Journal of the Faculty of Medicine Baghdad

Serum Zinc and Copper in Children with Febrile Seizures in Basrah,Iraq

2019-11-16T14:30:11+00:00

Background:Trace elements are essential micronutrients that exist in very low concentrations in the body. They play an important role in various physiological processes and are crucial for proper functioning of the immune system. Many studies have shown that some micronutrients may have a role in febrile seizure

such as selenium, zinc and copper.

objectives :To determine the level of serum zinc and copper in children with febrile seizures and explore their

relation to selected patients' variables.

Methods: The study included 66 infants and children with simple febrile seizures with two control groups;a

febrile control group which includes (62) children with febrile illnesses who were admitted to emergency department at Basrah Maternity and Children Hospital and Basrah General Hospital from the 1st of March to

the end of October 2013, and ahealthy control group which includes ( 58) children. Serum zinc and copper ere measured for all infants and children enrolled in the study.

Results: Patients with febrile seizure had a significantly lower mean serum zinc level (8.85 ±3.26) in comparison to febrile patients and healthy children (14.98 ±2.20), (13.33 ±1.99) respectively. There is no

significant association between the level of serum zinc and selected variables.S erum copper level did not show a significant difference between patients with febrile seizures and control groups.

Conclusion: Zinc supplementation may be considered in children who are at risk of recurrent febrile seizure

Etiological factors of cholestasis ininfancy andearly childhood in Children Welfare Teaching Hospital

2019-11-16T14:30:11+00:00

Background: Neonatal cholestasis is defined as prolonged elevation of the serum level of conjugated

bilirubin beyond the first 14 days of life. There are many causes of neonatal cholestasis which must be identified because early intervention may result in a better outcome , such as surgical intervention in biliary atresia within two months from birth , or effective dietary management in metabolic disorders like galactosemia.

Objective:To determine the causes of early childhood cholestasis in children attending the Children Welfare

Teaching Hospital in Baghdad and to study some of associated factors in infancy and early childhood cholestasis.

Patient and method: This is a cross sectional descriptive study conducted on 48 patients attending the Children Welfare Teaching Hospital in Baghdad for the period of 1Novembe r 2015 to 15 January 2016. These cases were evaluated by thorough history, examination and investigations. Results:O the 48 patients enrolled in this study, 30 (62.5%) lived in Baghdad, and the remaining 37.5% were referred from other governorates . the mean age of the patients was 11.1 ± 12.4 months, with 20 females (41.7%) and 28 males (58.3%). The Results revealed that 11(22.9%)were the result of congenital infections , 9 (18.8%) were idiopathic in origin, 8

(16.7%) were caused by biliary atresia, 8 (16.7%) of unknown origin, 5 (10.4%) were caused by sepsis (mainly

staphylococcus, streptococcus species, E coli, staphylococcus aureus) , 2 (4.2%) were caused by progressive

familial intrahepatic cholestasis and 1 (2.1%) case was caused by each of the following causes: Alagille snyndrome, Choledochal cyst, Galactosemia, hypothyroidism and Tyrosinemia.

Conclusion: Congenital infections were the most common cause in this study, of which the most common is cytomegalovirus ( CMV ). Clay color stool and high alkaline phosphatase levels were found mostly in biliary atresia. No method by itself is sufficient to diagnose the cause of neonatal cholestasis. D iagnosis can only be established using all available methods.

A Comparison of Three Different Treatment Regimens of HCV Infection in295 Iraqi Patients

2019-11-16T14:30:12+00:00

Background: Viral Hepatitis C infection is global public health problem throughout the world. Different

treatment regimens are used which produce different rates of response affected by many factors.

Objectives: To assess the efficacy of three different treatment regimens in 295 Iraqi patients infected with

chronic HCV.

Patients and methods: This is an observational cohort study; in which 295 (133 male and 162 female) patients with chronic HCV infection were enrolled during the period between August 2015 to January 2017

from Gastroenterology clinic of Baghdad Teaching Hospital and Gastroenterology and Hepatology Teaching

Hospital. Baseline HCV viral load measurements and genotyping were done for each patient. Patients were

followed up by viral load measurement at end of the treatment period and three months after the end of the

treatment.

Results: The majority of patients infected with chronic HCV achieved sustained virological response(SVR)

(defined as undetectable HCV RNA 12 to 24 weeks after the end of the treatment); were of the generic( sofosbuvir/ledipasvir) treatment group (51out of 72 (70.8% ) followed by generic Sofosbuvir with (peg interferon/ribavirin)treatment group (68 out of 111 (61.3%) followed by (peg interferon/ribavirin) treatment

group (42 out of 86 ( 48.8%).

Conclusions: The best treatment efficacy was obtained with generic sofosbuvir/ledipasvir followed by

sofosbuvir with peg interferon and ribavirin then peg interferon and ribavirin. The most responder genotype

in Iraqi patients was genotype 4 and the least responder genotype was genotype 1b

Observational Study of the Multisciplinaryteam role (MDT) on Healthcare Management of Cancer Patients: Benefits and Barriers, AbuDhabi 2017

2019-11-16T14:30:13+00:00

Background: Multidisciplinary team meetings (MDTs) are designed to optimize patient outcomes. It appears intuitive that MDTs are essential to clinical decision - making and patient management; however, it is unclear whether that belief is supported by evidence. With regard to cancer patients, studies demonstrated that treatment plans made by interacting health care professionals are more effective than those made by

individual practitioners.

Objectives: To assess the impact of multidisciplinary teams (MDTs) on clinical decision - making and patient outcomes.

Methods: We follow a descriptive questionnaire survey study design and created a (10) sections surveymonkey that was distributed via email to (150) experts in surgical oncology, general surgery, oncology, radiation oncology, pathologists, and administrative staff. Fourty (40) completed responses were collected to ensure a statistical basis on which to draw sound conclusions. The remaining 110 staff have submitted incomplete answers. Answers were discussed in a separate MDT meeting with most of the participants.The survey was followed by an interpretation of the respondents’ results and comparison with literatures. Results: 75% of the participants chose” Agree and strongly agree”, supporting the hypothesis that MDT meetings ensure an effective and up-to- date management guidelines. This means that the risk of not discussing a cancer patient cannot be neglected any longer. So the hypothesis statement (H0) is rejected

and the alternative statement (Ha) is accepted.

Conclusions: The majority of participants saw the value in the MDT process and expressed support for its

implementation locally and nationally; however, feedback about the most appropriate format is yet to be

established. The clinicians identified the need for agreed standards in MDT performance

Comparison between Mammography and Breast Ultrasound in the Detection of Breast Cancer in Dense Breast Tissue among a Sample of Iraqi Women

2019-11-16T14:30:12+00:00

Background: Breast cancer is the most common cancer reported in women worldwide . In Iraq, it is the most common registered malignancy. Mammography plays a major role in the early detection of breast cancers. Dense breast parenchyma has been reported to be the most important inherent factor that limits depiction of breast cancer on mammogram, and often needs supplementary breast ultrasound for complete assessment.

Objectives: To evaluate and compare the diagnostic performance of mammography and ultrasound in the

detection of breast cancer in dense breast tissue.

Patients and methods: A record review study was performed in the Oncology Teaching Hospital/ Medical

City from April 2018 to December 2018. The study included forty five females, who attended the Main

Referral Center for Early Detection of Breast Tumors during 2017 and 2018 were diagnosed with breast cancer histopathologically . They had dense breast tissues on mammography (either heterogeneously dense

breast tissue i.e . category C or extremely dense breast tissue i.e. category D). All patients underwent subsequent breast ultrasound . Their information including the mammogram findings, breast ultrasound,

fine needle aspiration (FNA) and biopsy results were reviewed analyzed and compared.

Results:Twenty four patients (53.3%) had heterogeneously dense breast tissue (ACR category C) and 21

patients (46.6%) had extremely dense breast tissue (ACR category D). The mammogram detected 36 from 45

breast cancers (80%) while 9 (20%) were not detected by mammogram, so the mammogram had a detection

rate of breast cancer of 80% in mammographically dense breast, while breast ultrasound had higher detection rate of about 97.7% .The sensitivity of mammography in extremely dense breast tissue was about 71% and in heterogeneously dense breast was about 87% while ultrasound had shown a higher sensitivity

with increasing tissue density (98% vs. 100%).

Conclusion: Breast cancer can be easily obscured and missed in mammographically dense breast tissue due

to overlapping surrounding fibroglandular tissue and additional complementary breast ultrasound is highly

recommended for a thorough evaluation and to depict mammographically occult breast carcinoma.

Role of Two- Dimensional Speckle Tracking Strain versus Conventional Echocardiography in the Assessments of Left Ventricular Systolic Function in Middle-aged Hypertensive Patients.

2019-11-16T14:30:13+00:00

Background: Global longitudinal strain (GLS) echocardiography is a new technique that can be used to detect an early left ventricular dysfunction in various heart diseases . Systemic hypertension is a major risk factor for cardiovascular accidents. The early management of its complication on the heart plays an

important role in the outcome of the disease. Hypertension is associated with changes in several aspects

of left ventricular structure, function, and systolic strains. Various echocardiographic techniques are used to evaluate left ventricular function in hypertensive patients.

Objectives: To evaluate the effectiveness of speckle tracking global left ventricular strain percentage (GLVS%) in the assessments of left ventricular systolic function in comparison to conventional echocardiography in middle -aged hypertensive patients.

Patients and Methods: The study was conducted from December 2017 till November 2018 at the Department of Echocardiography and Catheterization / Baghdad Teaching Hospital – Medical C ity,Baghdad, Iraq. One hundred and four hypertensive patients classified as ; group I that involved patients with reversed E/A ratio on PW Doppler with reversed Pulsed Wave ( PW) tissue Doppler study and group II with patients

having normal E/A ratio on PW Doppler and reversed Eprime/A prime on PW tissue Doppler study . The control (group III) recruited from the relative of the patients included 104 sex and age -matched healthy individuals . A detailed history with the recommended investigations and blood pressure measurements

was performed for all participants. Additionally, echocardiography examination was implemented using standard methods, considering eftventricle (LV) internal dimension, LVejection fraction percentage (LV EF%)

, LV diastolic function using PW Doppler and lateral mitralannular tissue Doppler Sprime,Mitral annular plane systolic excursion (MAPSE) and global LVspeckle tracking strain percentage (GLVS%).

Results: Group I included 76 patients with a mean age of (48 ± 6.6 years) and group II included 28 patients with a mean age of (48 ± 6.6 years). A ll the participants had normal EF% (> 60%), MAPSE (>13 mm), and S prime (> 9 cm /sec) while there were a significantly decreased GLVS% in the diseased groups in comparison to the control one (P < 0.005) being less in group II (-14 ± 1 %) than in Group I (- 16 ± 1 %) . In addition to a significant negative linear correlation between GL V S% with that of pulse pressure and IVST respectively ( p=0.04) and with that of E/A ratio and E/E prime ratio (p=0.001).

Conclusions: GLVS% is a better method in the assessment of LV systolic function in inmiddle- aged

hypertensive patients than conventional echo methods since it could detect an early impairment in LV

systolic function despite preserved LV systolic function measured by the conventional echo methods

ال Ultrasound Findings of MammographicallyDense Breasts in a Sample of Iraqi Female PatientsDOI:https

2019-11-16T14:30:12+00:00

Background: Breast problems including breast cancer have been increasing in Iraq during the recent years. Yet, early detection and screening programs using mammography mainly with complementary ultrasound had dramatically decreased the mortality rates from this emerging disease.

Objective: To assess the dense breast detected by mammography for the presence of any hidden

suspicious lesion by using ultrasound.

Patients and methods: this is a cross - sectional study on 53 female patients who came for breast cancer

screening or attended the Breast Clinic in the Oncology Teaching Hospital of the Medical City Complex in Baghdad –Iraq. The study was conducted from January to October 2018. Two -view mammography was done for each breast, and those with dense breasts underwent further ultrasound assessment done by a board-

certified radiologist.

Results: The mean age for the 53 patients included in the study was 48 years. Mammographic findings

showed that heterogeneous fibroglandular tissue density was present in (89%) of the study population.

Suspicious or clearly defined mass(es) by mammograph were seen in 16 (30%) of the patients, while no

mass was identified in (22%). Ultrasound findings we re as follows: Suspicious mass in (75%) of the cases

and benign lesions such as simple cysts or fibroadenoma in (9%). The results showed that ultrasound has

upgraded 12 cases that were diagnosed as BI -RADS I/II to BI-RADS IV/V and this represented (23%) of

the cases. On the other hand, the mammogram and the ultrasound were in concordance for BI RADS

IV/V in 28 cases (54%). The positive predictive value of the ultrasound and the mammogram for BI -

RADS IV and V breast lesions is 72% for BI - RADS IV and 95% for BI - RADS V for ultrasound and that of mammograph is 83% for BI - RADS IV 80% for BI- RADS V, while the negative predictive value of mammograph is 55% for BI - RADS I/II 25% for BI - RADS III.

Conclusion: Dense breast is still an important problematic issue in mammographic screening as it may

obscure small lesions, for which, ultrasound is proved to be a complementary and essential targeting tool

in the assessment process.

Risk factors of hearing defects and their relationship to the outcome of hearing screening among neonates

2019-11-16T14:30:13+00:00

Background: Increased exposure to risk factors of hearing loss leads to a high susceptibility to deafness

among neonates admitted to neonatal care units in developing countries.

Objective: This article aims to study the prevalence of risk factors for neonatal hearing defect and determine their effect on the result of transient evoked otoacoustic emissions hearing test ( TEOAE). Methods: A longitudinal study was carried out for a period of one year from 1st October, 2016 to 30 th September, 2017 in the CWTH, Medical city, Baghdad, Iraq Demographic characteristics and certain risk factors were recorded for screened neonates. TEOAE test was done and if they failed to pass two steps, they were referred to

autom ated auditory brainstem - response (AABR).

Results: Out of 400 neonates, 342 (85.5%) passed from step 1TEOAE, while 58 (14.5%) were referred to step 2. From 58, 26 (44.8%) have passed step 2 and 32 (55.2%) not pass step 2 and were referred to AABR. From those 32 neonates with suspected hearing defect, NICU stay >7 days, ototoxic drugs >7days, use of ventilator >7 days, birth weight <1500gm, and craniofacial malformations were the main risk factors for hearing defects occurring in (90.6%), (90.6%), (59.4%), (40.6%), and (21.9%) respectively.

Conclusions: Low birth weight , long intensive care stay, mechanical ventilation, drugs ototoxicity and

craniofacial malformation of neonates are the main risk factors for failed TEOAE test