About Journal

  The Iraqi Postgraduate Medical Journal is a medical journal issued in English; it is concerned in all medical specializations.It started from year 2000. It is a peer-reviewed based publication and it is approved for scientific promotion purposes. It is considered an important source for many researchers. It is published quarterly and available in paper and electronic forms. Our journal is indexed in: - Directory of Medical Journals for the Middle East Region, In 2005, it was selected to be one of the sources of input of the  IMEMR, Index Medicus - Scientific site of Iraqi scientific...
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Intraoperative Neuromonitoring (IONM)

Iraqi Postgraduate Medical Journal, 2020, Volume 19, Issue 4, Pages -

Intraoperative neuromonitoring (IONM) is the observation of a patient's nervous system (NS) during operative and other invasive procedures to assist the surgeon with avoiding patient injuries and to prevent a permanent neurological deficit.

Treatment Follow up in Patients Diagnosed with Breast Cancer in Iraq

Mena Muhammed Alassadi; Nada Abdulsahib Al- Alwan

Iraqi Postgraduate Medical Journal, 2020, Volume 19, Issue 4, Pages 279-286

BACKGROUND:
Breast cancer is the most common malignancy affecting the Iraqi population. As many cases are still detected in advanced stages of the disease, regular follow-up of the diagnosed and treated patients is crucial to manage therapy-related complications and limit loco-regional recurrences.
OBJECTIVE:
To report the clinicopathological features, the offered treatment options and the recurrence rates among a sample of Iraqi female patients followed up after diagnoses with breast cancer.
PATIENTS AND METHODS:
A retrospective study design was followed enrolling a sample of 154 female patients diagnosed with breast cancer at a referral center for early detection of cancer in Baghdad, Iraq during a six month period (from January to July 2019). All cases with histopathologically confirmed invasive breast carcinoma were included in the study if they  had reliable valid data related to their demographic, clinical, pathological and follow up status (for at least two years).
RESULTS:
The peak age frequency for breast cancer occurred in the fifth decade of life. Family history was observed in 18.2% of patients. The most common histological type was invasive ductal carcinoma (92.9%) while 46.8% of the patients presented in advanced clinical stages (III            and IV). ER and PR and HER2 were positive in 66.2%, 63.6% and 36.4% of the cases respectively. Surgery was prescribed in 95.5% of the patients; 83.8% underwent modified radical mastectomy. Chemotherapy, Radiotherapy, Hormonal and Biological therapy were received by 92.2%, 66.9%, 64.9% and 32.4%) of patients respectively. Overall, discontinuation of the treatment was observed in 8.4% while recurrence was recorded among 10.1% of the patients.   
CONCLUSION:
Frequent regular follow up of patients diagnosed with breast cancer is crucial to achieve better prognosis. Continuous monitoring of the response to therapy and coordination through multidisciplinary follow-up care are essential recommendations to avoid risks of local and regional recurrences.
 

Radiological Assessment of Anorectal Malformations; The Role of Transperineal and Infracoccgeal Sonography in Male Type Imperforate Anus

Zainab Kadhim Saeed; Waad Mohammed Salih

Iraqi Postgraduate Medical Journal, 2020, Volume 19, Issue 4, Pages 287-296

BACKGROUND:
Anorectal malformation is a complex spectrum of anomalies. There are different types of anorectal malformation. The distinction can usually be made on the basis of clinical data regarding the presence or absence of a visible perineal opening or passage of meconium through the vagina or urethra.
OBJECTIVE:
To assess the validity of ultrasonography in detection of the exact anomaly in male type imperforate anus, in order to help plan the proper surgical approach.
PATIENTS AND METHODS:
A prospective study carried out between December 2017 and December 2018, at pediatric surgery department in Central Teaching Hospital in Baghdad, Iraq. Nineteen patients with imperforate anus were enrolled in this study (all were males), their age ranged between 1 day and 6 months. All patients were sent for trans-perineal ultrasound and infracoccgeal ultrasound, which were performed by using a high-resolution 11 MHz linear array transducer, in which the rectal pouch-perineal distance(P-P distance), presence or absence of recto-urinary fistula along with its précised location and the relation of the blind rectal-pouch to the pubo-rectalis muscle were obtained for a proper classification of the type of imperforate anus.US findings were compared to the operative findings which were the gold standard.
RESULTS:
The rectal pouch-perineal distance(P-P) was identified using US in all patients with a mean (27.3211) mm and SD +\- (14.78631) mm. The puborectalis muscle was identified as a hypoechoic U-shaped band in all patients along with its relation to the blind rectal-pouch. There is a statistically high significant relationship between the US and the operative findings regarding the presence and precise location of the internal fistula (P-value=0.0001).US findings showed a high sensitivity of 92.8%, specificity of 100% and accuracy of 94.7%.
CONCLUSION:
U\S whether in (Transperineal \ Infracoccygeal) approach is highly accurate, it provides an excellent imaging modality with high sensitivity and specificity in the detection of the internal fistula. U\S measurements are independent of age.
 

Value of Strain Ratio in the Assessment of Solitary Thyroid Nodules

Iraqi Postgraduate Medical Journal, 2020, Volume 19, Issue 4, Pages 297-303

BACKGROUND:
Ultrasound elastography (UE) is widely used in the diagnosis of thyroid diseases.
OBJECTIVE:
to evaluate the diagnostic utility of elastography stain ratio in the assessment of solid solitary thyroid nodules.
PATIENTS AND METHODS:
a cross-sectional study was conducted on 65 selected patients with solid solitary thyroid nodules discovered on Ultrasound (U/S) examination. The study was conducted in the U/S unit of medical college/ Al-Nahrain university and U/S unit of Al-Imamein Al-Kadhimein Medical city in Baghdad during the period from February 2018 to October 2019. U/S findings (size, shape and echogenicity of the nodules, presence of calcification, elastography findings and measurement of stain ratio), and histopathological results of the FNA.
RESULTS:
the final histopathological diagnosis of the 65 thyroid lesions revealed 46 (71%) benign and 19 (29%) malignant. Of the 19 malignant nodules; 12 were papillary carcinoma and 7 were follicular carcinoma. The mean age of the patients was 43.7 ±11.7 years (range 28 - 60) years, 50 (77%) of them were female and 15 (23%) were male, male: female ratio is 5:1. Strain ratio (SR) of Benign nodules was lower than that of malignant nodules (1.95±0.62 versus 6.11±3.4) and this difference was statistically significant (P- value <0.001. Best SR Cutoff - value was (>2.6) with a sensitivity of 100% & specificity of 86.4% (a higher value was more indicative of malignancy).
CONCLUSION:
SR in a good parameter to aid differentiating benign from malignant solitary thyroid nodule. SR is higher in malignant thyroid nodules.
 

A Comparative Study of Posterior Fossa Tumor Approach in Pediatric Patients; Craniotomy Vs. Craniectomy

Hayder Abbas Mohsin; Ayad Yousif Abdulnaby

Iraqi Postgraduate Medical Journal, 2020, Volume 19, Issue 4, Pages 304-309

BACKGROUND:
The posterior fossa is the biggest and the deepest intracranial fossa, containing the most complicated intracranial organs. Posterior fossa tumor access used to involve bone removal permanently, the first craniotomy was done in 1974 using burr holes to access CPA tumors.
OBJECTIVE:
To evaluate the postoperative complications of posterior fossa tumor surgery operated by craniotomy versus craniectomy in pediatric patients. 
PATIENTS AND METHODS:
A prospective single-center study of 35 pediatric patients with posterior fossa tumors operated in    the neurosurgical center in Martyr Ghazi Al-Hariri Hospital from Oct. 2017 to Oct. 2018. Patients were categorized into two groups using craniotomy or craniectomy for tumor access; these patients were followed postoperatively for 3 months and any signs or symptoms of complications were recorded (CSF leak, Pseudomeningocoele, wound dehiscence and infection).
RESULTS:
Thirty-five patients were studied, craniotomy was done for 15 patients, and craniectomy for 20 patients. The patients’ age averaged 2-16 years with a mean age of 7 years. The study included 17 male and 18 female patients with a male: female ratio of 1:1.058.
CONCLUSION:
Craniotomy resulted in less postoperative complications like Pseudomeningocoele, CSF leak, wound infection and dehiscence as well as less hospital stay than craniectomy.
 

Does Preoperative Doppler Ultrasound and Resistive Index Measurement Predict the Solid Renal Masses Histopathology?

Mohammed Noori Al-Musawi; Mohammed Abdulameer Mahdi; Mohammed Oudah Jasim

Iraqi Postgraduate Medical Journal, 2020, Volume 19, Issue 4, Pages 310-316

BACKGROUND:
Renal masses have different histologic types and subtypes, aggressiveness and metastatic potential, depending on the changes in angiogenesis.
OBJECTIVE:
To differentiate between benign and malignant renal masses and predicate renal tumors histopathological subtypes by using non invasive methods (Doppler ultrasound and resistive index).
PATIENTS AND METHODS:
Sixty-eight patients with a renal mass prepared for surgical intervention were involved in this prospective study. Every patient was underwent Doppler ultrasonography by single operator. By gray and color Doppler ultrasound the site, location, dimensions, echogenicity and the vascularity of the renal mass were assessed. Then by spectral Doppler ultrasound specific vascular wave parameters from intra tumor vessels which include a Peak systolic velocity, end diastolic velocity and Resistive index was checked. All those patients underwent partial or radical nephrectomy and the histopathological result, were collected.
RESULTS:
It had been found that the mean RI in patients with clear RCC was 0.59 ± 0.09 and it was significantly higher than that of Wilms tumor (mean = 0.49 ± 0.05, (P. value = 0.029), and significantly higher than oncocytoma (0.42 ± 0.06) (P. value = 0.025).
Patients with malignant renal mass had significantly higher mean RI than that of benign renal mass, 0.58±0.11vs 0.42±0.06,(P-Value =0.021) . The optimal cutoff point of RI was 0.47 which gives the higher sensitivity and specificity of 88.9% and 100% respectively with an accuracy of 94.5%, (PPV) was 100% and  (NPV) was 90%.
CONCLUSION:
The usage of color spectral Doppler US parameter (Resistive index) is considered as an excellent predictor to differentiate between benign and malignant renal masses, but failed to differentiate and predicate the malignant renal tumors subtypes.
 

Evaluation of Keyston Design Perforator Island Flap in Treatment of Soft Tissue Loss

Mohammed Alaa Dawood; Redha Ali Tahir

Iraqi Postgraduate Medical Journal, 2020, Volume 19, Issue 4, Pages 317-325

BACKGROUND:
Closure of skin and soft tissue defects is a main stream procedure in the field of plastic and reconstructive surgery .Keystone perforator island flap is a curvilinear trapezoidal shape. It is essentially elliptical in shape and it is long axis adjacent and parallel to long axis of defect. We focused in this study specifically on pressure ulcer and traumatic wound as an example of chronic and difficult wounds.
OBJECTIVE:
To evaluate keystone design perforator island flap as reliable versatile method for closure of soft tissue defect.
PATIENTS AND METHODS:
In this prospective study,  keystone perforator island flap applied to 11 patients , 7 of them  were pressure ulcer and 4 of them with traumatic soft tissue defect.
RESULTS:
Keystone flap used in 11 patients in this study , all of patients showed complete flap survival without even minor necrosis, only one patient developed  wound dehiscence ,otherwise all patients showed complete recovery without any sequalae.
CONCLUSION:
Keystone flap is reliable ,safe ,easy to perform ,cost effective flap, with low rate of flap failure and no donor site morbidity, can be used as effective method of  wound closure even in chronic and unhealthy wound.
 

Feasibility of Minilaparoscopic Cholecystectomy. A pilot Study

Yasser Fawzy Zidan; Sahir Mahir Al-Azawii; Muthanna Asaad Al-Sharbaty

Iraqi Postgraduate Medical Journal, 2020, Volume 19, Issue 4, Pages 326-330

BACKGROUND:
Cholecystectomy  is the defacto standard operation for cholelithiasis and there are continuous attempts to do it through a less invasive incision known as mini laparoscopic cholecystectomy (MLC).
OBJECTIVE:
The purpose of this study is to evaluate the safety and feasibility of MLC in our center. 
PATIENTS AND METHODS:
This is a pilot study involving 6 selected patients for whom MLC was performed at Al-Jamhory teaching hospital after acquiring the ethical committee permission and patients’ informed consent.
RESULTS:
The study includes six patients, their average age is 27 years and their average BMI is 28kg\m2. The average operative time is 53 minutes without intra-operative complications. The post-operative pain is mild and the hospital stay is about 12 hours. All patients were satisfied with the cosmetic results.
CONCLUSION:
This study shows that MLC a safe and feasible procedure; it takes more time than LC but has mild post-operative pain and excellent cosmetic results. It can also be done as a day case surgery.
 

Awareness of Elderly Abuse among Patients Attending Geriatric Clinic in Medical City

Zahraa Hussam Eldin Ismaeel; Eman Jassim Mohammed

Iraqi Postgraduate Medical Journal, 2020, Volume 19, Issue 4, Pages 331-337

BACKGROUND:
Elder abuse or elder mistreatment is one of the most important problems encountered by the elderly. It includes harms by people the older person knows such as spouse, partner, family members, neighbor or people that older person relies on for services.
OBJECTIVE:
The aim of this study was to determine the abuse to which elder people were exposed and its relation with age, sex, marital status, economic income and education. The study increased awareness and helping families, relatives of the elderly, professionals, social workers, nurses, doctors and counselors about elder abuse.
PATIENTS AND METHODS:
The present cross- sectional study was carried out on 300 elderly patients of age range 60-84 years attending geriatric clinic Baghdad Teaching Hospital from April to August 2019 who answered face to face survey questionnaires to elicit elder abuse.
RESULTS:
This study showed that 66.2% of elderly abused patients experienced more than one type of abuse. Majority of the patients were victims of abandonment abuse (70.3%), followed by financial abuse (25.3%), emotional abuse (21%) neglected (10.3%) and physical abuse (7%). There was                             a significant relationship between sex, marital status, economic income and education of the elderly and being abused.
CONCLUSION:
Abuse of the elderly is an important social and public health issue. Elderly abused patients experienced more than one type of abuse. There was a significant association with gender, widow, divorced, poor economic income and low level of education.

The Utility of Calretinin Immunohistochemistry in the Diagnosis of Hirschsprung’s Disease

Safa Majid Khudhair; Adil Rabea Al Saadawi

Iraqi Postgraduate Medical Journal, 2020, Volume 19, Issue 4, Pages 338-344

BACKGROUND:
Hirschsprung’s  disease  (HD)  is  a  congenital  intestinal  motility  disorder  with absence  of  ganglion  cells  in  the  colonic  wall, Diagnosis of the disease is based primarily on histopathological analysis, but in this respect,  there are limitations associated with standard histology and histochemistry. Calretinin immunohistochemistry (IHC) was implemented to solve the diagnostic problems of this disease as a diagnostic marker.
OBJECTIVE:
We aimed to test, identify and compare the immunostaining calretinin in the aganglionic segment of colon specimens and to assess the diagnostic importance of the process with the normoganglionic segment (control group).
PATIENTS AND METHODS:
The specimens contained 40 patients with HD histopathology and 20 others (as a control group) who were colectomied for other reasons,60 paraffin wax blocks were analyzed for full-blown bowel specimens and rectum biopsy. Sixty) paraffin wax) blocksof full bowel thickness and rectal biopsy were examined. In IHC stained slides, calretinine immunoreactivity and pattern of stain for ganglion cells( nuclear  and  cytoplasmic)and nerve fibers in different bowel layers were assessed. 
RESULTS:
Calreinin Immunostaining was positive of  ganglion  cells(nuclear and  cytoplasmic  staining) and nerve  fibers  in  the mucosa)  lamina  propria(, submucosa  and  muscularis  propria  in  all  specimens of control group except one case (2.5 percent), calretinin immunoexpression of ganglion cells and nerve fibers was negatively(-) ,In aganglionic segments (case group).This  method  had  sensitivity  of 97.5%  and  specificity  of  100%  for  diagnosis  of  HD.  The  positive  predictive value was  100%  and  negative predictive  value was  95.2%.
CONCLUSION:
Immunohistochemistry Calretinin can be used for the diagnosis of HD as a dependable and ancillary method.
 

Relationship of Platelet Lymphocyte Ratio and Neutrophil Monocyte Ratio with Disease Severity of Knee Osteoarthritis

Faiq Isho Gorial; Ehab Sabri Maseer

Iraqi Postgraduate Medical Journal, 2020, Volume 19, Issue 4, Pages 345-349

BACKGROUND:
Osteoarthritis is a low-grade systemic inflammatory and degenerative disease in which many inflammatory mediators are known to be elevated in the peripheral blood. Platelet lymphocyte ratio and neutrophil monocyte ratio are novel markers in many systemic inflammatory disorders. Studies are limited on its link with knee osteoarthritis severity. 
OBJECTIVE:
To evaluate the relationship of  PLR  and NMR  with the Knee Osteoarthritis (KOA) severity
PATIENTS AND METHODS:
A total of 200 patients with KOA were diagnosed according to the American College of Rheumatology clinical criteria 2016.  Demographic and clinical characteristics data were recorded.  X-ray was taken for both knee joints in standing and lateral position view.   Blood samples were collected PLR and NMR were calculated.
RESULTS:
Mean age was 62.3 ± 8.7 years, female to male ratio as 1.5:1. Mean BMI was 29.2 ± 6.3 kg/m2, and knee OA duration  9.8 ± 7.8 years.   Age, knee OA duration, menopausal duration, total WOMAC score and menopause were significantly correlated with increase knee OA severity (p<0,001), (p<0,001), (p<0,001), and (p=0,003) respectively while marital status was significantly inversely correlated with knee OA severity (P<0.001).    Knee OA duration and total WOMAC score were the only independent predictors of knee OA severity (p<0.001), (p<0.001) respectively.  PLR and NMR were not correlated with severity of KOA.
CONCLUSION:
PLR and NMR had no significant correlation with the KOA severity

Preterm Premature Rupture of Membranes and the Value of Serum Ferritin during Pregnancy

Maha Mohamed Jasim Al Bayati; Baidaa Abdullah Mohammed

Iraqi Postgraduate Medical Journal, 2020, Volume 19, Issue 4, Pages 350-355

BACKGROUND:
Preterm premature rupture of membranes occurring from 24-37 weeks gestation. Ferritin is an acute phase reactant as it increases during inflammation that inflammation can predispose to preterm premature rupture of membranes during pregnancy.
OBJECTIVE:
To investigate the value of serum ferritin as a marker for preterm premature rupture of membrane.
PATIENTS AND METHODS:
The study includes 150 pregnant women attending the department of Obstetrics and Gynecology with a gestational age ranging from 28+0 – 36+6 weeks. 50 of them presented with Preterm premature rupture of membrane (group A), 50 women were presented with spontaneous preterm labor (group B), and the other 50 were without any complaint (group C). Venous blood samples of five ml were collected on admission for measurement of serum ferritin level by enzyme-linked immunosorbent assay.
RESULTS:
No statistically significant differences between study groups regarding age, parity, gestational age and hemoglobin level (P ≥ 0.05). The mean of serum ferritin was significantly higher among pregnant women presented with Preterm premature rupture of the membranes than those presented with spontaneous preterm labor and healthy women (45.07 versus 26.22 and 22.83 ng/ml respectively) (P= 0.001). By receiver operating characteristic curve analysis, the cut point of serum ferritin value was 38.6 ng/ml.
CONCLUSION:
Measurement of serum ferritin level is a simple rapid and accurate test. It can be applied as a marker for preterm premature rupture of membrane.
 

Thymic Cyst: An Unusual Cause of Cervical Mass in Children: A Case Report

Aws Amjad Al-Hamdany; Ammar Abdulsalaam Al-Sultan; Abdulhakeem Abdulkadir Al-Dabbagh

Iraqi Postgraduate Medical Journal, 2020, Volume 19, Issue 4, Pages 356-360

INTRODUCTION: Cervical thymic cyst is uncommon cause of neck cysts in children, more common in boys and on the left side of the neck, congenital typemore prevalent than the rare acquired types.
CASE PRESENTATION: We report a case of three years old boy who presented with soft, mobile, non tender cystic mass on left side of the neck. The cystic nature of the lesion was detected clinically and confirmed by CT-scan and MRI .Successful surgical excision through mid line sternetomy was done. The diagnosis was established by histopathological study
CONCLUSION: Congenital cervical thymic cyst is rare condition with an excellent prognosis especially if diagnosed early followed by prompt surgical excision by a surgeon who is familiar with anatomy and embryology of the thymic cyst
 

Penetrating Injuries of the Neck

Musaed L. H. Albadri; Uday A. Albeiruty; Ahmed Abass Mossa

Iraqi Postgraduate Medical Journal, 2009, Volume 8, Issue 3, Pages 196-203

BACKGROUND:
Penetrating injuries of the neck are potentially dangerous, causing high rates of morbidity and mortality due to their association with sever bleeding and serious damage to the vital structures in the cervical region.
OBJECTIVE:
To know the incidence and distribution of these injuries on the anatomical zones of the neck and the damage of the vital structures in the cervical region and their early surgical management.
METHODS:
A prospective study on 52 patients of both civilian and military personnel with penetrating neck injuries attended the casualty department at Alyarmouk hospital over a period of 7 months from June-December 2006.
RESULTS:
Fifty patients (96.15%) were males. Twenty four patients (46.15%) were in their third decade. Twenty six patients (50%) were injured by shrapnel of explosives, 23 patients (44.21%) by bullets & 3 patients (5.77%) by unknown objects. Thirty six patients (69.23%) were injured at zone 2, 11 patients (21.15%) at zone 3 & 5 patients (9.62%) at zone 1. Twenty nine patients (55.77%) had laryngeal & tracheal injuries. Thirteen patients (25%) had pharyngeal & esophageal injuries. Four patients (7.7%) had recurrent laryngeal nerve injury. Nine patients (17.3%) had vascular injuries 6 arterial & 3 venous. One patient had vertebral & spinal cord injury. Forty one patients (78.86%) had tracheostomy operations, & 13, (25%) had neck exploration.Six patients (11.54%) treated conservatively. Nine patients (17.3%) have died.
CONCLUSION:
Male patients at their middle age were the predominant victims either by shrapnel or by bullets. Zone 2 was most commonly affected followed by zone 3 & zone 1. Laryngo – tracheal, pharyngo – esophageal & vascular structures were mostly involved. Tracheostomy & neck exploration were the main urgent operations performed for them. The high mortality reflected the serious nature of these injuries.

Focal Dermal Hypoplasia )Goltz Syndrome(

Luay Abdulla Al-Nouri

Iraqi Postgraduate Medical Journal, 2010, Volume 9, Issue 1, Pages 110-112

ABSTRACT:
BACKGROUND:
Focal Dermal Hypoplasia (FDH) is a condition of multiple features . It is important to recognize on clinical grounds , as it may show life threatening complications that need to be dealt with by properly timed interventions

The Role of Repaglinide in the Management of Type 2 Diabetes Mellitus

Abbas M Rahmah; Majid R Al-Zaidee; Roaa abbas

Iraqi Postgraduate Medical Journal, 2013, Volume 12, Issue 1, Pages 51-56

ABSTRACT:
BACKGROUND :
Repaglinide belongs to the meglitinide class of blood glucose-lowering drugs.
Repaglinide lowers blood glucose by stimulating the release of insulin from the pancreas.
It achieves this by closing ATP-dependent potassium channels in the membrane of the
beta cells. This depolarizes the beta cells, opening the cells' calcium channels, and the
resulting calcium influx induces insulin secretion.
OBJECTIVE:
To evaluate the effect of repaglinide as a monotherapy or in combination with metformin on
controlling the fasting plasma glucose, postprandial plasma glucose, HBA1C, and body weight in
61 patients with type 2 diabetes mellitus, (DM).
PATEINTS & METHODS:
During the period between February 2005 and October 2005, the effects of repaglinide
has been reviewed in 61 patients with uncontrolled Type 2 diabetes mellitus (T2DM),
they are divided into two groups depending on their previous treatment , the 1st group
included 43 of them were on metformin while the remaining 18 patients were on diet
only. Weight, HBA1c, FPG and PPG were checked after 3 and 6 months.
RESULTS:
It has been found that six months after using Repaglinide in combination with metformin or as a
monotherapy cause significant reduction in HBA1c, from 9.8 to 8.1% (P < 0.01) in 1st group, and
from 7.9 to 6.7%, (P < 0.01) in 2nd group and a significant reduction of FPG from 214.0 mg/dl to
148.5 mg/dl (P < 0.01) in 1st group and from 170.7 mg/dl to 130 mg/dl (P < 0.01) in 2nd group.
While the PPG shows a decrement from 255.6 mg/dl to 178.8 mg/dl, (P < 0.01) in 1st group and
from 248.3 mg/dl to166.1 mg/dl (P < 0.01) in 2nd group. There’s no significant weight gain thus
mean weight rose from 84.4 Kg to 84.6 Kg, (P > 0.2) in 1st group and from 75.1 kg to 76.1 kg (P >
0.2) in 2nd group .
CONCLUSION:
Repaglinide when used as monotherapy or in combination with metformin improve
overall glycemic control and significantly reduced HBA1c but have no significant
change in body weight

Prevalence of Pressure Ulcers in Orthopaedic Patients

Ali M. Al-Shadedi

Iraqi Postgraduate Medical Journal, 2012, Volume 11, Issue 4, Pages 529-535

ABSTRACT:
BACKGROUND:
Pressure sore in orthopedic patients is a common problem with high expectation of occurrence on the ward, it should be watched for in any admitted patient having high liability for its development like, old age particularly those patients with dementia, patient with malnutrition or anemia and long stay in bed or complicated multiple surgeries.
Orthopedic staff should be familiar with measures required to prevent and reduce its occurrence.
OBJECTIVE:
To highlight the prevalence, onset, types and number and the most common sites of pressure sores, length of stay in hospital with various types of treatment delivered to these patients in orthopedic wards.
PATIENT AND METHODS:
215 patients were admitted with orthopedic problem for treatment and observed for the possibility of occurrence of pressure ulcer in orthopedic ward. The data collection period was over five years; these patients were treated for trauma to proximal femur, hip joint, pelvis and elective surgery at Al-Sader teaching Hospital of Kufa College of Medicine in Najaf City and Al-Yarmouk teaching Hospitals of Al-Mustanseria College of medicine in Baghdad city. Braden scale was used for predicting pressure ulcer and for assessing these patients.
RESULTS:
215 patients were assessed for being at risk of developing pressure sores by using Braden scale for predicting pressure ulcer. 60 patients with various levels of risk factors with prevalence of 27.90% developed the pressure sores. The age range of patients with pressure ulcer was 42-77 years, with mean age of 63.2 years. Female patients were 40 and male patients were Pressure sores developed in 42 [70%] patient with trauma out of 60 patient under study, 10 patient 16.6% with elective surgery patients, two patients 3.32% conservatively treated patients, and 6 patients 9.96% treated for removal of old implants.13 patients developed ulcer at the first week and 10 patients developed pressure ulcer at the second week of their stay in orthopaedic ward and the rest 37 patients developed it after the second week of their stay in the ward. .
CONCLUSION:
Prevention of pressure ulcer requires the collaboration of all the nursing and surgical staff from different specialty like orthopaedic surgery. Development of pressure sore is the cause behind delay of patient discharge after successful surgery. Expectation of the development of bed sore is significantly high in elderly or bed ridden and hemiplegic patients

Troponin Positive Acute Coronary Syndrome with and without Significant Stenosis on Coronary Angiography

Mohammed Hilal AL-Ali; Hassan A. Farhan

Iraqi Postgraduate Medical Journal, 2015, Volume 14, Issue 2, Pages 237-243

ABSTRACT:
BACKGROUND:
Occasionally, coronary arteries without significant stenosis are observed during invasive treatment of acute coronary syndrome (ACS).
OBJECTIVE:
The aim was to study the frequency and to determine the most predictive factors of Troponin positive ACS without significant Stenosis on angiography.
METHODS:
The study involved one hundred twenty four patients admitted with Troponin positive ACS who underwent cardiac catheterization during hospitalization. The primary end-point was the estimation of coronary arteries without significant stenosis, and the secondary end-point was analysis of the most predisposing factors. In evaluating the primary end-point, the patients were divided into two groups according to the presence of ST elevation myocardial infarction (STEMI) or not. Also the patient who has no significant coronary artery Stenosis (< 50%) was subdivided to two groups:
a- Myocardial Infarction with No critical lesion in Coronary angiogram (MINC)
b- Normal coronary angiogram
RESULTS:
Overall, 20 patients (16%) had coronary arteries without significant lesions, from which 8 patients (6.4%) had MINC and 12 patients (9.6%) had normal coronary angiogram. The predictors were: female sex (P=0.008), age <45 years (P=0.001), and the absence of: diabetes (P=<0.001), hypertension (P=0.005) and absence of ST-segment elevation (P=0.001). Furthermore absence of regional wall motion abnormality (RWMA) is considered as another predictors for non-significant coronary artery lesion (P=0.008). Also the angiographic analysis of all lesions revealed that single vessels CAD are the commonest finding in Group I patients (P= 0.02). We further analyzed a suspicious angiographic lesions by using QCA {18 lesions (14.5%)} and FFR {6 lesions (4.8%)} technique.
CONCLUSION:
Overall, patients with Troponin positive ACS had non- significant coronary artery Stenosis on angiography, and female sex, age <45 years and the absence of diabetes, hypertension, ST- segment elevation or RWMA were all associated with coronary angiography showing no significant stenosis.

Pregnancy with Stroke

Abathar Qahtan

Iraqi Postgraduate Medical Journal, 2012, Volume 11, Issue 4, Pages 490-495

ABSTRACT:
BACKGROUND:
Although stroke in pregnancy is uncommon, the risk of stroke is increased during pregnancy and puerperium, and considered a major contributor to the serious morbidity and mortality of pregnancy
OBJECTIVE:
This study had been designed to find the frequency of stroke in relation to different periods of pregnancy and puerperium, to assess the effect of variable risk factors and their association with stroke and to verify which type of stroke is more frequent among pregnant ladies
METHODS :
This is a cross sectional study that enrolled 30 pregnant patients who had stroke either during pregnancy or puerperium and being admitted to the Neurology words of Al-Yarmouk, Baghdad and Al-kadhemia teaching hospitals during the period from the 1st of January, 2001, to the 31st of December, 2002. All of the patients, who had been included in this study, had been subjected to detailed history, physical and neurological examinations and investigations.
RESULTS:
19 patients (63.3%) of the sample included in this study acquired stroke during pregnancy while 11 patients (36.3%) had developed stroke during puerperium. 2/3rd of the sample had ischemic stroke. Impaired consciousness was the commonest presenting symptom with a frequency of 50% of the sample, cerebellar signs were the least observed signs, in the other hand; all of the patient included in this study had motor dysfunction during the disease course. 53.3% of the sample was hypertensive 6.7 % was diabetic, while 36.7% of them had no significant past medical history. Oral contraceptive pills had been used by 50% of the sample, 2/3rd of those using oral contraceptive pills had ischemic stroke. 63.3% of the sample had cesarean delivery, 50% of the sample had history of abortion, 60% of whom had positive history of recurrent abortion.
CONCLUSION:
This study revealed that most of stroke happened during the 3rd trimester and early weeks of puerperium. Being hypertensive, whether pregnant related or not, is the most important risk factor, in addition, other recognized risk factors included diabetes mellitus and use of oral contraceptive pills.

Pulmonary Function Test in Cement Workers in Iraq

Haider Noori Dawood; Abdul Razak Makki Abd Lrazak; Adnan Majeed Muhasen

Iraqi Postgraduate Medical Journal, 2013, Volume 12, Issue 1, Pages 85-89

ABSTRACT:
BACKGROUND:
Exposure to cement dust has long been associated with the prevalence of respiratory symptoms and decline in pulmonary function.
OBJECTIVE:
This study assessed the effect of exposure to cement dust on lung function in cement factory workers in Iraq , by measuring Forced Vital Capacity (FVC), Forced Expiratory Volume in the first second (FEV1), FEV1/FVC ratio and Forced Expiratory Flow 50% (FEF50%).
PATIENTS AND METHODS
180 workers enrolled in the study , 171 , are male (93.44%) and only 12 are female(6.56%). and 100 workers controls (non exposed) were selected.The age of the subjects ranged between 20-50 years. Both groups were smokers and non smokers, had no chronic pulmonary diseases or symptoms during the time of study. Spirometeric study was used to measure FEV1, FVC, FEV1/FVC ratio and FEF50% .
RESULTS:
Statistically, significant reduction in FEV1 and the FEV1/FVC ratio were found in exposed workers when compared to control. Lung
function indices were found to be not affected with increasing duration ofexposure to cement dust nor with smoking.
CONCLUSION:
Exposure to Portland cement dust may result in reduction in the pulmonary function and may lead to respiratory diseases.Implementing measures to control dust and providing adequate personal respiratory protective equipment for the production workers are highly recommended

The Outcome of Two Modes of Treatments in Patients with Posterior Urethral Valve

Saad Dakhil Farhan Daraji

Iraqi Postgraduate Medical Journal, 2015, Volume 14, Issue 2, Pages 203-208

ABSTRACT:
BACKGROUND:
The obstructive effect of the posterior urethral valve (PUV) can manifest along a spectrum of severity, ranging from disease incompatible with postnatal life to conditions that have such minimal impact that they may not manifest until later in life.
OBJECTIVE::
To compare the outcome of patients with PUV underwent both techniques of PUV incision and primary urinary diversion (with a delayed PUV incision).
PATIENTS AND METHODS:
A prospective and retrospective study of twenty-eight children with posterior urethral valve was conducted. Details of age, presenting symptoms, serum creatinine, ultrasound and Voiding cystographic (VCUG) findings, the presence or absence of vesicoureteric reflux and the type of surgical interventions done were recorded. On the follow-up between 1- 2 year period, the patients were assessed by progression of the clinical state, biochemical analysis and ultrasound of the abdomen. Outcomes of surgery and further surgical intervention also assessed in addition to the assessment of the bladder function for older children.
RESULT:
The primary treatment of the PUV was with incision of the PUV in 13 cases (46.4%) while the primary treatment with urinary diversion and delayed incision of the PUV was performed in 15 cases (53.3%). A posterior urethral valve incision was cured in 46% of patients, while the primary diversion and the delayed incision operation was cured in 26.6%; Most of the patients (60.7%) still needed further urological intervention. There was no statistical significance between the results of both surgical procedures. Renal impairment and poor bladder function were more common with diversion operation.
CONCLUSION:
There is no convincing evidence to support any procedure as a way of improving long-term renal function or long-term bladder function. Therefore, urinary diversion is to be considered in selected cases with clear goals and endpoints in mind as it has an important place in the management of boys with PUV.

Primary Repair of Unilateral Cleft Lip Nasal Deformity

Zakaria Y.Arajy; Ahmed A.M.Nawres

Iraqi Postgraduate Medical Journal, 2009, Volume 8, Issue 3, Pages 212-219

ABSTRACT:
BACKGROUND:
There is a growing attitude towards correcting the nasal deformity in conjunction with primary repair of cleft lip. Many studies had concluded that this repair will not affect the nasal cartilages growth; it usually reorients the deformed nasal cartilages into a near normal position, and will allow a better growth pattern.
OBJECTIVE:
This study was conducted to document the pattern of primary unilateral cleft lip nasal repair and to evaluate the medium term outcome.
METHODS:
A total of 33 babies with unilateral cleft lip deformities underwent simultaneous nasal correction with their lip closure, between March of 2004 and April of 2008.Through short nostril rim incision, alar suspension to the dorsal skin at the nasion and interdomal sutures were performed primarily. Alar transfixion stitches were used to maintain the new position of the suspended cartilages.
RESULTS:
The average follow up periods were 3 years (ranging from 1 – 5 years).The results were assessed by 4 parameters: Nostril asymmetry, nasal dome projection, alar buckling deformity, and flaring deformity of the alar base. Eleven patients had good results, 16 patients had acceptable results, and 6 patients had poor results.
CONCLUSION:
Alar suspension is a relatively simple effective procedure for the primary correction of cleft lip nasal deformity. Short nostril rim incision can be relied on to access the alar dome and facilitate insertion of suspension sutures. Weather it interferes with nasal growth or not, it is necessary to have a long period of follow up to answer this question.

“Cytomegalovirus Seroprevelance in Iraqi Pregnant Women”

Sajed Nader; Mohammed Ayad

Iraqi Postgraduate Medical Journal, 2012, Volume 11, Issue 3, Pages 303-307

ABSTRACT:
BACKGROUND:
Cytomegalovirus is the commonest cause of congenital viral infection in the developed and developing countries. It is a symptomatic in 90% of infected females. Forty percent of pregnant females transmit the virus to their fetus. Ten percent of born infants whom gain the virus will get the clinical signs plus its neurological sequelae.
OBJECTIVE:
To outline the relationship between Cytomegalovirus infection among pregnant women and its influence upon their pregnancy outcome.
PATIENTS AND METHODS:
A case-control study was carried out was carried out in the teaching laboratories – medical city, Baghdad through a period from June 2010 till March 2011; upon 165 pregnant women whom taken as a patient group. Blood samples were taken from them and Cytomegalovirus-IgM antibodies plus Cytomegalovirus-IgG antibodies levels were measured via Elisa technique in both to evaluate the viral infection if present or not.
RESULTS:
The usual age whom attended the gynea-obestetric clinics were the age group from 11-19 years old 73 cases (44.24%); Next came the age group from 20-29 years old 66 cases (40.00%), thirdly was the age group from 30-39 years old 20 cases (12.12%), Lastly was the age group from 40-49 years old 6 cases (3.64%). The concentration of CMV-IgG among females whom attended clinics were seropositive in nearly half the included cases 66/165 (40.0%); while the CMV-IgM concentration was within the seronegative limits. Secondly came another group of patients with seronegative limits regarding both the CMV-IgM and CMV-IgG antibodies 56/165 cases (33.94%), next 30/165 cases (18.18%) were seropositive in their results pointing to both CMV-IgM and IgG limits; and this might be a middle point distance between the previous group and the last group were the CMV-IgM was positive and the CMV-IgG concentration was negative 13/165 cases (7.88%).
CONCLUSION:
Cytomegalovirus-IgG antibodies got important role as a protective agent against gestation abortion, if Cytomegalovirus-IgM antibodies are seropositive alone this is a risky factor to the pregnancy outcome

Publisher: The Iraqi Board for Medical Specializations

Email:  ipmj2000@yahoo.com

Editor-in-chief: Prof. Yasir M.H. Hamandi

Managing Editor: Prof. Abdul Munem AL- Dabbagh

Print ISSN: 1608-8360

Online ISSN: 9893-2708

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