International Research Journal of Medicine and Medical Sciences

94-98

Authors: Omisakin O. O., Ajike S. O. and Aminu S. M.

The aim of this study was to assess powers of haemoglobin in determining the appropriateness of units of blood transfused in maxillofacial surgical patients and the patients socio-economic status. The haematocrit and haemoglobin concentration of one hundred patients, scheduled for elective maxillofacial surgery were determined at presentation in the hospital, pre, intra and postoperatively. Out of 100 patients, 75% of the patients had haemoglobin concentration of 10 g/dl and above while the remaining 25% had below 10 g/dl at presentation. The pre-transfusion haemoglobin concentration ranged from 8 to 12 g/dl. The hemoglobin level 24-h postoperative ranged between 7 and 13.3 g/dl. 20% of the transfusion done was unwarranted. We believed that raising the hemoglobin level of the patient with nutritional and iron supplements, lowering the transfusion trigger and target haemoglobin threshold for blood transfusion has a significant effect on the use of allogeneic blood without compromising patient outcome. Keywords: Haemoglobin, haematocrit, blood transfusion.

72-79

Authors: Bhat Shabir, Raza A., Paras Wani and Shah Abuddin

Menopause is a complex and multifaceted phenomenon, one that is very challenging to study for a number of reasons. Menopause involves multiple domains, including physiological as well as psychological and lifestyle changes. The loss of estrogen following menopause has several effects, not only physically, but also psychologically. Whether to take hormone replacement therapy (HRT) is one of the major decisions women during menopause or early menopause have to make. The overwhelming majority will decide against it, either out of fear of potential risks or simply to avoid unpleasant side effects. The main objective of this review paper was to investigate the effects of isoflavones in women during menopause on the hot flashes, bone mass, breast, cardiovascular diseases. Epidemiologic and clinical data suggest that soy foods can make important contributions to the health of women, particularly postmenopausal women. Soy foods potentially reduce coronary heart disease through multiple mechanisms and may be especially beneficial when consumed by young postmenopausal women. Keywords: Menopause, hormone replacement therapy, soy isoflavones, bone health, cardiovascular disease.

56-63

Authors: Hammodi F. Al-jumaily, Attalla M. Turky and Mohammed S. Dawood

Hepatitis B causes significant morbidity and mortality worldwide. Little is known about the existence of hepatitis B among high risk groups of the Ramadi population and the prevalence of anti-HBs alone or in combination with other markers. The present study was conducted to determine the magnitude of anti-HBs alone (a serologically confirmed past vaccination) in certain high risk groups, their comparison and its relation to age and other factors associated with serological marker positivity. This cross sectional study was carried out in Al-Ramadi city, Al-Anbar province, western Iraq, from January 2011 to July 2012. A screening of anti-HBs was performed on blood samples that were collected from five vulnerable or risky groups including hemodialysis patients, barbers, family contacts to a known hepatitis B patient, cuppers and health care workers (HCWs). Demographic information was recorded and the vaccination status was assessed by detailed interview. Analysis was conducted using the Epi info 7 software. A total of 789 subjects were screened. Of these, 294 individuals were reactive with anti-HBs alone. Most of the studied groups showed higher rate of findings with high significant statistically. In concern to age, being ≤ 19 years old age showed the highest rate (45.5) for testing positive for anti-HBs alone. Other age groups were of lower rates ranging from (25.4 to 40.1%). Males showed higher rate (38.7%) of positivity in contrast to females (33.8%). However, positive past history of jaundice showed lower rate (15.1%) than negative history (40.9%), regarding anti-HBs positive (alone) with high significance (p < 0.001). The vaccinated group showed the highest positivity for anti-HBs (alone) (55.8%) and the difference was statistically high significance (p < 0.001). Also, unknown history regarding vaccination status showed lower rate (31.1%) with statistical high significance (p < 0.001). For number of vaccine versus seropositivity of anti-HBs alone, highest rate (65.03%) was apparently among those with 3 doses followed by those with 2 doses and 1 dose (60 and 15.2%, respectively) with statistically significant (p value < 0.001). In concern to the duration of last dose effect on seropositivity of anti-HBs alone, those of last dose duration between 1 and 5 years showed the highest rate (57.89%), while those of less than one year duration was slightly lower (56.89%). On the other hand, those with more than 5 years duration were of rate (39.02%) and the difference was statistically significant (p = 0.03). The importance of the control of chronic hepatitis B in certain high risk groups was highlighted by this study, as these pools provide a trigger for the spread of disease in the community. Family contacts and HCWs showed the higher rate of anti-HBs positivity. Males were more affected than females with predominance of ≤ 19 years old age. Moreover, vaccinated group showed the significantly highest rate, particularly among those who received the 3rd dose of vaccine. Keywords: Anti-HBs alone, hepatitis B, high risk groups, Ramadi City.

13-26

Authors: Ashraf Elyamany, Mohamed Aboziada and Hamza Abbas

Cancer bladder represents the fourth most common cancer in men and ninth most common cancer in women. It is the second most prevalent cancer in men 60 years of age or older in United States. Radical cystectomy is the most widely used treatment for invasive bladder cancer. Radical cystectomy and urinary diversion has long-term effects on urinary, gastrointestinal and sexual function, and changes the body image of patients who use incontinent urinary diversions. Five-year specific and overall survival rates are 68% and 40 to 60%, and that is probably dependent upon the existence of micrometastases at the time of diagnosis. Clinical trials in the adjuvant setting require large numbers of patients to detect a survival advantage. It has been difficult to demonstrate a survival benefit from adjuvant chemotherapy. Neo-adjuvant cisplatin-based combination chemotherapy resulted in a significant 14% reduction in the risk of death, which translated into a 5% absolute improvement in five-year OS (from 45 to 50%). In appropriately selected patients, bladder preserving treatment with transurethral resection, radiation therapy and concurrent chemotherapy offers a probability of long term cure and overall survival at 5-years is comparable to cystectomy-based approaches (49 to 63% at 5 years) in patients of similar clinical stage and age. Five-year survival with bladder preservation is 40 to 45%. In addition, these selective bladder-preserving approaches result in approximately 80% of the long-term survivors maintaining a normal functioning bladder. Keywords: Bladder cancer management, bladder preservation, cystectomy, chemotherapy bladder cancer.

34-39

Authors: Mohammed Hegazy and Eman Taher

Child resuscitation requires actual weight measurement if possible. Multiple pediatric weight estimations are now available. Garwood and McEwen developed a new formula (age in months/4) +6. The aim of the study is to validate this formula versus advanced pediatric life support formula and Shann formula among pediatric cancer patients. Cross sectional study was conducted in 508 pediatric patients aged 1 to 16 years attending outpatient clinic at the children cancer hospital (57357 hospitals). Their age and actual weight were recorded. Accuracy of weight estimation was done using mean bias, 95% agreement, mean percent error, and estimation within 10 and 20% from actual weight. The mean bias from actual weight of the new formula was 1.3 kg versus -2 kg for Shann formula. The new formula outperformed the other two formulae in the age group 11 to 16 with a mean bias 0.8 kg and percent error -5.9% versus 8% for Shann formula. The new formula is among the more accurate age-based weight estimation formulae especially for older children. It is an acceptable option for estimating children's weight. Keywords: Advanced Pediatric Life Support formula, Garwood and McEwen formula, pediatric weight estimation, Shann formula.

43-50

Authors: Mohamed Abd El Ghafar

The aim of this study is to compare electric vacuum aspiration (EVA), manual vacuum aspiration (MVA) and uterine curettage (D&C) for first trimester abortions, in terms of the efficiency of eliminating ovular remnants, frequency of complications, duration of the procedure, and duration of patients' hospitalization. In a prospective study, 50 patients in EVA group, 50 patients in the MVA group and 50 in the D&C group were randomly included. Inclusion criteria were: spontaneous abortion, gestational age less than 12 weeks, patent cervix, endometrial thickness >15 mm, afebrile state, and hemoglobin >9 g/dl. Blood samples were collected before and after surgical procedures for control of hemoglobin levels. Anesthesia was performed in all cases. The time required for each surgical procedure was recorded. Groups were similar regarding gestational age and endometrial thickness before surgery. Durations of the procedure and of hospitalization were significantly shorter in the EVA and MVA group compared to the D&C group. EVA group showed the least incidence of complications regarding the amount of blood loss, uterine perforation and cervical laceration. Regarding the incomplete evacuation, both the EVA and MVA groups showed the same results. EVA caused less blood loss, was less time consuming, and resulted in shorter hospitalization. Keywords: Abortion, electric vacuum aspirations, manual vacuum aspiration, dilatation and curettage.