaCl2.The milleri Streptococci and Streptococcus pneumoniae also were affected at the concentration of 4 g/l of MgSO4 and at the concentrations of (12+4) g/l and (6+2) g/l of CaCl2 and MgSO4 the milleri Streptococci was clearly affected while the Staphylococcus aureus and Streptococcus pneumoniae were affected only at the concentration of (12+4) g/l of CaCl2 and MgSO4 with availability of vancomycin at the same concentration above. The bacterial isolates also were affected at the concentration of vancomycin (6.25) mg/l with CaCl2 and MgSO4 but at lower percentage.
Conclusions: The vancomycin , CaCl2 and MgSO4 showed great effects on the induction of conversion to L-forms where the best growth of L-forms appeared when the vancomycin added at the concentration of (12.5 mg/l) to the media containing (CaCl2 and MgSO4) together especially at concentration (12 g/l) for the CaCl2 and (4 g/l) for the MgSO4.

The Outcome of the Misuse of 3rd Generation Cephalosporins In Fallujah City, West of Iraq

Samira T. Abdulghani

Al- Anbar Medical Journal, 2012, Volume 10, Issue 2, Pages 46-50

Objectives: The main objective of this study is to identify the incidence of resistance pattern developed against 3rd generation Cephalosporins as a consequence to the misuse of this group of antibiotics in Fallujah city.
Subject & methods: One hundred laboratory samples were collected during the period from June 2008 to March 2009. The samples were cultured & checked for sensitivity toward Cefotaxime, Ceftazidime, & Ceftriaxone, which were commonly misused in Fallujah.
Results: Among the 100 samples (including urine, stool, semen, &ear throat & high vaginal swab), the bacteria isolated were Escherichia coli 51(51%), Streptococci 19(19%), Klebsiella 12(12%), Pseudomonas auroginosa 8(8%), Proteus 6 (6%), Staphylococci 4(4%) .The degree of resistance of these bacteria was ranging from 52.6% - 100% to Cefotaxime , 62.5% -75% to Ceftazidime , &25% - 66.6% to Ceftriaxone.
Conclusion: There is a significant degree of bacterial resistance against 3rd generation Cephalosporins as a consequence to the misuse of this group of antibiotics

The Histological Changes on Liver and Spleen of Mice Treated with Alcoholic and Aquatic Extract of Cupressus sempervirens

Nusaibah Amer

Al- Anbar Medical Journal, 2012, Volume 10, Issue 2, Pages 51-57

Background: Cupressus sempervirens has been widely cultivated as an ornamental tree for millennia away from its native range, mainly throughout the central and western Mediterranean region. It contains some active chemical constituents.
Objectives: The aim of the study was to investigate the effect of Cupressus sempervirens on the histological structure of liver and spleen.
Methods: For this purpose, thirty males Swiss albino mice were divided into five equal groups, the groups of aqueous and alcoholic extract of cupressus sempervirens were (350, 150, 0 mg/ml), six mice were used for each group. Then the animals were sacrificed and the histological change on liver and spleen was studied.
Results: Histopathology of liver in mice treated with 350 mg/ml alcoholic extract of Cupressus sempervirens showed aggregation of inflammation cells mainly neutrophil and lymphocyte, as dilated as congestion in the central vein , and the aquatic extract of 350 mg/mlCupressus sempervirens showed mononuclear cell infiltrate in the portal area together with amyloid deposition in sinusoid and multiple area of liver necrosis, while liver in mice treated with 150 mg/ml alcoholic extract of Cupressus sempervirens showed proliferation of kapffer cell and congestion of central vein , while at 150 mg/ml aquatic extract of Cupressus sempervirens showed proliferation of kapffer cell with double nucleated. Histopathology of spleen in mice treated with 350 mg/ml alcoholic and aquatic extract of Cupressus sempervirens showed severe amyloid deposition in red pulp and around white pulp, while spleen in mice treated with 150 mg/ml alcoholic extract of Cupressus sempervirens showed moderate periarterial hyper plasma, and a sectional view of 150 mg/ml aquatic extract of Cupressus sempervirens showed depletion of white pulp mainly neutrophil and macrophage.
Conclusions: from the result of this study it can be conclude that the high concentration of Cupressus sempervirens histopathological effect on liver and spleen of mice that induced with.

Types of Renal Stones in Al-Anbar Governorate

Ehab Jasim Mohammad

Al- Anbar Medical Journal, 2012, Volume 10, Issue 2, Pages 58-61

Background: Urinary calculi are the third most common affliction of the urinary tract, exceeded only by urinary tract infections and pathologic conditions of the prostate. The lifetime prevalence of kidney stone disease is estimated at 1% to 15%.
Aim of study: to determine different types of renal stones in Al-Anbar Governorate.
Materials and methods: from November 2008 till November 2010 (265) patients having upper tract stone disease were studied in Al-Ramadi Teaching Hospital.All these stones that were analyzed by chemical method were obtained from those patients either by spontaneous passage, medical expulsive therapy, Extracorporeal Shock Wave Lithotripsy [ ESWL], or by surgical operation.
Results: In this study, the age of those patients ranges from 17-62 years old. The male to female ratio was 3:1. The distribution of stones in Al-Anbar Governorate was: Uric acid stone 50.6%, calcium oxalate stone 38.1%, calcium phosphate stone 5.3%, cystine stone 1.9%,mixed(calcium and uric acid) stone 4.1%.
Conclusion: High incidence of uric acid stones in Al-Anbar Governorate
which are more in males than in females .The main cause for these results is unknown, but dietary factor (proteins) may play a major role in stone formation in Al-Anbar Governorate.

Factors Predicting Positive Axillary Lymph Nodes Metastasis in Primary Breast Cancer in Women

Jamal K.AL-Qaisy

Al- Anbar Medical Journal, 2012, Volume 10, Issue 2, Pages 62-68

Objective: To predict factors which influence positive axillary lymph node metastasis (ALNM) in early stage of breast cancer in women.
Patients and Methods: A prospective study was carried out between the 1st of October 2002 and the 1st of October 2008 at Al-Ramadi Teaching Hospital. One hundred women in early stage of breast cancer with impalpable axillary lymph nodes were included. The breast lamp and the axillary lymph nodes samples were histopathologically assessed.
Results: Analysis of axillary lymph nodes biopsies showed positive axillary lymph nodes metastasis in 34 (34%) of the patients. Four out of 30 patients (13.3%) were in stage I their mean age was (42±18.7 years) and 30 out of 70 patients (42.8%) were in stage II, their mean age was (45±16.9 years).
Conclusion: Tumor size, poor histological grade, lymph vascular invasion, age and, parity are significant predictors of axillary lymph nodes metastasis

Caries - Severity in Relation to Salivary Constituents Among Down's Syndrome Children in Comparison to Normal Children

Nada J. Radhi

Al- Anbar Medical Journal, 2012, Volume 10, Issue 2, Pages 69-77

Background: Considerable attention has been given to the degree to which children with Down's syndrome are susceptible to dental caries. These observations have been questioned by many researchers whether they are inherently resistant to caries or not.
Aim of study: Was to measure the changes in the level of calcium, phosphorus, sodium, potassium and urea in stimulated saliva and their relations to severity of dental caries among Down's syndrome children in comparison to normal children.
Materials and Methods: Fifty institutionalized children with Down's syndrome (study group) and 50 normal children (control group) aged 7-10 years old were included in this study. D1-4S and d1-4s were assessed according to Muhlemann's criteria (1976) and stimulated whole saliva samples were collected and chemically analyzed to determine the concentrations of the following constituents: Ions of calcium, sodium, potassium by Flame Atomic Absorption Spectrophotometer as well as salivary phosphorus and urea by using colorimetric method. All data were analyzed using SPSS version 13.
Results: The D1-4S and d1-4s scores were significantly lower in Down's syndrome children than the control group (P< 0.01, P< 0.001 respectively). Salivary sodium, potassium and urea were significantly higher in Down's syndrome children (P< 0.001), while salivary phosphorus concentration was noticed to be lower among study group compared to control group (P> 0.05).
Conclusion: This study suggests that children with Down's syndrome presents higher levels of salivary calcium, sodium, potassium and urea which may explain a lower caries severity compared to normal children

Antibacterial Activity of Crude Herbal Mixture (Oak bark, Miswak , Cinnamon , Mint, Clove , Common Camomile and Glycerin oil) on Oral Pathogenic Bacteria

Karama T. Al-Taee

Al- Anbar Medical Journal, 2012, Volume 10, Issue 2, Pages 78-85

Objective: To investigate the antibacterial activity of the crude herbal mixture on some oral pathogenic bacteria.
Material and Methods : Out of seventy clinical samples ( 17 gingival swab, 7 saliva , and 46 dental caries swabs ) , fifty four isolates were identified as (18.5%)10 isolates Streptococcus mutans ,(11.1%) 6 isolates Staphylococcus aureus ,(42.6%) 23 isolates Staphylococcus epidermidis,(9.3%) 5isolates Micrococcus and(18.5%) 10 isolates Lactobacillus .
The crude herbal mixture composed of (10% Qurecus aegilops L. ( ground of oak bark ) , 20% Salvadora persica L.( ground of miswak) , 20% Cinnamomum zeilanicum (ground of Cinnamon bark ) , 10% Mentha spicata L. ( leaves of mint ) , 5% Syzygium aromaticum (dried flower buds of clove) ,30% glycerin oil and 5% Matricaria chamomilla L. ( flowers of camomile ) .
The crude herbal mixture was evaluated against Streptococcus mutans, Staphylococcus aureus, Staphylococcus epidermidis, Micrococcus and Lactobacillus isolated from seventy oral infection samples . Antimicrobial activity was determined by the agar diffusion method and the zones of growth inhibition were measured.
Results: The crude herbal mixture was found to possess strong antibacterial activity against range of studied bacteria which was isolated Conclusion : The crude herbal mixture can be used as tooth paste component

The Effect of Aqueous Extract of Capparis spinosa Flowers on the Level of Serum Lipids in Rabbits

Wajeeh Y. AL-Ani

Al- Anbar Medical Journal, 2012, Volume 10, Issue 2, Pages 86-91

Background: The aqueous and alcoholic extract of Capparis spinosa Possessed many different pharmacological activity such as anti-hyperlipidemic Properties.
The aim: The present study aims at investigating the influence of the aqueous extract of Capparis spinosa flowers on the levels of serum lipids profile for normal and hyperlipidemic rabbits.
Material and method: Twenty male white rabbits of (2-2.5)Kg. in weight and of age six months hyperlipoproteinaemia was induced experimentally by feeding the first ten with a were used, The high cholesterol diet ( 2gm/kg/day animal fat with adding 2 gm / Kg / day cholesterol powder.) For six weeks then they divided into two subgroups: (A) as a positive control and ( B ) . The other ten rabbits were given ordinary diet and served as controls ,then divided into two subgroups ( C ) as negative control and ( D ). Subgroups (B) and (D) were treated daily for 30 days with an aqueous extract of Capparis spinosa flowers with concentration of 100 mg / ml and an oral dose of 5 ml/ Kg / day, that was given orally by intragastric tubation.
After 12- 14 hours of fasting, 5 ml of venous blood was drawn, then centrifuged for 10 min. at 3000 rpm for serum separation. Serum lipids were determined by the enzymatic method and Statistical analysis was performed.
Results :The results showed that the treatment of rabbits with an aqueous extract of Capparis spinosa flowers in concentration of 100 mg / ml and therapeutic dose of 5 ml/ kg / day via oral administration and for thirty days , reduced significantly (P < 0.05) the total serum cholesterol ( TC) level , triglycerides ( TG ) , low- density lipoprotein cholesterol (LDL-C) and very low-density lipoprotein cholesterol (VLDL-C) in hyperlipidemic rabbits ( group B ) and had no effect on the level of high-density lipoprotein cholesterol (HDL-C) . Also the aqueous extract reduced significantly (P < 0.05) the level of ( TG) and ( VLDL-C ) in normal rabbits (group D) ,while no significant reduction was seen in the level of TC., LDL-C and HDL-C .
Conclusion: The experimental results showed a therapeutic importance of Capparis spinosa flowers in lowering the levels of serum lipids and decreasing the infection risk of acute coronary syndrome.

Cleft Lip and Palate in Anbar Province

Mohammed Kh. Al-Rawi

Al- Anbar Medical Journal, 2012, Volume 10, Issue 2, Pages 92-95

Background: Orofacial clefts are birth defects where the mouth or roof of the mouth (palate) does not grow together properly during development, Orofacial clefts include cleft lip [CL], cleft lip and palate [CLP], cleft palate [CP] alone, as well as median, lateral [transversal], oblique facial clefts(involved other parts of facial structures and classified by Tessier to 15 lines) are among the most common congenital anomalies at birth.
Aim: To study the types of clefts lip and palate and its distribution in Al Anbar province. Patients and Methods: This descriptive study was carried out at Maxillofacial Unit, Ramadi Teaching Hospital from the period of August 2007 till June 2010.
Result: 125 cases of clefts (of different types) were treated surgically. Children who have an orofacial cleft require several surgical procedures and complex medical treatments. The study showed that 81 of patients with cleft palate, 27 with cleft lip and 17 with cleft lip and palate.
Conclusion: Increasing in number of cleft lip in female (60%). Increasing the percent of cleft palate may be related to environmental factors

Thallium Poisoning ------ Case report

Basim Attallah Alabdily

Al- Anbar Medical Journal, 2012, Volume 10, Issue 2, Pages 96-99

Thallium is a heavy metal that is used in the manufacture of electronics, alloys, and glass. In clinical practice, thallium is used as a radioactive tracer in heart scintigraphy to detect myocardial ischemia1,2.
Thallium and its salts are highly toxic; however industrial safety guidelines exist in the workplace. Accidental poisoning has become rare in the domestic setting since the 1970s, when thallium-based rodenticides were banned in many countries. The majority of reported cases of thallium poisoning in the past two decades has been caused by deliberate poisoning