Journal of the Pakistan Medical Association最新文献

Objective: To compare the efficiency of three-dimensional conformal radiotherapy and intensity-modulated radiation therapy techniques.

Method: The cross-sectional study was conducted from February to August 2021 at Al-Amal National Hospital, Baghdad, Iraq, and comprised patients aged 19-45 years with cancerous head and neck tumours of size 2-7cm. All the patients underwent magnetic resonance imaging or computed tomography simulation scans. Treatment planning techniques used for each patient were three-dimensional conformal radiotherapy and intensitymodulated radiotherapy. After evaluating patterns, a better plan and treatment with an X-ray beam was chosen. Data was analysed using SPSS 24.

Results: The study involved thirty participants, with 17(57%) females and 13(43%) males, aged 19-45, and 28 patients having chemotherapy. Six out of thirty had craniotomy surgery. The intensity-modulated radiation therapy had a safer radiation dose than the three-dimensional conformal radiotherapy for spinal cord (p=0.3203), brain stem (p= 0.17924), right parotid gland (p=0.8556) and left parotid gland (p=0.2193). The three-dimensional conformal radiotherapy protected the organs better than intensity-modulated radiation therapy for left optic nerve (p=0.1227), right optic nerve (p=0.0032), left eye (p=0.3859), right eye (p=0.1189), left lens (p=0.0004), right lens (p=0.0001), optic chiasm (p=0.0320) and pituitary gland (p=0.9162).

Conclusions: The intensity-modulated radiation therapy technique protected the spinal cord, brain stem, and right and left parotid glands. The three-dimensional conformal radiotherapy was safe for left and right optic nerves, left and right eyes, left and right lenses, optic chiasm and pituitary glands.

Objective: To genetically diagnose the isolates of methicillin-resistant staphylococcus aureus taken from patients with severe diabetic foot infections, and to test the inhibitory effect of reuterin on the growth of these bacteria.

Method: The experimental study was conducted from June to November 2021 at the Diabetes Unit of Al-Faihaa General Hospital, Basrah, Iraq, and comprised 62 foot ulcer swabs from the necrotic lesions of patients with type 2 diabetes. The swabs were cultivated first in brain heart infusion broth media, and then streaked on Mannitol salt agar and staphylococcus chromogeneic agar media for phenotypic and genetic analysis. The genetic identification of bacteria was confirmed by deoxyribonucleic acid extraction, and methicillin-resistant staphylococcus aureus was confirmed by the presence of plasmid mecA gene. The inhibition activity of reuterin towards methicillin-resistant staphylococcus aureus was determined using the minimum inhibitory concentration test. All data was analyzed with SPSS version 23.

Results: A total of 62 swabs were taken from the necrotic lesions of type 2 diabetes mellitus (T2DM) patients with diabetic foot ulcers. Of the total isolates, 9(14.5%) gave mauve to purple colour on staphylococcus chromogeneic agar, which was then genetically confirmed as methicillin-resistant staphylococcus aureus. The minimum inhibitory concentration value of these bacteria was 10μl/ml at 16mm inhibition zone diameter. There was no cytotoxicity of reuterin to human red blood cells.

Conclusions: Reuterin was found to be a natural antimicrobial substance suitable for use to disinfect diabetic foot wounds from bacterial contamination and infection, especially those caused by methicillin-resistant staphylococcus aureus.

Objective: To investigate the relationship between dietary fibres and muscularis externa layer.

Methods: The experimental study was conducted at the Anatomy Department of the College of Medicine, Al- Nahrain University, Iraq, from November 2020 to April 2021, and comprised adult healthy males. They were divided randomly into experimental group A and control group B. Group A was fed high-fibre diet, and group B was fed standard pellet diet. The tissue samples were harvested at day 30 post-surgery. The stomach samplings were placed in 10% neutral formalin for 24 hours to obtain paraffin sections for routine histological and immunohistochemical staining. The protein expression in stomach's smooth muscle of each group was detected by immunohistochemical staining. Data was analysed using SPSS 24.

Results: Of the 20 mice, 10(50%) were in each of the two groups. Group A exhibited significant weight-gain compared to group B (p≤0.01). There was significant reduction in the thickness of the muscularis layer in group A compared to group B (p≤0.01). Anoctamin 1 expression in group A was significantly lower than that in group B (p≤0.01).

Conclusions: The stress induced by an unstable fibre diet significantly affected the stomach by decreasing the muscularis layer thickness and Anoctamin 1 expression in interstitial cells of Cajal.

Objective: To investigate the effect of diode-pumped solid-state laser irradiation with yellow 589nm and red 650nm wavelengths on rheological parameters in vitro.

Methods: The comparative study was conducted between November 2021 and April 2022 at the at the Postgraduate Medical Physics Laboratory, Mustansiriyah University, Baghdad, Iraq, and comprised blood samples from healthy adult volunteers. The samples were divided into 4 aliquots. The first was preserved as a control sample, while the other 3 were exposed to a diode-pumped solid-state laser, delivering the beam for 589nm and 650nm wavelengths at radiation dose 15, 22.5, 33.5J/cm2 for 20, 30 and 45 minutes, and with each laser having a 50mW output power and a 4 mm2 spot diameter. Data was analysed using SPSS (version 24).

Results: There were 6 subjects aged 18-60 years. There was no significant difference in the viscosity values between laser wavelengths (p>0.05). Compared to the laser wavelength of 650nm, irradiation with a 589nm wavelength at the same dose resulted in a significant reduction (p<0.009) in deformability. The rigidity index of red blood cell suspension was reduced the most at a radiation dose of 22.5J/cm2 for both lasers compared to the control samples. No significant variations were found in suspended erythrocyte viscosity (p>0.05).

Conclusions: The wavelength with 589nm lasers showed more effective influence than its 650nm counterpart in improving the rheological parameters of blood viscosity and erythrocytes deformability.

Objective: To evaluate better dose distribution with three-dimensional radiation therapy, and to compare it with multi-segmented treatment planning techniques in patients with head and neck cancer.

Method: The prospective study was conducted at the Baghdad Centre for Radiation Therapy and Nuclear Medicine, Baghdad, Iraq, and comprised data of 50 patients with head and neck cancerous tumours from June 2021 to February 2022. There were 35 (70%) females and 15(30%) males. The mean age was 47.31 ± 3.95 years (range 19 - 69 years The patients had undergone computed tomography simulation. The images were exported to Monaco 5.1 for contouring by the radiation oncologist. The data was then imported to XiO planning system. Each plan was repeated twice; once with three-dimensional conformal radiation therapy and the other with field-in-field technique. Data was analysed using SPSS 24.

Results: There were 50 patients whose data was analysed. The results showed significant differences between three-dimensional conformal radiation therapy and field-in-field techniques for dose coverage at 90% and 95% volumes (p<0.05). There was a significant difference between the two techniques for 2Gy dose (p<0.05), but the difference was not significant for 5Gy dose (p>0.05).

Conclusions: The field-in-field treatment planning technique was found to be more effective than the threedimensional conformal radiation therapy technique.

Objective: To evaluate the serum neutrophil gelatinase-associated lipocalin levels in multiple myeloma patients as an indicator of disease progression.

Methods: The case-control study was conducted at the Clinical Biochemistry Department of the National Centre of Haematology, Mustansiriyah University, Baghdad, Iraq, from October 2020 to July 2021, amd comprised diagnosed multiple myeloma patients and healthy controls of either gender aged 40-60 years. Neutrophil gelatinaseassociated lipocalin and renal functions were measured for all patients in addition to obtaining a complete history and physical examination. Data was analysed using MedCalc.

Results: Of the 60 sujects, 30(50) were cases with mean age 64±2.1 years and 30(50%) were controls with mean age 60 ±3.2 years. There were 18(68%) males among the cases and 17(55%) among the controls. In the cases group, mean levels of creatinine, urea and neutrophil gelatinase-associated lipocalin were 1.62±0.85mg/dl, 55.56±28.05mg/dl and 389.39±116.12pg/mL, respectively. The corresponding values for the controls were 0.9518±0.1623mg/dl, 30.17±8.47mg/dl and 120.82±68'52pg/ml. The neutrophil gelatinase-associated lipocalin cutoff level >190pg/ml in multiple myeloma patients was strongly associated with renal impairment (p<0.001).

Conclusions: Neutrophil gelatinase-associated lipocalin was found to be an accurate indicator of early kidney disease in patients with de novo multiple myeloma.

Objective: To estimate the prevalence of workplace violence and its impact on doctors in hospitals.

Methods: The cross-sectional study was conducted from August 2021 to January 2022 in Baghdad and Karbala governorates of Iraq, and comprised resident doctors at a number of hospitals. Data was collected using a selfadministered questionnaire that focussed on the frequency of exposure to violence, type, source, most common time, and other details about violence as well as its impact on doctors and their careers. Data was analysed using SPSS 23.

Results: Of the 1,079 subjects working at 18 participating hospitals and having a mean age 30.0±5.72 years, 567(52.5%) were females and 512(47.5%) were males, while 570(52.8%) were aged <30 years and 509(47.2%) were aged >30 years. Overall, violence exposure was reported by 811(75.2%) subjects; 427(52.6%) females and 384(47.4%) males. Gender was not significantly associated with exposure to violence (p>0.05). Due to missing data, further analysis was limited to 792(97.6%) subjects who faced exposure to workplace violence. In 671(85%) cases, the assaults were nonphysical. However, 110(14%) doctors reported physical attacks and severe consequences. There were 673(85%) doctors with exposure to violence who expressed their intention to change their job, workplace, or leave the country because of violence.

Conclusions: The problem of violence against Iraqi doctors was found to be highly prevalent with a seriously negative impact on the medical professionals.

Objective: To assess the changes in blood vessel stiffness and digital pulse wave amplitude because of flowmediated dilatation, and to explore how these two variables change when endothelial dysfunction is experimentally induced.

Methods: The experimental study was conducted at the departments of physiology at the College of Medicine, Mustansiriyah University, and the College of Medicine, Al-Iraqia University, Baghdad, Iraq, from October 14, 2021, to May 31, 2022, and comprised healthy young males who were subjected to the flow-mediated dilatation technique on the left brachial artery. Pulse transit time and the amplitude of the digital pulse wave were measured during reactive hyperaemia for 2.5 minutes from the left middle finger using a piezoelectric pressure sensor and a simultaneous Lead I electrocardiogram. Endothelial dysfunction (ED) was induced by oscillatory and retrograde shear rates. The correlation between variables was calculated in Excel running on the Windows operating system.

Results: There were 10 second-year medical students with mean age 22±0 years and mean body mass index 25.7±4.8kg/m2. During reactive hyperaemia, pulse transit time was significantly increased by 3-5% in both normal endothelium and experimentally induced endothelial dysfunction relative to the pre-occluded artery, and the difference was not significant (p>0.05). Digital pulse wave amplitude increased significantly in normal endothelium relative to the pre-occluded artery (p<0.05), but not in experimentally-induced endothelial dysfunction (p>0.05).

Conclusions: The pulse transit time and digital pulse wave amplitudes of the photo plethysmography signal may be used to detect changes in vessel wall diameter and tone throughout the reactive hyperaemia process. Digital pulse wave amplitude was better able to detect experimentally-induced endothelial dysfunction, as assessed by the flowmediated dilatation protocol, than pulse transit time.

Objective: To assess hearing loss in rheumatoid arthritis (RA) patients, and to explore its association with disease attributes and activity.

Methods: The cross-sectional case-control study was conducted from June to December 2022 at Al-Imamein Al- Kadhimein Hospital, Medical City, Baghdad, Iraq, and comprised rheumatoid arthritis patients and healthy controls of either gender aged 18-45 years. Data was collected using electronic instruments and a physical examination, including pure tone audiometry and tympanogram. Data was analysed using SPSS 24.

Results: Of the 90 subjects, 60(66.7%) were patients; 45(75%) female and 15(25%) males with mean age 32.9 1±7.21 years and mean body mass index 27.14±8.58kg/m2. There were 30(33.3%) controls; 18(60%) female and 12(40%) males with mean age 30.25±5.51 years and mean body mass index 26.92±6.66kg/m2. The control group had thresholds below 25dB for all frequencies in both ears, which were notably lower than those of the RA patients (p=0.005). The left ear showed significant variation at 2000Hz and 4000Hz, while the right ear showed substantial differences at all frequencies except 1000Hz.

Conclusions: The risk of hearing loss was found to be increased in rheumatoid arthritis patients, and it seemed to be related to illness duration.

Objective: To assess the electron beam dose verification, and to investigate the dependability and stability of the Startrack two-dimensional array.

Methods: The is cross-secional study was conducted from January to April 2021 at the Baghdad Centre for Radiotherapy and Nuclear Medicine, Baghdad Medical City, Baghdad, Iraq. Quality assurance measurements were made using a StarTrack two-dimensional detector on an electron beam with an energy of 12MeV at 1.5cm depth for field sizes 6cm×6cm and 14cm×14cm. The detector was positioned 100cm from the source to the surface of the linear accelerator infinity. Testing was done using the International Electrotechnical Commissioning protocol.

Results: There was a significant difference between field sizes 6cmx6cm and 14cmx14cm (-4.97±0.83, -2.01±0.68, respectively) (p<0.05). The beam profile measurements of penumbra, flatness and symmetry were within limits ±2 cm, and ±2 cm, 2%, respectively. The percentage of output dose curve against distance showed instability in crossline for 6cm x 6cm and 14cm x 14cm field size.

Conclusions: The output dose was found to be above the tolerance level, and should be corrected before patient treatment for 12MeV energy electron beam therapy.