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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A Review on Vitamin B12 and Diabetic Neuropathy

Rana Ali Hamdi

Iraqi Postgraduate Medical Journal, 2021, Volume 20, Issue 2, Pages 99-101
DOI: 10.52573/ipmj.2020.168616

Vitamin B12, also called cobalamin, is a vitamin that is important for several biological functions. It is acted as a neurotrophic factor with an affinity for neuronal tissues and has been showing to be essential in preserving and regenerating peripheral nerves. It is important in supporting the process of myelination, participating to functional restoration. Diabetic neuropathy mentions to various types of nerve damage linked to diabetes mellitus. These conditions are microvascular complications of diabetes mellitus including small blood vessels that provide nerves. Relatively,  third, fourth, or sixth cranial nerve palsy are common conditions that may be linked with diabetic neuropathy. Interestingly, a significant correlation was found between lower vitamin B12 concentrations and possessing a positive diagnosis of diabetic neuropathy.

Clincopathological Assessment of Cases of Inflammatory Bowel Disease & Other Types of Colitis in Province of Basrah

Russul Mahmood Ali; Alaa G. Hussein

Iraqi Postgraduate Medical Journal, 2021, Volume 20, Issue 2, Pages 102-109
DOI: 10.52573/ipmj.2020.168617

BACKGROUND:
Inflammatory bowel disease is group of inflammatory disorders of unknown etiology. The main members of this group are ulcerative colitis and Crohn's disease (granulomatous colitis).Histopathologic evaluation of colonoscopic mucosal biopsy remains one of the earliest modalities of investigation in patients which clinically suspected. Any biopsy underwent histopathological diagnosis should be accompanied by endoscopic findings and full clinical history.
OBJECTIVE :
Assessment of colonic biopsies in patients of colitis on the basis of specific histopathological criteria and correlation with clinical and endoscopic presentations.
METHOD :
A Retrospective and prospective study included randomly selected 102 colonic specimens from
January 2016 to June 2018.The clinicopathological parameters including (age of the patients, gender, hematochiza, diarrhea and abdominal pain) obtained from endoscopic reports and correlated with                 the histopathological parameters and sections which revised by a senior pathologist.
RESULTS:
Out of (102) patients in this study; there were 41(40.2%) males and 61(59.8%) females. hematochiza is the main presentation in ulcerative colitis, while abdominal pain is the main presentation in Crohn's disease patients and diarrhea in those with non-specific colitis. Certain parameters can favoring                 the diagnosis of non-specific colitis over inflammatory bowel disease and another set favoring ulcerative colitis over Crohn's disease and vice-versa. This leads in shifting of diagnosis of most of endoscopic biopsies rather than resection biopsies. And there is under diagnosis of cases of non-specific colitis and Crohns disease in comparism to Ulcerative colitis.
CONCLUSION:
Inflammatory bowel diseases are female predominate.Ulcerative Colitis predominate in 3rd and 4th decades of life, Crohn's disease is more in 2nd and 3rd decades while non specific colitis are more
found in old age. Correlation between clinical, endoscopic and histopathological features is essential  in the diagnosis of inflammatory bowel diseases. Accurate diagnosis of inflammatory bowel diseases depends on finding of certain histopathological features.

The Effect of Opening Injection Pressure Monitoring Device to Detect Needle Nerve Contact During Ultrasound Guided Popleatial Approach in Diabetic Patients for Below Knee Amputation

Ayad Abbas Salman; Ahmed Basim Qasim

Iraqi Postgraduate Medical Journal, 2021, Volume 20, Issue 2, Pages 110-115
DOI: 10.52573/ipmj.2020.168618

BACKGROUND:                                                                                                                                              Ultrasound-guided popliteal sciatic nerve blocks is a useful approach for below- knee surgery. Using the injection pressure monitoring device.
OBJECTIVE:
This study to assess the role of opening Injection Pressure monitoring device in providing and avoid nerve injury in patients who underwent, popliteal sciatic nerve block under ultrasound-guided.                                                                                      
METHODS:
This study involve fifty patients underwent unilateral below knee amputation were randomly assigned under ultrasound-guided popliteal sciatic nerve block and femoral nerve block have been done, with use opening Injection Pressure monitoring device and additional ultrasound guided.
RESULTS:                                      :                                                                                       
Regarding the pressure of the injections monitoring , we noticed that in this study, the highest proportion of study patients recorded needle nerve contact (44%) ,needed low pressure CONCLUSION:                                                                                                                                                There is high incidence of intraneural needle placement or needle neve  contact of nerve under ultrasound guide.                                                                                                                     

Short Segment Posterior Instrumentation with Intermediate Screw in Thoracolumbar Junction Injury: Prospective Study

Karam Fawaz Aldarzi; Walid W. Al-Rawi

Iraqi Postgraduate Medical Journal, 2021, Volume 20, Issue 2, Pages 116-127
DOI: 10.52573/ipmj.2020.168619

BACKGROUND:
Thoracolumbar fractures are traditionally treated surgically by short segment fixation;
however, they may be associated with high implant failure. The insertion of an additional screw at
fracture site makes it more stable with a better clinical outcome.
OBJECTIVE:
The aim was to evaluate the radiological and clinical parameters of posterior short
segment fixation with intermediate screw implantation into the fractured vertebra.
METHODS:
We evaluated 30 patients with unstable thoracolumbar fractures, managed with short
segment posterior instrumentation with intermediate screw in the fractured vertebra; fractures
classification was done according to AOspine and TLICS systems . Eighteen male and 12 females
qualified for the study; male to female ratio was 1.5:1; average age 28.86 years. Neurological status
was classified according to the ASIA impairment scale. Pain was evaluated by VAS score. The
percentage of vertebral body collapse and segmental kyphosis were assessed by Cobb method.
Duration of follow-up lasted for 12 months.
RESULTS:
The mean preoperative VAS score was 8.55, had significantly improved to 0.87 at final
follow up. Preoperative mean vertebral body collapse was 48.40%, which had significantly improved
to 12.85% at final follow up. Mean segmental kyphotic angle was 21.83° before surgery, final mean
segmental kyphosis was 8.63°. Fifteen patients with incomplete neurologic deficits had improvement
by at least one ASIA grade on final follow-up observation, and 2 of 4 patients with complete
neurologic deficit remained unchanged. All neurologically intact patients remained unchanged. None
of patients had implant failure.
CONCLUSION:
Short segment fixation with intermediate screws in treatment of thoracolumbar junction
fracture effectively improve stability with most of patients achieve significant improvement in clinical
outcomes.

Nail Changes in Alopecia Areata and Their Correlation with Disease Severity

Hayder Raouf Al-Hamamy; Ghusoon Nazar Al-Ani

Iraqi Postgraduate Medical Journal, 2021, Volume 20, Issue 2, Pages 128-135
DOI: 10.52573/ipmj.2020.168620

Alopecia areata (AA) is a chronic, autoimmune, inflammatory, non-scarring type of hair loss. Significant variations in the presentation of AA have been observed, ranging from small, well-circumscribed patches of hair loss to complete absence of body and scalp hair. Nail involvement is                  a common finding in patients with alopecia areata.
OBJECTIVE:
Study of nail changes in alopecia areata and evaluation of the correlation between the nail changes and severity of alopecia areata
PATIENTS AND METHODS:
The study is an observational, cross-sectional, descriptive study that was carried out at                                         the Dermatology center, Medical City, Teaching Hospital, during the period from May 2018 to July 2019.  The severity of (AA) was measured by the Severity of the Alopecia Tool Score1 (SALT1) score, in 70 patients with different severities of AA. A new measurement tool (Nail in Alopecia Areata Severity Index, NAASI score) was applied for the evaluation of the nail changes associated with AA.
RESULTS: 
Seventy AA patients were divided into two groups, patients with nail changes, group A, which included 48 patients; 33 were males and 15 were females, the mean age was 19.19 ± 14.28 years. Group B included patients without nail changes; 22 patients; 11 were males and 11 were females,                   the mean age was 22.36 ± 11.50 years. NAASI score for patients in group A was 34 ± 31. Pitting  was the most common nail changes (38 patients), followed by trachyonychia, 15 patients. Group A was subdivided into two groups according to severity of AA. The mean NAASI score for the group with mild to moderate AA was 20 ± 23, while it was 56 ± 28 for patients with severe AA. There was positive correlation between SALT1 and NAASI scores.
CONCLUSION:
The prevalence of nail changes in AA was 68.6%. They were associated with early onset and long duration of AA. Pitting was the most common changes. A new scoring system for nail changes was described. Nail changes correlated with severity of AA.
 

Use of Bipolar Vessel Sealing Device(Ligasure) Versus Conventional Suture Ligation in Thyroid Surgery

Muhammed Faiz Abdullah Hassan; Qahtan Adnan Mahdi

Iraqi Postgraduate Medical Journal, 2021, Volume 20, Issue 2, Pages 136-142
DOI: 10.52573/ipmj.2020.168621

BACKGROUND:
Effective vessel hemostasis can be achieved by knot tying or newer techniques like ligasure as an alternative bipolar surgical diathermy system. Various diathermy techniques have been proposed to reduce intraoperative blood loss in surgery and the new electrothermal bipolar tissue sealing system (Ligasure) has been applied in various specialties of surgery.
OBJECTIVE:
To compare the outcome of ligasure versus conventional suture ligation in thyroid surgery.
METHODS:
This study was conducted in Al–Imamein Alkadhmein Medical City over 2 years period from the first of  October 2016 to the first of October 2018.A Total of 110 patients were operated upon by the same surgical Team, using ligasure in 55 and conventional suture ligation in 55 patients for hemostasis. The medical records of the patients enrolled were reviewed and compared regarding age, sex, histopathological diagnosis, types of thyroidectomy, operating time, estimated intraoperative blood loss, postoperative complications, hospital stay , postoperative pain and outcome evaluation.
RESULTS:
There was no statistical difference between the two groups regarding age, sex and histopathological Data. The mean operating time was significantly shorter in the Ligasure group compared with the conventional group. Transient hoarseness of voice was detected in 2 patients (3.6%) of both groups. no permanent complication was seen in LVSS group but EBSLN injury (1.8%) was the only permanent complication occurred in conventional group. 
CONCLUSION:
The use of LigaSure Vessel Sealing System for thyroid surgery is proved safe and effective as conventional suture ligation Technique, with the benefit of reducing intraoperative blood loss, reduced operating time, and postoperative pain severity.
 

Evaluation of a Modified Dome Holding Technique for Transdomal Suture in Rhinoplasty

Mustafa Khalid Khudhair; Redha Ali Taher

Iraqi Postgraduate Medical Journal, 2021, Volume 20, Issue 2, Pages 143-148
DOI: 10.52573/ipmj.2020.168622

BACKGROUND :
There are multiple techniques for gaining the refinement of tip, increase projection and rotation.
This study based on A modified dome holding technique for transdomal Suture in rhinoplasty.
OBJECTIVE:
To evaluate the result of A modified dome holding technique for transdomal suture in rhinoplasty.
PATIENTS AND METHODS:
Between November 2018 and March 2020, 10 patients were subjected to aesthetic rhinoplasty in Alwasity teaching hospital. Their ages between 19-30 years “8 females versus 2 males”. Those patients were undergoing rhinoplasty with using innovative technique. Nine out of ten of our patients had thin skin and only one of them had thick skin.
RESULTS:
Average time of operation was one hour and a half (1 hour-2 hour), our results showed that the post-operative appearance had acceptable aesthetic results in all our patients with narrow nasal tip without pinching and with adequate tip projection and rotation.
CONCLUSION:
Dome stabilizing suture using this innovative method is effective way for producing narrow of nasal tip, dome symmetry, and enhancing tip rotation and projection, with good functional results.
 

Seasonal Variations of Lipid Profile

Noor Falih Ahmed; Azher Sebieh

Iraqi Postgraduate Medical Journal, 2021, Volume 20, Issue 2, Pages 149-154
DOI: 10.52573/ipmj.2020.168623

BACKGROUND:
Cardiovascular and cerebrovascular disorders have been the most prevalent cause of death and morbidity in the world over the last decades. Seasonal differences in blood lipids have recently raised interest in this area of lipid metabolism. In the current study
OBJECTIVE:
To determined if changes in weather having effect on lipid profile readings
METHODS:
Eighty five subjects, forty males and fort five females were included with age range of (22-85) years. Two serum samples were investigated in hospital lab for lipid profile for every participant from outpatient clinic/Baghdad teaching hospital, in 12 months’ period. Other clinical data and some modifiable risk factors were also obtained.
RESULT:
The results showed that a significant increase in winter was shown in LDL and total cholesterol among males only (P value 0.011, and 0.012), respectively, but no changes in HDL, triglyceride and LDL/HDL were found. Systolic blood pressure was also found increased in winter significantly (P=0.008), while diastolic pressure, FBS and BMI did not change significantly.
CONCLUSION:
The present study concludes that there are significant changes of lipid parameter in male sex may affect assessment of risk of cardiovascular disease.
 

Immunohistochemical Assessment of MGMT Expression in Human Gliomas. A Clinico-Pathological Study

Mustafa Hafudh Hamoodi; Ban J. Qasim

Iraqi Postgraduate Medical Journal, 2021, Volume 20, Issue 2, Pages 155-164
DOI: 10.52573/ipmj.2020.168624

BACKGROUND:
Gliomas are the most common primary malignant brain tumors in adults. They can occur anywhere in the central nervous system but primarily occur in the brain and arise in the glial tissue. O6-alkylguanine DNA alkyl transferase is a protein (DNA repair molecule) encoded by the O6-methylguanine DNA methyltransferase (MGMT) gene in human, and are able to remove alkyl adducts from the O6 position of guanine, and the O4 position of thymine, restoring these DNA bases and preventing temozolomide induced cell death.
OBJECTIVE:
To assess the immunohistochemical expression of MGMT in human glioma.
METHOD:
This retro and prospective study included 56 tissue paraffin blocks of intracranial gliomas assigned as cases group, and 28 tissue paraffin blocks of normal brain tissue as control group. From each block, two sections were taken; one was stained with the routine hematoxylin and eosin stain, and the other was stained immunohistochemically for marker MGMT.
RESULTS:
MGMT showed a highly significant difference in its expression between the control group and the disease group (p value<0.001). MGMT showed a highly significant relation between its expression and the age of patients with glioma (p value< 0.001). MGMT expression showed no significant correlation with other clinicopathological parameters like the histological types and gender (p value CONCLUSION:
MGMT revealed a highly significant difference inits expression in brain tumors (gliomas) compared to control groupwhich mayreflects the need in proliferating cells for greater capacity to repair O6-alkylguanineadducts before replication. Besides there was a significant correlation between age and MGMT expression which may reflect processes associated with the physical and functional maturation of the CNS during life.
 
 

Clinicopathological Evaluation of CD44 Expression as a Proliferative Marker in Prostatic Adenocarcinoma

Wurood Abdullah Imran; Hadi Muhammad Ali Almosawi; Rafid Fakhir Al Husseini

Iraqi Postgraduate Medical Journal, 2021, Volume 20, Issue 2, Pages 165-171
DOI: 10.52573/ipmj.2020.168625

BACKGROUND:
Prostatic cancer is the 6th commonest cancer worldwide, and the 2nd commonest cancer among men. In Iraq, it is the fourth most common cancer and cause of cancer deaths in males.
The commonest form of prostatic cancer is adenocarcinoma (75% of patients > 65 years). Prevalence of prostate cancer rises with age and hormonal causes. Core needle biopsy is a standard technique and largely preferred for non-operative diagnosis since it permits architectural and cytological assessment.
OBJECTIVE:
Immunohistochemical evaluation of CD44 expression in prostatic adenocarcinoma as                                a proliferative marker and correlate it with clinicopathological parameters (age, PSA level, and tumor grade).
MATERIALS AND METHODS:
Prostatic specimens were obtained via different procedures (TURP, and tru-cut biopsy). Formalin fixed paraffin embedded blocks from 50 patients with prostatic adenocarcinoma, histological sections taken for hematoxylin and eosin staining to determine histopathological features, monoclonal antibody for CD44 used for immunohistochemical staining of tissue sections and CD44 expression correlated with clinicopathological parameters (age, PSA level, and tumor grade).
RESULTS:
There was a significant inverse correlation between CD44 expression and Gleason grade score (i.e. high expression in low grade tumors), while there was no correlation between age and PSA level with CD44 expression.
CONCLUSION:
CD44 expression in prostatic adenocarcinoma can be utilized as a prognostic marker as it implies less tumor aggressiveness with positive high expression which means lower grade tumor and better differentiation.
 

Association of Carotid Intima Media Thickness with the Severity of Coronary Artery Disease

Hafidh Jaleel Hussein; Hussein Jubair Lazim; Ameer Adnan Muhsen

Iraqi Postgraduate Medical Journal, 2021, Volume 20, Issue 2, Pages 172-177
DOI: 10.52573/ipmj.2020.168626

BACKGROUND: 
Nevertheless, of a number of prevention schemes, coronary artery illness continues to exist as                    the leading cause of death worldwide disease. Within this context, Intima media thickness is believed to have a key role in the atherosclerosis initiation. The development of ultrasound machines, advances in echocardiographic devices with great determination transducers facilitate total study of carotid –intima media thickness (C-IMT).                                            
OBJECTIVE:
To investigate the relationship of Carotid Intima Media Thickness with the severity of coronary vessels illness.                                                                                                             
PATIENTS AND METHODS:
Through the sections of a cross sectional multicenter diagnostic accuracy survey assessing C-IMT in a total of one hundred thirty two  patients preselected to undergo coronary angiography. For this purpose, patients' demographic data and the disease- associated risk factors were evaluated. Two dimensional transthoracic echocardiographic measurements were done. Furthermore, C-IMT measurements were obtained as it specified by the American society of echocardiography (ASE). Consequences of the study sample as all were revised according to angiographic findings.
RESULTS:
 In the present study, a total of 132 patients, of them 72 patients were included in the CAD group while 60 patients with no CAD served as control. The most important risk factors for CAD are modifiable, while family history of CAD ( a non- modifiable risk factor) was not significant                         (P value=0.348). There was direct and significant correlation between C-IMT and severity of CAD. ROC analysis for validity of C-IMT to discriminate between multiple vessels disease and no vessel involvement is excellent (AUC= 0.961, cut point > 1.04mm, sensitivity=92.9%. specificity=86.7%). C-IMT is fair to discriminate between single vessel disease and no vessel involvement (AUC=0.738, cut point ˃ 0.84mm, sensitivity 100%), so if correlated with age, C-IMT above 0.84 is utilized as  can  be used as a detached theme to guessing of CAD.                                  
CONCLUSION:
C-IMT is simple, inexpensive and reproducible parameter that is utilized to be showing aid to the presence and severity of CAD particularly earlier indications showing in great danger for sick people.                                                                 
 
 

Evaluation of Release of Wide Post Burn Contracture of Joints Using Central Axis Propeller Flap

Rabaab Abass Hasan; Hassan Salman Attai

Iraqi Postgraduate Medical Journal, 2021, Volume 20, Issue 2, Pages 178-185
DOI: 10.52573/ipmj.2020.168627

BACKGROUND:
Post burn contractures of joints can produce significant impact on quality of life by interfering with the ability to perform activities of living. Varieties of techniques are available for coverage of defect following contracture release. A Central axis propeller flap a strategy that used in patient with contracture deformities. It's a reliable method of reconstruction in release of axillary, elbow and popliteal region of knee joints contractures.
OBJECTIVE:
To evaluate of central axis propeller flap in wide joints post burn contractures release.
PATIENTS AND METHODS:
Between October 2017 to May 2019 ten patients with wide joints post burn contracture, their age range between (10-45) years .A central axis (propeller) flap based on random sub dermal pedicle              of two design was used (rhomboid design for eight patients and Namaste design for two patients) by designed and elevated as a “propeller,” and then rotated by 90° to straddle the defect after contracture release.
RESULT:
Good functioning result in all patients indicated by good range of motion in affected joints and no serious complication, only one case of superficial epidermal sloughing was managed conservatively.
CONCLUSION:
Central axis propeller flaps are reliable methods for surgical management of post burn contractures with good range of motion .However it used scary tissue, a result appearance is cosmetically acceptable for those patients, when the functions the primary concern.
 

Barriers for Insulin Therapy Initiation among Type 2 Diabetic Patients Attending the Specialized Center for Endocrinology and Diabetes / Baghdad 2019

Ruaa Naji Zidane; Wijdan Akram Hussein

Iraqi Postgraduate Medical Journal, 2021, Volume 20, Issue 2, Pages 186-192
DOI: 10.52573/ipmj.2020.168628

BACKGROUND:
The beginning of insulin therapy is a mutual decision between the health care provider and the patient. People    with   type 2 diabetes   mellitus often   have   strongly   negative attitudes toward insulin therapy. This refusal is often   based on a range of patient concerns and misconceptions.
OBJECTIVE:
To determine the barriers for insulin therapy refusal among type 2 diabetic patient, and to find the association between socio-demographic characteristic and the barriers of refusal.
PATIENTS AND METHODS:
A cross sectional study was conducted during the period from first of March to 30th of June 2019 in the Specialized Center for Endocrinology and Diabetes in Al-Kindy Teaching Hospital in Baghdad/Al-Rusafa. .The study was conducted by using a convenient sampling method of 400 patients’ withT2DM. A questionnaire form was used to collect demographic data, and appraisal of insulin therapy measured by Insulin Treatment Appraisal Scale (ITAS).
RESULTS:
Perceived loss of control/ life style adaptation and restriction were the first barrier to initiation of insulin therapy (70.6%), and the least barrier to start insulin was perceived lack of positive gain               (43. 1%), also there is statistically less negative appraisal scores in patients aged 45-60 years, males, higher educational levels and ‘10-12 years’ duration of illness, but no statistical difference in regards whether a family member or a friend used, or did not use insulin.
CONCLUSION:
Many misconceptions about the use of insulin therapy can be corrected by working to increase patient education.
 

Management of Bile Leak after Laparoscopic Cholecystectomy

Ali Momtaz Bikhtiyar; Sattar Jabbar Kadhim

Iraqi Postgraduate Medical Journal, 2021, Volume 20, Issue 2, Pages 193-199
DOI: 10.52573/ipmj.2020.168629

BACKGROUND:
Bile leak after laparoscopic cholecystectomy is not an uncommon complication, it’s a serious one and its management requires a lot of resources, and expertise. The evolution of laparoscopic cholecystectomy and being the standard of management had a disadvantage of slightly elevating bile leak incidence.
OBJECTIVE:
To identify the best way management to decrease the burden on the patient either quick healing, decrease complications and outline the complications after management modalities.
PATIENTS AND METHODS:
This is a prospective study describing route of management from the period January 2018- January 2019 in Al-Yarmouk Hospital and Gastrointestinal and hepatology teaching Hospital. Where 34 patients enrolled for bile leak after laparoscopic cholecystectomy. Patients were followed from their admission, investigations, determining site of leakage, choosing the method of management according to out-put grade, site. Comparing closure time and complications related to each.
RESULTS:
The study involved 34 patients who were managed for bile leak, mean age 42.13. Females were 76.5% (26), males were 23.5% (8). ERCP and MRCP used to determine the site of leakage: cystic duct 55.9% (19), liver bed 8.8% (3) and major duct injuries: Strasberg D 32.4% (11) and Strasberg E1 2.9% (1). These sites further divided in to low-grade <300 cc/day 73.5% (25) and high-grade >300 cc/day 26.5% (9). Management was according to site and grade of leak: conservative 23.5% (8), Endoscopic Retrograde Cholangiopancreatography alone/stent 70.6% (24) and surgical reconstruction 5.9% (2).             All patients were followed for 4 months. These modalities compared to each other in terms of closure time and complications.
CONCLUSION:
Some patients with bile leak can be managed using conservative measures alone. Sphincterotomy alone can be used in low grade leaks, from cystic duct. High grade, major duct injuries is best managed with sphincterotomy plus stenting to enhance healing.
Although conservative management or sphincterotomy alone decreases the complications rate but carries a disadvantage of delaying closure time.
Sphincterotomy plus stenting enhances closure time over other methods.
 

Sedimentation Sign Appraisal in Lumbar Spinal Stenosis

Mazin S. Mohammed Jawad

Iraqi Postgraduate Medical Journal, 2021, Volume 20, Issue 2, Pages 200-208
DOI: 10.52573/ipmj.2020.168630

BACKGROUND:
Lumbar nerve roots normally sediment, due to gravity, to the dorsal part of the dural sac, which is known as negative sedimentation sign. If there is a magnetic resonance finding of nerve roots in  the ventral part of the dural sac the sedimentation sign is positive.
OBJECTIVE:
To evaluate the presence of the MRI finding of positive sedimentation sign in patients clinically suspected to have lumbar spinal stenosis and if this sign can be a valid tool to differentiate  symptomatic spinal canal stenosis from other causes of non-specific back pain.
METHODS:
A planned cohort design prospective study had conducted over a year through July 2019 at the department of neurosurgery at Medical City / Baghdad / Iraq. The study incorporates 200 patients. Those with symptomatic lumbar spine canal stenosis (n=100) show claudication with or without low back pain, leg pain, a dural sac cross-sectional area < 80 mm2, and a walking interval < 200 meters. The nonspecific low back pain group (n=100) had no leg pain, no claudication, a cross-sectional area of the dural sac >120 mm2, and a walking interval >1000 meters. The frequency of a positive sedimentation sign compared between both groups to evaluate if this sign can be a valid tool to differentiate spinal canal stenosis from other causes of back pain, intra-rater and inter-rater assessment dependability in a stochastic subsample executed.
RESULTS:
A positive sedimentation sign recognized in 96 patients in the symptomatic lumbar spine canal stenosis group (96%; 95% Confidence Interval CI, 90%–98%), no positive sedimentation sign recognized in the nonspecific low back pain group (0%; 95% Confidence Interval CI, 0%–5%). Credibility was Kappa (ĸ) =1.0 (intra-rater) and Kappa (ĸ) =0.90 (inter-rater), in sequence.
CONCLUSION: 
A positive sedimentation sign is dependably seen in lumbar spine canal stenosis cases, recommending its value in clinical application.
 

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YASIR Mohammed Hasan HAMANDI

Iraqi Postgraduate Medical Journal, In Press
DOI: 10.52573/ipmj.2021.131393.1009

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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.

Peripapillary Retinal Nerve Fiber Layer Thickness by Optical Coherence Tomography in Patients with Unilateral Amblyopia

Noor Adnan Laylani; Salah Alasady

Iraqi Postgraduate Medical Journal, 2021, Volume 20, Issue 1, Pages 91-98
DOI: 10.52573/ipmj.2021.167831

BACKGROUND:
Amblyopia is a common cause of unilateral visual defect, affecting patients with history of strabismus, refractive errors, and those who had visual deprivation in the critical period of visual development.  Amblyopia may have an effect on various levels of the visual pathway. Cells atrophy in the lateral geniculate nucleus that receives information from the affected eye, and a shift in the dominance pattern in the visual cortex have been reported. Retinal involvement in amblyopia is controversial.
SUBJECTS AND METHODS:
This is a cross sectional study carried out in Al-Shaheed Ghazi al-Hareery Teaching Hospital in Medical City at Baghdad, Iraq .Forty-two patients with unilateral amblyopia were selected, 23 males and 19 females with age range of 12-40(mean age of 25.33 years) all of these patients had one amblyopic eye and the other eye normal.  OCT scan was done for both eyes of each patient and the RNFLT measured after complete ophthalmological examination ( VA, refraction, slit lamp, and funduscopic examination
RESULTS:
It has been noticed that the mean of NFLT in normal eyes was higher than that of amblyopic eyes (108.88 versus 105.05) but this difference was statistically not significant (P=0.074).
CONCLUSION:
OCT is a sensitive way to estimate RNFLT, we concluded that there is no statistically significant difference in NFLT between the amblyopic, compared to the normal eyes. Also NFLT seems not affected by: type of amblyopia, age of patients and also the severity of amblyopia as all these factors didn’t reach statistical significant.
 

Surgical Correction of Caudal Septal Dislocation in Septoplasty and Septorhinoplasty

Emanuel Sargon Emanuel; Hiwa Asaad Abdulkareem

Iraqi Postgraduate Medical Journal, 2021, Volume 20, Issue 1, Pages 17-26
DOI: 10.52573/ipmj.2021.167821

BACKGROUND:
Several techniques and maneuvers for surgical correction of caudal septal dislocation have been
mentioned in the literature nevertheless the subject has still bearing different opinions and preferences
on which approach to be applied.
AIM OF STUDY:
to assess different surgical approaches and techniques that are used in the management of caudal septal
dislocation.
PATIENTS AND METHOD:
A prospective, observational study was conducted on 50 patients from 10 January 2018 to August 2018
with age range from (18-39 years) who underwent nasal surgery (septoplasty, septorhinoplasty). The
study conducted in Center of Otolaryngology- Head and Neck surgery/ Sulaymaniyah Teaching
Hospital and Azmar private hospital. Preoperative assessment data were gathered & compared with
postoperative assessment data after 3-6 months follow up. The data was analyzed statistically using
SPSS version 25.
RESULTS:
patients included in the study were 64% males and 36% females, 22% went through septoplasty while
78% went through septorhinoplasty. For the techniques that used in surgical correction of the caudal
dislocation (wedge resection, batten graft and L-strut graft) the results were significant postoperatively
while for scoring technique the results were insignificant postoperatively .
CONCLUSION:
There are different techniques used in surgical correction of caudal septal dislocation with good results
and according to each patient. The use of L-strut graft technique whenever it needed especially in
severe deviation .

Efficacy of Etanercept Treatment in Iraqi Patients with Moderate to Severe Psoriasis

Iraqi Postgraduate Medical Journal, 2020, Volume 19, Issue 1, Pages 9-15

ABSTRACT:
BACKGROUND:
Etanercept is a tumor necrosis factor (TNF) α inhibitor that has been approved for the treatment
psoriasis.
OBJECTIVE:
Assessing the efficacy of etanercept therapy in Iraqi patients with moderate to severe psoriasis.
PATIENTS AND METHODS:
This study was a therapeutic interventional study at Medical City; center of dermatology and
venereology (Baghdad, Iraq) from January 2017 till June 2018, with 53 patients, 31 (58.49%) males
and 22 (41.51%) females, with 51 patients having moderate to severe plaque psoriasis and 2 patients
with pustular psoriasis. All patients were given 50 mg subcutaneous injection of etanercept twice
weekly for 3 months, followed by single injection of etanercept weekly for the next 9 months.
Psoriasis area and severity index calculations were done every 3 months until 1year of treatment.
RESULTS:
The baseline PASI score changed from a mean ± standard deviation of 24.28 ± 14.56 to 1.62 ± 3.11
At the end of 12 months of treatment with a significant difference (P=0.001). Regarding the
reduction in the patients' PASI score: At 3 months of treatment, (71.4%) achieved PASI 50, (48.2%)
had PASI 75, and (5.35%) had PASI 90, at the 12th month of treatment (75.4%) reached PASI 90,
(86.79%) reached PASI 75, &(94.33%) had PASI 50. Side effects were mild and tolerable.
CONCLUSION:
Etanercept is an effective therapy in treating moderate to severe psoriasis with tolerable side effects.

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.

Topical Nitroglycerin in Treatment of Plantar Fasciitis

Qais A. Adi; Sami Salman; JewadIbraheem Resheed

Iraqi Postgraduate Medical Journal, 2013, Volume 12, Issue 0, Pages 751-759

ABSTRACT:
BACKGROUND:
Planter fasciitis is the most common cause of inferior heel pain in adults; it is a degenerative process of the planter fascia at its origin on the calcaneus. Many treatment modalities are used including NSAIDs, orthotics, local steroid injection, extracorporeal shock wave therapy and others. Recent studies have shown that topical nitroglycerin has a healing and analgesic effect in other tendinopathies like: tennis elbow, suraspinatus tendinitis and Achilles tendinitis.
OBJECTIVE:
We want to establish the role of topical nitroglycerin in treatment of plantar fasciitis.
PATIENTS AND METHODS:
A double blind placebo controlled study included 54 patients, after taking medical history they were subjected to physical examination. Nitroderm TTSR 5 patches were used in the treatment group, similar placebo patches were used in the placebo group. The severity of the symptoms was quantified initially for each patient using the visual analogue scale (VAS). By using SPSS (statistical package for social sciences) software for windows, data of all patients were entered and analyzed with appropriate statistical tests according to the types and distribution of variables (Chi square test and Students’t test).
RESULTS:
Response to topical treatment was (76.7%) in the GTN group most of them with moderate and good response compared to (41.7%) in placebo group most of them with mild response.
CONCLUSION:
It was clear that NGT patches were superior to placebo patches in improving the symptoms of patients, so that topical NGT can enhance healing of planter fasciitis. This may be a useful alternative to the current modalities of treatment used for this common

Indications of IV Fluids in Medical City

Bassam Hameed Al-Jarrah; Zeena Muthafer Al-Nema

Iraqi Postgraduate Medical Journal, 2009, Volume 8, Issue 4, Pages 380-383

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.

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.

Salvage of Extruded Cochlear Implant By Interposing Pericranial Flap

Ahmed Khalaf Jasim; Tawfeeq Waleed Tawfeeq; Hamed Mahmood Mohammed Alnakeeb

Iraqi Postgraduate Medical Journal, 2013, Volume 12, Issue 0, Pages 727-731

ABSTRACT:
BACKGROUND:
Cochlear implant has become a routine procedure for management of severe sensorineural hearing loss. Cochlear implant extrusion is one of the most devastating complication of this procedure. A double layer closure of pericranial flap and scalp rotational flap has being showed to decrease the rate of late implant extrusion.
OBJECTIVE:
The purpose of this study is to evaluate the use of the pericranial flap as second layer coverage after cochlear implant extrusion.
PATIENTS AND METHODS:
Eight patients with cochlear implant extrusion in Al-Shaheed Gazi Al-Hariri hospital were operated on by using two layer closure ; the pericranial flap as salvage layer used to cover the cochlear implant and scalp rotational flap as a routine coverage, with mean postoperative follow- up period of 6 months.
RESULTS:
Eight patients with late cochlear implant extrusion where operated on by using double layers closure, seven of them had no evidence of extrusion during the 6 months follow-up period. No complications were notice apart from one case who developed flap necrosis and the implant was removed later on, and another patient who had postoperative hematoma, which was surgically evacuated and the flap healed uneventfully. The results show that using pericranila flap as salvage second layer coverage in patients with cochlear implant extrusion had significant role in prevention of secondary cochlear implant extrusion.
CONCLUSION:
We concluded that the use of combination of pericranial flap as first layer with scalp rotational flap as secondary coverage of implant had superior result in prevention of secondary cochlear implant extrusion.

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.

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: 2706-9893

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