Document 7095

VOL. 8(4), 2010, 1431H
ISSN 1608-8360
The Official Journal of the Iraqi Board for Medical
Specializations
General Supervisor: Nazar B. Elhassani
Editor - in – chief: Zakaria Y. Arajy
Editorial board
Nazar B. Elhassani
Misaied Lafta H. Al-Badri
Zakaria Y. Arajy
Neda Salih Amen
Raja Kummoona
Dawood Sadik Al-Obidi
Raji H. M. Al-Hadithi
Safa M. Al-Obaidi
Khalifa E. Sharquie
Samir H. Aboud
Rajaa' M. Hassan
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VOL. 8(4), 2010, 1431H
ISSN 1608-8360
The Official Journal of the Iraqi Board for Medical
Specializations
National Advisory Board
Abdul Monaf Al -Jadiry
Khalil Al -Shaikhly
Adil S. Abdul- Ghafor
Maad M. Abdul Rahman
Ala H. Bashir
Miqdad A Al -Ani
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Mudher A. Amin
Abdul Baki M. Raof AL-Khatib
Najim A. Al -Ruznamaji
Bassam A. Al-Brazanchee
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Abbas
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List of Contents
Volume 8 . (4).2009
Effect of Very Early Atorvastatin Initiation for Acute Myocardial Infarction on Creatine Kinase
Release
Faris Abdul Kareem, Lewai S. Abdulaziz , Adnan A. Al.Adeem …309-313.
Experience in ICD Implantation and Follow –up in IBN Albitar Hospital
Ali Abdul Ameer Mohammad , Kasim Abbas Ismael , Muthana Hameed Al-Qurashee ,
Ameer Rahman Bearm , Kasim Mohammad Jumaa Al-Doori …314-317.
Relation of Immuno- Inflammatory Markers (IL-6, CR Pand ESR Value) with Prediction of
Ischemic Heart Disease
Mahdi Haider Al-Najy , Ikbal Khider Al-Joofy…318-322.
The Value of Using Echocardiography in Patients of Advanced Liver Disease with Cardio
Pulmonary Complications
Basil. N. Saeed , Sameer Hakeam , Lutf Ahmed , Jalal Ahmed …323-326.
The Prevalence of Weight Loss Assessed by Body Mass Index in Patients with Stable Chronic
Obstructive Pulmonary Disease
Kassim .M. Sultan, Muhammed .W.Al.Obaidy , Alaa. I.Hussein …327-331.
Scarring and Non Scarring Facial Acne Vulgaris and the Frequency of Associated Skin Diseases
Khalifa E. Sharquie , Khalil I. Al-Hamdi , Adil A. Noaimi , Razan A. Al-Battat …332-338.
A Study on Humoral Immunity and Oral Bacterial Diversity in Patients with Trichomonas
Tenax Infection
Batool M. Mahdi , Waffa Hazim , Bassma Mekii , Ali Ghalib M. Mahdi , Mazin K. Ameen …339-343.
The Lipid Profile in Children with Type 1 Diabetes Mellitus in Erbil Governorate
Abbas A. Alrabaty , Abdulkader A. Alnakshabandi , Nazar B. Yahya … 344-349.
Kerosene Poisoning In Children
Mahjoob Al-Naddawi , Mohammad Abdul-Qader Al-Chalabi, , Khawla Mohammad Kamil …350-355.
Cytogenetic Response of Peripheral Blood in Chronic Myeloid Leukemia Patients Treated with
Imatinb
Maysaa Abdul Razaq Dhahi, Daad Imad , Nidhal Abdul Mohaymen ,Nabeel Salman Murad …356-362.
Comparative Study between Ileo Colic Pedicle Versus Superior Mesenteric Pedicle Division for
Mesenteric Lengthening
Ibtesam Khalid Salih Al-Shadydy …363-367.
Computed Tomography Performance in Renal Cystic Diseases
Haider Qasim Hamood …368-374.
Study of Risk Factors for Breast Cancer in A Hundred Breast Cancer
Sroor Mahdi , Hassan Hadi Baker , Kholod Daher Habeeb… 375-379.
Indications of IV Fluids in Medical City
Bassam Hameed Al-Jarrah, Zeena Muthafer Al-Nema …380-383.
Postoperative Urological Complications of Renal Transplantation; Al Karama Hospital
Experience
Yousuf M. Alhallaq, Shawqi Ghazala, Mohammad Batal, Ausama S. Abdul Muhsin …384-386.
Effectiveness of Immediate Mitomycin C Instillation in Patients with Low Risk Non-Muscle
Invasive Bladder Cancer
Usama Sulaiman Al-Nasiri , Wisam Ali Kareem …387-392.
Evaluation of Focused Abdominal Sonography for Trauma (FAST) in Baghdad Teaching
Hospital
Raed J .Wiwit , Saad Abdulla Ibrahim Sarsam , Salah M.Tajer ... 393-397.
Role of Antioxidant on Nephropathy in Alloxan Induced Diabetes in Rabbits
Israa F. Jaffar Alsamaraee , Huda Arif Jasim …398-402.
THE IRAQI POSTGRADUATE MEDICAL JOURNAL
THE IRAQI POSTGRADUATE MEDICAL JOURNAL
VOL.8, NO.4, 2009
VOL.8, NO.4, 2009
Effect of Very Early Atorvastatin Initiation for Acute
Myocardial Infarction on Creatine Kinase Release
Faris Abdul Kareem*, Lewai S. Abdulaziz **, Adnan A. Al.adeem***
ABSTRACT:
BACKGROUND:
It have been suggested that pre-treatment with a statin agent prior to myocardial infarction limits
myocardial creatine kinase release, and thus may act to limit myocardial infarct size in humans.
OBJECTIVE:
To examine the effect of very early statin initiation for AMI, to the extent of myonecrosis as
manifested by peak serum creatine kinase levels.
MEHTODS:
Patients with AMI admitted to Al-Kindy teaching hospital cardiac care unit from February 2007
through February 2008, who fulfilled the inclusion criteria cited in the present study, were randomly
assigned into two study groups. The statin group patients have received a single oral dose of 40 mg
atorvastatin at time of admission and repeated for the next days until discharge, patients not receiving
statin serves as controls. Blood samples were obtained upon admission and every 8 h for another
PATIENTS AND METHODS:
three consecutive samples to identify peak creatine kinase levels.
RESULTS:
Patients with AMI, admitted to Al-Kindy teaching
Patients who had statin therapy initiated immediately after hospital admission have similar peak
hospital cardiac care unit (CCU) from February
creatine kinase concentrations as compared to those not receiving statin therapy (1020 ± 621 IU/L vs.
2007 through February 2008, who fulfilled the
911 ± 591 IU/L ; P= 0.332).
following criteria, were included in the present
CONCLUSION:
study: (1) not on concomitant statin therapy before
Statin initiation in AMI patients fails to show any observable effect on creatine kinase release, which
admission; (2) no history of myocardial infarction;
can be attributed to the need of an extended period for the statin agent to achieve the predictable
(3) normal serum CK level on admission, followed
outcome and suggesting the necessity of statin pretreatment in patients at high risk for AMI
by elevation of CK to more than the upper limit of
KEY WORDS: atorvastatin, AMI, CK, infarct size.
normal; (4) finally to circumvent incomplete
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Experience in ICD Implantation and Follow-up in IbnAlbitar Hospital
Ali Abdul-Amir M. Al-Musawi , Kasim Abbas Ismail , Muthanna Hameed AlQuraishi , Amjad Rahman Bairam , Kassim Mohamad J. Al-Doori
ABSTRACT:
BACKGROUND:
Survivals of sudden cardiac death (SCD) episodes have recurrence rate of 30-50% within two years,
with malignant ventricular arrhythmias most often responsible1, 2. The overall survival rate for SCD
in USA is 5%. Ninety-five percent of patients suffering their initial event fail to survive to become
candidate for secondary prevention1.Because of the wide spread acceptance of implantable
cardioverter defibrillator ( ICD ) as a method treating the survivals of SCD, attention has turned to
primary prevention 1. Implantable cardioverter-defibrillator (ICD) is highly effective in primary and
secondary prevention of SCD due to life threatening ventricular tachycardia (VT).
OBJECTIVE:
To register and interpret the results of implantation and follow-up of ICD during the period between
2002-2007 in Ibn Al-Bitar hospital.
METHODS:
Sixty patients with standard indications for ICD; data were pooled from patients history, ECG,
Echocardiography, Holter, blood investigation and coronary angiography.75% males and 25% females.
After implantation, class III anti-arrhythmic drugs (Amiodarone) were stopped, except for patients
with a history of supraventricular tachycardia or recurrent VT.
RESULTS:
Coronary artery disease (CAD) was the most common presentation of patients for whom
implantation was done; coronary artery disease (CAD) 43%, dilated cardiomyopathy (DCM) 26%,
and hypertrophic obstructive cardiomyopathy (HOCM) 16%. Sixty-three of them had moderatesevere LV dysfunction (LVEF<40%). Recurrent VT was the most common cause of implantation
(76%). Primary prevention was aimed in (60%) of patients and secondary prevention in 40%. Sixty
percent of those with ICD implanted due to primary prevention fulfil MADIT II (Multicenter
Automatic Defibrillator Implantation Trial II) criteria. The majority of patients had structural heart
disease. Most non-sustained VTs reverted to sinus rhythm by antitachycardia pacing (ATP) therapy
from ICD (90%).All VF events reverted to sinus rhythm by high energy shock from ICD devices.
CONCLUSION:
ICD is highly effective in primary and secondary prevention of life threatening VT/VF.
KEY WORDS: CAD: coronary artery disease, ICD: implantable cardioverter-defibrillator,
SCD: sudden cardiac death, VT: ventricular tachycardia.
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THE
IRAQI
POSTGRADUATE
MEDICAL
JOURNAL
THE
IRAQI
POSTGRADUATE
MEDICAL
JOURNAL
VOL.8,
VOL.8,NO.4,
NO.4,2009
2009
Relation of Immuno-Inflammatory Markers (IL-6, Crpand
ESR Value) With Prediction of Ischemic Heart Disease
Mahdi Haider Al-Najy *, Ikbal Khider Al-Joofy **
ABSTRACT:
BACK GROUND:
Ischemic heart diseases (I.H.D) become more common during 21st century as the dominant chronic
diseases in many parts of the world, and it is predicted to be become the main causes of disability and
death world wide. Many factors play a role in pathogenesis of I.H.D among those could be immunoinflammatory markers which may lead to development of this disease.
OBJECTIVE:
The present study was conducted to obtain more clarification about the impact of some immunoinflammatory markers (IL-6, CRPand ESR value) on the clinical expression of heart disease among
Iraqi patients.
METHODS:
Hundred Iraqi patients with I.H.D (80 male and 20 female) ages ranged from 20 to 80 year were
involved in this study, including 4 subgroups: 17 with heart failure (H.F). ; 26 with myocardial
infraction (M.I); 12 with stable angina (S.A) and 45 with unstable angina (U.A) who was attending
the Iraqi center for heart disease and Baghdad hospital from December 2006 to march 2007. Using
enzyme amplified sensitivity immuno assay (EASIA) technique to measure the level of IL-6, and
enzyme linked immunosorbant assay (ELISA) technique to measure the levels of CRP, in addition to
westergren method to determine ESR were done for both patients groups and healthy control group.
RESULTS:
Significant increased (p<0.05) in the serum level of IL-6 in all patients subgroups: MI, HF, UA, and
SA. Respectively compared with control group, also all patients subgroups: SA, HF, MI, UA,
consequently revealed significant increased (p<0.05) in the mean of CRP concentration compared
with control group. Moreover, highly significant elevated (p<0.01) in the erythrocyte sedimentation
rate (ESR) value in the patients subgroups: SA, UA, MI, HF respectively compared with control group.
CONCLUSION:
Elevated levels of inflammatory markers, particularly CRP and IL-6 are a relatively strongly
predictor of I.H.D and in one way or another ESR value and CRP level reflect the degree of the
inflammatory status of these diseases.
KEY WORDS: ischemic heart diseases, inflammation, IL-6, CRP, ESR.
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The Value of Using Echocardiography in Patients of Advanced Liver Disease with
Cardio Pulmonary Complications
Basil. N. Saeed *, Sameer Hakeam**, Lutf Ahmed**, Jalal Ahmed**
ABSTRACT:
BACKGROUND:
Patients with chronic liver disease are liable to get cardio – pulmonary complications, one of these
complications is development of pulmonary hypertension ranging from mild to it's sever form – this
complication could give some abnormal findings in chest x-ray, electrocardiography but more
prominently by echocardiography.
OBJECTIVES:
To clarify the benefit of using the echocardiogram is detecting pulmonary hypertension prior to the
use of invasive methods (catheterization) in patients with advanced liver disease.
METHODS:
A total of 50 patients with chronic liver diseases (cirrhosis, chronic active hepatitis) their age range is
(25-70 years) (mean are 37.07 years), the fifty patients were free from any cardiac or respiratory
diseases.The study extending from December 2007-August 2008. All patients went through full
history and routine blood test: including complete blood picture, fasting blood sugar, blood urea &
screatinne, lipid profile, liver function tests, clinical examination, and investigations included routine
blood test, chest x-ray, and electrocardiography, echocardiography (Transthoracie and
transoesphageal). The child-Pugh score used for assessing the severity and prognosis of chronic liver
disease and it classified into three groups (A, B, C) used in this study.
RESULTS:
Fifteen patients from the 50 cases (30%) only proved to have cardio-pulmonary changes (i.e.
pulmonary hypertension right ventricular hypertrophy and dilatation with the mean value of ≥ 25mm
Hg at rest or ≥ 30mm Hg during exertion) those patients were having fatigue in (70%) of them while
dysponea, chest pain, cyanosis, syncope were detected in 30%, 10%, 1%, 2% respectively in those
cases of pulmonary hypertension with chronic liver disease.
CONCLUSION:
The use of non invasive methods especially echocardiography were helpful in detecting the presence
of pulmonary hypertension in patients with chronic liver disease.
KEYWORDS: echo, chronic liver disease
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The Prevalence of Weight Loss Assessed by Body Mass Index
in Patients with Stable Chronic Obstructive Pulmonary
Disease
Kassim M. Sultan*, Muhammed .W.AlObaidy **, Alaa. I. Hussein **
ABSTRACT:
BACKGROUND:
The association between chronic obstructive pulmonary disease (COPD) and weight loss has long been
recognized and is a common clinical observation and it is one of the systemic manifestations of COPD.
A number of studies have identified weight loss and low body mass index (BMI) as independent
predictors of mortality and worse prognosis.
OBJECTIVE:
We have undertaken this study to confirm the association between BMI, weight loss and COPD and
the relation to its severity.
METHODS:
A cross section study of 100 patients with stable COPD have been identified and classified according
to Global initiative for Chronic Obstructive Lung Disease (GOLD) guideline. BMI have been
calculated according to the formula: BMI=Body Weight (kg)/Height2 (kg/m2) Subjects; were classified
according to the BMI in to three groups using World Health Organization guideline: underweight,
normal weight and overweight also classified as current cigarette smokers and ex smokers.
RESULTS:
It had been shown in this study that the underweight more common in COPD (23%),compared with the
control subjects only (7%).low BMI significantly associated with more severe stages of COPD and in
current smoker than in Ex-smoker and with increase in age ,but there is no significant difference
between gender and nutritional status .
CONCLUSION:
Weight loss is a prevalent condition in patients with COPD and BMI can be used to assess this
relationship there was an interaction between smoking habits and BMI in COPD patients. BMI
correlates well with FEV1 and COPD severity and can be used by every clinician because it is a
simple, inexpensive, readily available tool.
KEYWORDS: chronic obstructive pulmonary disease (COPD), body mass index (BMI).
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Scarring and None Scarring Facial Acne Vulgaris and the
Frequency of Associated Skin Diseases
Khalifa E. Sharquie *, Khalil I. Al-Hamdi **, Adil A. Noaimi ***,
Razan A. Al-Battat ****
ABSTRACT:
BACKGROUND:
Acne vulgaris(AV)is chronic inflammatory disease of pilosebaceous unit of young people. Patients
with acne with or with out scarring might differ in regard to their immunological background from
those free from acne.
OBJECTIVES:
To evaluate the problem of facial AV especially patients with scarring and to determine the
frequency of associated skin diseases and to be compared with acne free control.
METHODS:
A cross sectional randomized controlled epidemiological study was conducted from Oct.2005-Oct.
2006.Three hundred students from Basra University; 132 (44%) males and 168 (56%) females were
enrolled, their ages ranged from 18-25 (20.9±1.8) years. They were divided into: Group A those free
from acne (98 individuals),Group B with non scarring facial AV (96 patients), and Group C with
scarring facial AV (106 patients). History and examination were done for their acne, scarring acne
and associated skin diseases. Allen and Smith grading system for AV were used, and a new invented
multiparametric scoring system for scarring acne was applied.
RESULTS:
AV was in 98(73.24%) males and 104 (61.9%) females. Scarring was 54 (50.95%) males and 52
(49.05%) females. Greasy skin was the most common type among Group B 67 (69.8%) versus 39
(39.8%) among Group A(P=0.000029) and was more common among Group C 84(79.2%)
(P=0.00000001).Family history of AV was nearly similar in A and B Groups 55(57.29%) and 56
(52.83%) respectively, while in Group A was 39 (39.79%). Family history of scarring acne was in
35(33.02 %) of Group C, 16 (16.66 %) of Group B, and 3 (3.1%) in Group A; (P=0.00000017). The age
of onset was similar in A and B Groups between 15-16 years. Majority of patients in Group B had
non inflammatory type or mild inflammatory (papular) 65 (67.8%) patients, most of case were mild and
moderate 86 (89.58%) patients, while high percent in Group C had inflammatory type 95 (89.62%), and
more than half of them had severe and very severe types upon grading 56 (52.8%). The aggravating
factors were similar in A and B Groups with stress and hot weather being the leading aggravating
factors. Squeezing and digging habit was in 53 (50%) in Group C versus 23 (23.95%) in Group B
(P=0.00024). In most cases of scarring acne, scarring was mild and moderate 85 (80.19%), and the
most common type scars was the flat hyperpigmented [50 (47.17%) and 66 (62.26%) respectively].The
most common effect of scarring acne on psyche was mild discomfort and mild dysmorphophobia 75
(70.75%).Associated skin diseases were more common among Group A 31 (31. 63%) than among
Group B 22 (22.91%) and least common among Group C 14 (13.20%) (P=0.0067) and they were mainly
dermatitis and skin infections.
CONCLUSION:
AV might reflect the immunological status especially among patients with scarring. The frequency of
skin diseases was much less among patients with scarring acne.
KEY WORDS: acne, skin diseases, immunity, scoring system for scarring acne.
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A Study on Humoral Immunity and Oral Bacterial Diversity
in Patients with Trichomonas Tenax Infection
Batool M. Mahdi*, Waffa Hazim*, Bassma Maki**, Ali Ghalib M. Mahdi***,
Mazin K. Ameen****
ABSTRACT:
BACKGROUND:
Trichomonas tenax (T tenax) is a protozoan that inhabit the oral cavity of poor oral hygiene. It is
found in the dental caries, tartar and periodontal area. It feed on the normal flora of the mouth. It had
been found to cause pulmonary infection and respiratory diseases in immunocompromised patients
and patients with advanced cancer.
OBJECTIVE:
To determine the humoral immune response to Trichomonas tenax and studying if there is any
relation with specific bacteria.
METHODS:
Forty patients who consult Al-Kindy Teaching hospital –maxillofacial and dental department from
June-2008 to January -2009.Two gingival swabs were taken from those patients, one examined
directly for the presence of T tenax by light microscope and other swab was cultured on Blood,
Chocolate and MacConkey's agar for isolation of oral bacteria. Blood was collected from patients for
estimation of serum IgG, IgA, IgM, C3 and C4 levels by using radial immune diffusion method.
RESULTS:
The study group consists of forty individuals, their ages range from 6-65 years. Male more than
female (22:18), thirty of them was smoker, 25% of them were positive for T tenax. The types of
bacteria that were isolated are a normal flora of the mouth like Streptococcus viridans. In spite of the
level of Immunoglobulins and complement in both groups lie within normal values, there was
a significant increased in serum IgM level and significant decreased in serum IgG, IgA, C3
and C4 level.
CONCLUSION:
There was increased in the prevalence of T tenax infection due to low social class and low oral
hygiene .There was no specific bacteria that was confected with it. Lastly, increased in T tenax
infection when there is an immune suppression as in advanced cancer patients and on radiotherapy
and or chemotherapy.
KEY WARDS: trichomonas tenax , immunity, bacteria.
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The Lipid Profile in Children with Type 1 Diabetes Mellitus
in Erbil Governorate
Abbas A. Alrabaty*, Abdulkader A. Alnakshabandi**, Nazar B. Yahya***
ABSTRACT:
BACKGROUND:
Diabetes Mellitus is the most common endocrine-metabolic disease in children. Diabetic patients with
hyperlipidemia frequently develop atherosclerosis which is an important cause of morbidity and mortality.
OBJECTIVE:
The aim of this study was to evaluate serum lipids total serum cholesterol, total serum triglyceride (TGs),
High density lipoprotein (HDL-C), Low density lipoprotein (LDL-C) and very low density lipoprotein
(VLDL-C) in children with type-1 diabetes mellitus in comparison with controls, and to determine the
relationship of lipid profile with gender, body mass index (BMI) and duration of diabetes among patients.
METHODS:
In this case-control study, the lipid profiles of 52 patients aged 6-18 years (27 males 25 females) with
established type 1 diabetes were compared with those of 52 healthy controls of the same age and gender
from the first of December 2007 to the 29th of February 2008.
RESULTS:
The lipid profiles of patients with type 1 diabetes mellitus showed the following values, the mean total
serum cholesterol 175 ± 55 mg/dl, total serum TGs 140 ± 135 mg/dl, HDL-C 59 ± 19 mg/dl, LDL-C 93 ±
51 mg/dl and that of VLDL-C 23 ± 13 mg/dl, whereas for the controls they were 136 ± 34 mg/dl, 74 ± 25
mg/dl, 53 ± 15 mg/dl, 68 ± 30 mg/dl and 15 ± 5 mg/dl respectively.
CONCLUSION:
The abnormalities in lipid profile regarding total serum cholesterol, total serum TGs, LDL-C and VLDLC showed that they were significantly higher in diabetic patients than in control group, while HDL-C
although it was higher among diabetic patients, but it was not statistically significant. Total serum TGs
was significantly increased with the duration of diabetes.
KEYWORDS: diabetes mellitus-lipid profile-BMI.
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Kerosene Poisoning In Children
Mahjoob Al-Naddawi*, Mohammad Abdul-Qader Al-Chalabi **,
Khawla Mohammad Kamil ***
ABSTRACT:
BACKGROUND:
Accidental kerosene ingestion is the commonest cause of poisoning and its subsequent mortality and
morbidity in children less than five year of age in developing countries. Low socio- economic status
and frequent use of kerosene for cooking, lighting and heating are the major cause.
OBJECTIVES:
To study the epidemiology, presentations and radiological appearance of kerosene poisoning in
children.
METHODS:
A prospective study comprised fifty patients, who were admitted with accidental kerosene poisoning
into children welfare hospital in medical city complex /Baghdad. In the period from the 1st of January
to the 31st of august 2008. History was taken from the relatives on a specially designed
questionnaire. Every patient was examined completely concentrating on symptoms of cough,
dyspnea, cyanosis, drowsiness, vomiting, and fever. Chest X-ray was done to every patient after 6-8
hours from the time of ingestion. White blood cell count was done to 39 patients within the 1st 24
hour of admission. Fisher's exact test was considered for the statistical analysis with a significance
level of P < 0.05.
RESULTS:
Of the fifty admitted children, 86% of them aged between 1-3 years, 31(62%) were boys, the
majority from poor and crowded families, and the kerosene ingested, in the majority, from small
containers. The most common presentations were cough (96%), fever (94%) and dyspnea
(80%).Vomiting which occurred in 90%, had a significant association with the development of
pneumonitis the major radiological abnormality was right lower lobe infiltration in 16 patients (32%).
The major complication was pneumothorax, pleural effusion and respiratory failure. Fever appeared
in 94% of the patients in the first 24 hours, lasting 2-7 days. Pneumonitis occurred in 42 patients who
were diagnosed clinically and radiologically. All patients improved except one who died.
CONCLUSION:
All the kerosene poisoning was accidental, occurred in children under five year of age. Ignorance and
poor storage of kerosene played a big role in the kerosene ingestion process. The respiratory system
is the main target involved. Vomiting playing a role in the development of pneumonitis.
KEY WORDS: kerosene, hydrocarbon, children, pneumonitis, vomiting.
THE IRAQI POSTGRADUATE MEDICAL JOURNAL
VOL.8, NO.4, 2009
THE IRAQI POSTGRADUATE MEDICAL JOURNAL
VOL.8, NO.4, 200
Cytogenetic Response of Peripheral Blood in Chronic Myeloid
Leukemia Patients Treated With Imatinb
Maysaa Abdul Razaq Dhahi*, Daad Imad**, Nidhal Abdul Mohaymen* ,
Nabeel Salman Murad**
ABSTRACT:
BACK GROUND:
Chronic myeloid leukemia (CML) is a stem cell disorder associated with an acquired chromosomal
abnormality, Philadelphia chromosome (Ph), which arises from the reciprocal translocation of part of
long arm of chromosome 9, in which proto-oncogene ABL gene (ablson) is located, to long arm of
chromosome 22, in which BCR gene (break point cluster region) is located forming BCR-ABL fusion
gene. The suppression of BCR-ABL is likely to be crucial for therapeutic success. The development
of the BCR-ABL-targeted Imatinib mesylate represents a paradigm shift in the treatment of CML.
OBJECTIVE:
This is a prospective study designed as a try to apply cytogenetic technique as a conformational
diagnosis of Philadelphia chromosome (Ph) in CML patients and also, to follow up CML patients
treated with imatinib mesylate (IM) for assessment of cytogenetic response of peripheral blood at
different IM treatment duration.
METHODS:
Prephral blood samples were collected from CML patients every 3-6ms. At first, (310) prephral
blood(PB) samples related to 135 CML patients were cultured but only 181(58 %) cultures related to
(42) patients were successful (gave obvious metaphases). The degree of cytogenetic response of
peripheral blood was quantified according to the proportion of Philadelphia chromosome positive
metaphases.
RESULTS:
The results showed that (64.28%) of CML achieved major peripheral blood cytogenetic response
while (35.71%) achieved partial cytogenetic response.
CONCLUSION:
Conventional cytogenetic karyotyping is necessary for Ph–chromosome detection and also, as an
assay for periodical assessment of cytogenetic response in CML patients treated with imatinib.
Imatinib has resulted in cytogenetic responses in first line IM treated patients and in those who have
failed previous IFN-α therapy and in CML patients at early and late chronic phase.
KEYWORDS: chronic myeloid leukemia-philadelphia chromosome-imatinib-cytogenetic response.
THE IRAQI POSTGRADUATE MEDICAL JOURNAL
VOL.8, NO.4, 2009
THE IRAQI POSTGRADUATE MEDICAL JOURNAL
VOL.8, NO.4, 200
Comparative Study between Ileo Colic Pedicle Versus
Superior Mesenteric Pedicle Division for Mesenteric
Lengthening
Ibtesam Khalid Salih Al-Shadydy
ABSTRACT:
BACKGROUND:
Lengthening of the mesentery by vascular division may be necessary to perform an ileal pouch anal
anastomosis without tension. Our objective is to compare the increase in mesentery length after
division of ileo colic pedicle (ICP) and the superior mesenteric pedicle (SMP).
OBJECTIVE:
Was to compare the increase in length of the mesentery after division of the (ICP) and after division
of the (SMP).
METHODS:
Total colectomy was performed in (14) patients. Which were then randomly divided into two groups.
Pouch anal anastomosis was performed with division of the (ICP) in one group of seven patients and
with division of the (SMP) in the other. The ileum was measured and the increase in length was
recorded and compared statistically.
RESULTS:
The mean (s.d.) increase in length was 2.9 (0.8) cm. after (ICP) division and 6.5 (1.1) cm after (SMP)
division (P<0.001). The distance between the end of the ileum and the point giving the greatest length
was 27.5 (4) cm in the (ICP) group and 46.8 (4.2) cm in (SMP) group (P<0.001).
CONCLUSION:
The increase in mesenteric length was greater after (SMP) division than after (ICP) division, but if
pouch-anal anastomosis is performed a short segment of small bowel must be removed.
KEY WORDS: ileo colic pedicle, superior mesenteric pedicle, mesenteric lengthening, ileal pouch
anastomosis .
THE IRAQI POSTGRADUATE MEDICAL JOURNAL
VOL.8, NO.4, 2009
THE IRAQI POSTGRADUATE MEDICAL JOURNAL
VOL.8, NO.4, 200
Computed Tomography Performance in Renal Cystic
Diseases
Haider Qasim Hamood
ABSTRACT:
BACKGROUND:
Renal cysts represent notably dilated nephrons or collecting ducts. A cystic kidney is a kidney with three
or more cysts. The accuracy of CT diagnosis of typical simple renal cyst approaches 100% but many
renal cysts do not fulfill the criteria for simple renal cyst, such lesions vary from simple renal cysts which
do not require surgery to renal neoplasms with cystic component that need surgical resection. Contrastenhanced helical CT scanning has 96% sensitivity and 95% specificity in detecting carcinoma in acquired
renal cystic diseases.
AIM OF STUDY:
To confirm the sensitivity, specificity and performance of the spiral computed tomography (CT) in
diagnosis and evaluation of the renal cysts and to study the CT criteria which categorize and separate the
renal cystic lesions that require surgery (malignant neoplasm) from those that do not.
METHODS:
Fifty patients were scanned with spiral CT, 22 of them were males and 28 were females, their ages
ranging from 20-70 years with mean age 50 yeas old, these patients undergo CT examinations with and
without contrast enhancing material. All the patients were proved to have renal cysts radiologically and
symptomatically.
RESULTS:
The patients presented with cortical simple renal cysts were 16 patients (32% of all the cases). Medullary
simple renal cyst were found in 9 patients (18% of the total number of cases). 3 patients presented with
autosomal recessive and dominant poly cystic kidney disease (8% of total cases). 1 case found with cystic
kidney associated with tuberous sclerosis (2% of total cases). Para-pelvic renal cysts are seen in 7 patients
(14% of total cases). Cystic angiomyolipoma (fat density) are seen in 3 patients (6% of total cases).
Acquired renal cystic disease is found in 1 patient (2% of total cases). Complicated renal cysts
(hemorrhagic) are seen in 2 patients (4% of total cases). Medullary cystic diseases were found in 2
patients ( 4% of total cases). Multicystic dysplastic kidney was found in 1 patient (2% of total cases).
Malignant Cystic kidney lesion (cystic renal cell carcinoma) was found in 1 patient (2% of total cases).
Females are more affected than the male, 28 females (56%) while the affected males were 22 (44%). The
more involved age group was between 50-59 years old, they were 15 patients (9males and 6 females). The
left kidney (34%) is more involved than the right kidney (32%), while both kidneys were involved in
(34%) of the cases.
CONCLUSION:
The spiral CT scan is the most sensitive imaging modality useful in diagnosis of cystic kidney and it is of
valuable importance in evaluation and categorization of cystic renal masses in attempt to separate the
lesions that require surgical resection from those do not.
KEYWORDS: Renal cystic disease, computed tomography (CT) performance.
THE IRAQI POSTGRADUATE MEDICAL JOURNAL
VOL.8, NO.4, 2009
THE IRAQI POSTGRADUATE MEDICAL JOURNAL
VOL.8, NO.4, 200
Study of Risk Factors for Breast Cancer in A Hundred Breast
Cancer Patients
Sorror Mahdi Latif *, Hassan Hadi Baqer**, Kholod Dhaher Habib***
ABSTRACT:
BACKGROUND:
Breastfeeding has been found to provide a measure of protection against uterine, cervical and ovarian
cancers as well as breast cancer. . It's long been known that breast cancer is common in situations
where women have few children and breast feed for short periods. Various physiopatholoical
mechanisms are involved in the protective effect of breast feeding; anovulation , and cellular
differentiation of the mammary cells.
OBJECTIVE:
To assess the impact of breast feeding on breast cancer incidence.
METHODS:
One hundred married Women with breast cancer were evaluated to find out the impact of breast
feeding on breast cancer incidence in these women .Data on risk factors were collected by selfadministered questionnaires .The questionnaire included data like woman's age of having breast
cancer ,woman's age at menopause , woman's age of first full term pregnancy , number of
pregnancies ,lactation period , the age at menarche ,woman's social habit like smoking , type of
contraception ,and family history of breast cancer ,the data were collected and analyzed .
RESULTS:
We studied 100 married women with breast cancer .Their age groups were distributed between
22years and 55 years when they had been discovered to have breast cancer, most of women were
house wives (81%).Only three of them were smokers. Seventy nine women had menarche between
age of 13-15 years, and only 4 of them had menarche at 16-17 years. Thirteen women had one full
term pregnancy, other 48 women had 2- 4 full term pregnancies and only 38women had more than
5full term babies. According to lactation periods we found that 21 women had never lactating their
babies, 49 women lactated their children for 7-12 months and only 18 women lactated their children
for 19-24 months. Regarding the age of women at first full term baby birth, there were 4 women had
their first full term baby at age of 14-17 years ,58 women at age of 18-22 years , 37 women at age
of 23-33 years and only one woman at age of 35year.
CONCLUSION:
There was significant increasing risk of breast cancer with reducing periods of lactation (p value
<0.001), with decreasing age at menarche (p value<0.001), early age of marriage (p value <0.001),
and early age of having first full term baby (p value<0.001) .We can conclude that lactation for more
than 24 months can provides important benefits for the women's health, such as reduced risk of breast
cancer. There was no evidence of a statistically significant difference in breast cancer risk between
subjects who had ever smoked and those who had not. There was a statistically insignificant
relationship between a positive Family history of breast cancer, and increasing risk of breast cancer,
(p value >0.05).
KEYWORDS: cancer, breast feeding, risk factor, breast cancer.
THE IRAQI POSTGRADUATE MEDICAL JOURNAL
VOL.8, NO.4, 2009
THE IRAQI POSTGRADUATE MEDICAL JOURNAL
VOL.8, NO.4, 200
Indications of IV Fluids in Medical City
Bassam Hameed Al-Jarrah *, Zeena Muthafer Al-Nema**
ABSTRACT:
BACKGROUND:
Intravenous (IV) fluids are the most commonly used drugs in the inpatient wards and the emergency
units. They are not usually dealt with as a medication, and are frequently prescribed even by junior
doctors and even the nursing staff. Serious side effects and complication may arise from this practice.
OBJECTIVES:
To evaluate the indications of IV fluid prescription in the Medical City.
METHODS:
A cross-sectional study of the use of IV fluids in surgical wards and emergency units in the Medical
city in Baghdad during a period of ten weeks. Two hundreds and ninety three patients were collected.
Studying the indication for prescription, monitoring of the patients, combinations and role of
pharmacists.
RESULTS:
Most common IV fluid used was glucose water (28.3%). The most common indication in the
emergency unit was vomiting and diarrhea (19.1%). While in the inpatient wards, routine
postoperative hydration was the commonest indication for IV fluid (13.6%). Unnecessary or wrong
uses were recorded in number of cases (36.8). Deficient monitoring of patients on IV fluids was
noticed in most cases (95%). No apparent role for the clinical pharmacist in this respect was reported.
CONCLUSION:
There was a quiet high ratio of unnecessary or wrong use of IV fluids and also a high ratio of low or
deficient monitoring of patients that necessitate more attention by the specialists and more
supervision to the practice of IV fluid prescription.
KEY WORDS: intravenous fluid, monitoring, emergency unit.
THE IRAQI POSTGRADUATE MEDICAL JOURNAL
VOL.8, NO.4, 2009
THE IRAQI POSTGRADUATE MEDICAL JOURNAL
VOL.8, NO.4, 200
Postoperative Urological Complications of Renal
Transplantation; Al Karama Hospital Experience
Yousuf M. Alhallaq*, Shawqi Ghazala**, Mohammad Batal ***,
Ausama Saadi Abdul Muhsin****
ABSTRACT:
BACKGROUND:
Studying early post kidney transplant urological complication will provide a feed back evaluation for
the surgical technique used and the way of complication management.
OBJECTIVES:
To study the postoperative urological complications and their management in the first 6 months
following renal transplantation.
METHODS:
This is a retrospective study in which 123 patients with end stage renal disease (ESRD) underwent
renal transplantation from January 2001 to October 2004 in Al Karama teaching hospital, Baghdad –
Iraq. All the transplanted kidneys were from living donors. Direct matching between the serum of
recipient and lymphocytes of the donor was negative. Extravesical ureteroneosystostomy was carried
out using a stent across the anastomotic site. Postoperatively recipients were followed for 6 months
by clinical and regular laboratory tests. Ultrasound and color Doppler examinations were performed
when there was any evidence of decreased urinary output, allograft dysfunction, or clinical suspicion
of rejection.
RESULTS:
In 123 patients aged 5 – 59 years with a mean age of 34 years, renal transplantation was carried out.
Postoperative urological complications within the first 6 months were reported in 12 (9.75%) patients
including urinary leakage in 6 (4.8%), ureteral obstruction in 3 (2.4%), and lymphocele in 3 (2.4%)
patients.
CONCLUSION:
Major urological complications after renal transplantation contribute to patient morbidity and
compromise graft function. Early diagnosis and treatment will avoid loss of the graft.
KEYWORDS: kidney transplantation, urological complications.
THE IRAQI POSTGRADUATE MEDICAL JOURNAL
VOL.8, NO.4, 2009
THE
THE IRAQI
IRAQI POSTGRADUATE
POSTGRADUATE MEDICAL
MEDICAL JOURNAL
JOURNAL
VOL.8,
NO.4,
200 2009
VOL.8,
NO.4,
Effectiveness of Immediate Mitomycin C Instillation in
Patients with Low Risk Non-Muscle Invasive Bladder Cancer
Usama Sulaiman Al-Nasiri *, Wisam Ali Kareem**
ABSTRACT:
BACKGROUND:
We determined if immediate instillation chemotherapy after transurethral resection (TUR) decrease the
risk of recurrence and\or progression in patient with stage Ta T1 bladder cancer.
OBJECTIVES:
This study has been designed to analyze the impact of a single immediate mitomycin C instillation after
transurethral resection of bladder cancer on recurrence and progression rates in patients with low risk
superficial bladder cancer.
METHODS:
A total of 50 patients with low risk superficial bladder cancer were included in a prospective randomized
controlled trial. All patients had a 3 cm. or less single, papillary bladder tumer. The tumor was completely
resected before patients were randomized into 2 arms of no further treatment (control group) and a single
immediate instillation (usually within 6 hours) of 40 mg. mitomycin c (mitomycin c group). Median
follow up was 24 months .The events studied were the recurrence free rate, the recurrence rate/year, and
the number of new tumors developing /year.
RESULTS:
At 24-month follow-up the recurrence-free rate was significantly increased (84.7% VS 54.2%).
Recurrence (15.3% VS 45.8%), and recurrence per year rate (7% VS 20%) and tumor per year rate(11%
VS 33%) were significantly decreased in the mitomycin c compared to the control group.
CONCLUSION:
This study confirms the positive effect of a single immediate mitomycin C instillation in patients with low
risk superficial bladder cancer. Thus, this approach is an alternative to observation. This study also
suggests cell implantation as a mechanism of early recurrence can be controlled with a single immediate
mitomycin c instillation.
KEY WORDS: transurethral resection, mitomycin c, non-muscle invasive bladder cancer.
THE IRAQI POSTGRADUATE MEDICAL JOURNAL
VOL.8, NO.4, 2009
THE
IRAQI
POSTGRADUATE
MEDICAL
JOURNAL
THE
IRAQI
POSTGRADUATE
MEDICAL
JOURNAL
VOL.8,
VOL.8,NO.4,
NO.4,200
2009
Evaluation of Focused Abdominal Sonography for Trauma
(FAST) in Baghdad Teaching Hospital
Raed J .Wiwit , Saad Abdulla Ibrahim Sarsam , Salah M.Tajer
ABSTRACT:
BACKGROUND:
Focused Abdominal Sonography for Trauma (FAST) is widely applied in the initial management of
trauma patients, Being non invasive, repeatable and without risk of irradiation, make it attractive tool
in evaluation of trauma patients.
OBJECTIVE:
Evaluation FAST sensitivity and specificity in detection of hemoperitoneum in abdominal trauma
victims .
METHODS:
Prospective study conducted in the emergency department of Baghdad teaching hospital for one year
period .The FAST done by a general surgeon or emergency physician during the secondary survey of
blunt and penetrating abdominal trauma victims with equivocal clinical findings.
RESULTS:
Ninety three (93) patients included in the study, with over all sensitivity of FAST was 80.9 % and
specificity 95.8 %. In blunt abdominal trauma the sensitivity was 92.3 % and specificity was 96 %
while in penetrating abdominal trauma the sensitivity was only 62.5 % and specificity 95.2 %.
CONCLUSION:
FAST is highly sensitive and specific in detection of hemoperitoneum after blunt abdominal trauma
,but its lower sensitivity in penetrating abdominal injury require modification in the protocols like
repetition of the scan or application of extra views. Its high specificity make it suitable as "rule in"
test in both blunt and penetrating abdominal injury.
KEY WORDS: abdominal trauma, ultrasound, focused abdominal Sonography for trauma.
THE IRAQI POSTGRADUATE MEDICAL JOURNAL
VOL.8, NO.4, 2009
THE IRAQI POSTGRADUATE MEDICAL JOURNAL
VOL.8, NO.4, 200
Role of Antioxidant on Nephropathy in Alloxan Induced
Diabetes in Rabbits
Israa F. Jaffar Alsamaraee*, Huda Arif Jasim **
ABSTRACT:
BACKGROUND:
The development and progression of diabetic nephropathy is dependent on glucose homeostasis and
many other contributing factors. Diabetic nephropathy is a leading cause of end-stage renal failure,
accounting for 35 to 40% of all new cases that require dialysis therapy worldwide. Recent clinical
studies clearly demonstrated that hyperglycemia and oxidative stress is an important causal factor in
mediating the development and progression of diabetic kidney disease.
OBJECTIVE:
To evaluate the therapeutic effect of levamesole in diabetic nephropathy .
METHODS:
The study included 10 rabbits Weight (1kg ±20 gm); they were followed up for 7months. Blood was
aspirated from marginal ear vein after agitation with xylol for estimation of fasting blood glucose and
malondialdehyde (MDA) which is used as marker of oxidative stress. Rabbits were given 110 mg / kg
alloxan to induce diabetes. In the second month rabbits became diabetic without development of
nephropathy. After 1 month from being diabetic a bosture dose of alloxan was given (125 mg\kg).
After 1 month of the bosture dose blood glucose level further increased and rabbits developed
albumin urea. Once rabbits developed albumin urea they received levamesole 2 mg\kg EOD for 6
weeks.
RESULTS:
The study results showed that diabetic nephropathy is associated with high blood glucose level (300400mg\dl) and oxidative stress (significant increase in MDA level). The nephropathy (albumin urea)
and oxidative stress can be reversed by levamesole.
CONCLUSION:
The antioxidant effect and immune modulating properties of levamesole provided a protective
therapy against the development of diabetic nephropathy.
KEY WORDS: diabetic nephropathy, levamesole, MDA.
THE IRAQI POSTGRADUATE MEDICAL JOURNAL
VOL.8, NO.4, 2009
‫اﻟﺘﺮﻗﻴﻢ اﻟﺪوﻟﻲ ‪160-8360‬‬
‫اﻟﻤﺠﻠﺪ اﻟﺘﺎﺳﻊ ‪ ،‬اﻟﻌﺪ داﻻول ‪ 2010‬م‪ 1431 ,‬هﺠﺮي‬
‫‬
‫‬
‫ﻣﺠــﻠﺔ اﻟﻤﺠـﻠﺲ اﻟﻌـﺮاﻗﻲ ﻟﻼﺧﺘﺼـﺎﺻـﺎت اﻟﻄــــﺒﻴﺔ‬
‫اﻻﺷــــﺮاف اﻟﻌــﺎم ‪ :‬ﻧﺰار ﺑﺎﻗــــــــــﺮ اﻟﺤﺴــــــــــــــــﻨﻲ‬
‫رﺋﻴﺲ اﻟﺘﺤﺮﻳﺮ ‪ :‬زآـﺮﻳﺎ ﻳﺤﻴﻰ اﻻﻋﺮﺟـﻲ ‬
‫هﻴـﺌـــﺔ اﻟﺘﺤـﺮﻳــــــــﺮ‬
‫ﻧﺰار ﺑﺎﻗــﺮ أﺣــــﻤﺪ اﻟﺤـــﺴـــــﻨﻲ‬
‫ﻣﺴـــﺎﻋﺪ ﻟﻔﺘـــﻪ ﺣــﻤﺰة اﻟﺒــﺪري‬
‫زآــــــﺮﻳﺎ ﻳﺤــــﻴﻰ اﻻﻋـــــــﺮﺟــﻲ‬
‫ﻧـــﺪى ﺻــــــــــــﺎﻟﺢ أﻣـــــــــــﻴﻦ‬
‫رﺟــــــــﺎء آــــــﺎﻇﻢ آـــﻤﻮﻧـــــــﺔ‬
‫داود ﺻـــــــــﺎدق اﻟﻌـــﺒﻴـــــــﺪي‬
‫راﺟﻲ ﺣﺴـــــــﻴﻦ ﻣﺤﻤﺪ اﻟﺤﺪﻳﺜـﻲ‬
‫ﺻــــﻔﺎء ﻣﺰهﺮ ﻣـــﻬﺪي اﻟﻌــﺒﻴــﺪي‬
‫ﺧــﻠﻴﻔﺔ ﻋﺒﻴــــﺪ اﻟﺸـــــــــــــــﺮﻗﻲ‬
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‫رﺟﺎء ﻣﺼﻄﻔﻰ ﺣﺴـــــــﻦ اﻟﻘﻄــــﺎن‬
‫اﻟﻤﺮاﺳـــــــﻼت‬
‫اﻟﻤﺠﻠﺔ اﻟﻌﺮاﻗﻴﺔ ﻟﻼﺧﺘﺼﺎﺻﺎت اﻟﻄﺒﻴﺔ‪/‬ﻣﻘﺮ اﻟﻤﺠﻠﺲ اﻟﻌﺮاﻗﻲ ﻟﻼﺧﺘﺼﺎﺻﺎت اﻟﻄﺒﻴﺔ‪-‬ﺑﺎب اﻟﻤﻌﻈﻢ ‪ ،‬ص ب ‪5116:‬‬
‫هﺎﺗﻒ ‪ ، 00964-1-4140664‬ﻓﺎآﺲ ‪00964-1-4140664‬‬
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‫‪E-mail: IPMJ [email protected] yahoo.com‬‬
‫رﻗﻢ اﻹﻳﺪاع ﻓﻲ دار اﻟﻜﺘﺐ واﻟﻮﺛﺎﺋﻖ‬
‫ﺑﺒﻐﺪاد ‪ 687‬ﻟﺴﻨﺔ ‪1999‬‬
‫اﻹﻋﺪاد أﻟﻄﺒﺎﻋﻲ ‪ /‬اﻟﻤﺠﻠﺲ اﻟﻌﺮاﻗﻲ ﻟﻼﺧﺘﺼﺎﺻﺎت اﻟﻄﺒﻴﺔ‬
‫اﻟﺘﺮﻗﻴﻢ اﻟﺪوﻟﻲ ‪160-8360‬‬
‫اﻟﻤﺠﻠﺪ اﻟﺘﺎﺳﻊ ‪ ،‬اﻟﻌﺪ داﻻول ‪ 2010‬م‪ 1431 ,‬هﺠﺮي‬
‫‬
‫‬
‫ﻣﺠــﻠﺔ اﻟﻤﺠـﻠﺲ اﻟﻌـﺮاﻗﻲ ﻟﻼﺧﺘﺼـﺎﺻـﺎت اﻟﻄــــﺒﻴﺔ‬
‫اﻟﻬﻴﺌﺔ اﻻﺳـــﺘـﺸـــﺎرﻳﺔ‪ -‬اﻟﻌﺮاﻗﻴﺔ‬
‫اﺑﺮاهﻴـــــﻢ ﺑﺸــــــــــــﻴﺮ اﻟﻨﺎﺋــــــﺐ‬
‫ﻋﺒﺪ اﻟﻤــﻨﺎف ﺣﺴـــــــﻴﻦ اﻟﺠـﺎدري‬
‫أﺣﺴــــــــــﺎن رؤوف اﻟﺒﺤـــﺮاﻧــــﻲ‬
‫ﻋـــــــﻼءﺣﺴـــــــﻴﻦ ﺑﺸــــــــــﻴــﺮ‬
‫أﺳــــــــــﺎﻣـﺔ ﻧﻬــــﺎد رﻓﻌـــــــــــــﺖ‬
‫ﻓﺨﺮي ﻣﺤﻤﺪ ﺟﺎﺳـــــــــﻢ اﻟﺤﺪﻳﺜـﻲ‬
‫ﻧﻴـــــــــــــﺎزي‬
‫ﻗﻴـــﺲ ﻋﺒﺪ اﻟﺤـــــﻤـﻴــــﺪ آﺒـــــــﺔ‬
‫ﺑﺴـــــــﺎم ﻋﺒﺪ اﻟﻮهـﺎـﺐ اﻟﺒﺮزﻧﺠــﻲ‬
‫ﻣﺤـــــــﻤﺪ ﺣﺴــــــــﻦ اﻻﺷـــﻴـــﻘـﺮ‬
‫ﺣﺴﺎم اﻟﺪﻳﻦ ﻋﺒﺪ اﻟﻤﺠﻴﺪ اﻟﺠﺮﻣـﻜﻠﻲ‬
‫ﻣﻈﻬــــــــــــﺮ ﻋﻠــــﻲ اﻣــــــــــــﻴﻦ‬
‫ﺧﻠﻴــــــﻞ اﺑﺮاهـــــــــﻴﻢ اﻟﺸـــﻴﺨـﻠﻲ‬
‫ﻣﻌـــــﺪ ﻣﺪﺣــــــﺖ ﻋﺒﺪ اﻟﺮﺣﻤـــــﻦ‬
‫زهـﻴـــﺮ رؤوف اﻟﺒﺤـــــــــــــﺮاﻧــﻲ‬
‫ﻣﻘـــــــﺪاد ﻋﺒﺪ اﻟﺠـــﺒﺎراﻟﻌﺎﻧــــــــﻲ‬
‫ﺳﻌــــــﺪ هﺎﺷــــــﻢ اﻟﻮﺗـــــــــــــﺮي‬
‫ﻧﺠﻢ اﻟﺪﻳﻦ ﻋﺒﺪ اﷲ اﻟﺮوزﻧـﺎﻣﺠـــــﻲ‬
‫ﻋــﺎدل ﺳﻠﻴــــــﻢ ﻋـــــﺒﺪ اﻟﻐﻔـــــــﻮر‬
‫وﻓـــــﺎء رﻣــــــــﺰي اﻟﻌـﻤـــــــﺮي‬
‫ﻋﺎﻣـــﺮﺷـــــــــﺎآﺮ اﻟﻬﺎﺷــــــــــﻤـﻲ‬
‫وﻟﻴـــﺪ ﻏﺎﻧـﻢ ﺑﻬـــﻨﺎم اﻟﻄــــــــﻮﻳــﻞ‬
‫ﻋﺒـﺪ اﻟﺒﺎﻗـﻲ ﻣﺤﻤﺪ رؤوف اﻟﺨﻄـﻴــﺐ‬
‫رﻳﺎض ﻋﺒﺪ اﻟﺮزاق اﻟﻌـــــــــﺰاوي‬
‫اﻣﺠـــــــــــﺪ داود‬
‫‬
‫اﻟﻬﻴﺌﺔ اﻻﺳـــﺘـﺸـــﺎرﻳﺔ‪ -‬اﻟﻌﺎﻟﻤﻴﺔ‬
‫‬
‫ﻓﺮﺣــــــــــــــﺎن ﺑــــــــــﺎﻗـــﺮ‬
‫‪ -‬اﻣـﺮﻳﻜﺎ‬
‫ﻣـــــــــــــــــﺎهﺮ أﻟﺤﺴـــــــــــــﺎﻣـــﻲ‬
‫‪ -‬ﺳـﻮرﻳﺎ‬
‫اﺳــــــﻤﺎﻋــــــﻴﻞ اﻟﺠـــــﻠﻴـــﻠﻲ‬
‫‪ -‬اﻧـﻜﻠﺘﺮا‬
‫ﻣﺤﻤـــــﺪ ﻋﺒﺪ اﻟﺮؤوف اﻟﻘـــــــــﺒﺮون‬
‫‪ -‬ﻟﻴـــﺒﻴﺎ‬
‫ﺳـــــــــــﻼم ﺻــــﺎﻟﺢ درادآــــﺔ‬
‫‪ -‬اﻻردن‬
‫ﻣﺎرﻳﺘــــــــــــﺎ اﺑﺎﺳــﻤﻦ آـــــــــــﻼﻳﻦ‬
‫‪ -‬اﻟـﻤﺎﻧﻴﺎ‬
‫ﻃـــﺎرق ﺳــــــــﻌﻴﺪ ﺁل ﺳﻌــــﻮدي‬
‫‪ -‬اﻟﺴـﻮﻳﺪ‬
‫ﻣـﻨـــــــــﺬر اﻟـــــــــــــــــــــــــــﺪوري‬
‫‪ -‬اﻧﻜـﻠﺘﺮا‬
‫ﻋﺒــــــــــــــﺪ اﷲ اﻟﻘــــــﻀــــــــــــﺎة‬
‫‪ -‬اﻻردن‬
‫ﻧــــــــــﺰار ﻋﺒــــــــــــــــــــــــــــﺎس‬
‫‪ -‬ﺳـﻮرﻳﺎ‬
‫ﻓــــــــــــــﺎﺿﻞ اﻟﻀـــــــــﺮﻳـــــــﻊ‬
‫‪ -‬اﻧﻜـﻠﺘﺮا‬