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...
Read More ...

Thulium Fiber Laser in Urology

Ula Al-Kawaz

Iraqi Postgraduate Medical Journal, 2021, Volume 20, Issue 4, Pages 310-312
DOI: 10.52573/ipmj.2020.170473

Minimally invasive surgery (MIS) has seen large uptake in recent decades, with increasing numbers of such procedures being performed. Laser technology is widely used in the management of urological diseases, including urolithiasis, benign prostatic enlargement (BPE), and urinary tract malignancies.(1,2)
Laser lithotripsy was first adopted by urologists in the 1980s, with Holmium:Yttrium- Aluminium-Garnet (Ho:YAG) becoming the laser of choice in the mid 1990s( 3,4)
Compared to other lithotripsy techniques, the Holmium:YAG laser presents several important advantages:
(1) suitability for fragmentation of all known urinary stone types into small stone particles (3,4);
(2) ability to operate with thin and flexible delivery fibers with limited energy losses and with core diameters as small as 200 μm (5,6);
(3) favorable safety profile with minimal tissue penetration depth and low risk of undesirable tissue damage due to the relatively high absorption coefficient of the Holmium:YAG laser wavelength in water(7)
In recent years, there has been a surge of interest in Thulium Fiber Laser (TFL) which has a 4x higher absorption coefficient in water-containing tissue, smaller operating fibers (50–150 μm core diameter), lower energy pulses (0.025 J), and higher pulse rate capability (up to 2 KHz).(2)
One advantage of TFL is its higher water-absorption coefficient compared with Ho:YAG, which means that water absorbs TFL energy around four times higher than it does with Ho:YAG laser energy. Using water absorption as a model for cell absorption, the implication of this is that more energy from TFL is absorbed by cells and therefore they are better ablated (8,9)

Workplace Stress, Physical Activity and Eating Behavior and Its Relation to Obesity among Medical and Paramedical Staff

Baraa Kadhim Mohammed; Salam Jasim Mohammed

Iraqi Postgraduate Medical Journal, 2021, Volume 20, Issue 4, Pages 313-318
DOI: 10.52573/ipmj.2020.170474

ABSTRACT:
BACKGROUND:
Obesity is   a medical condition in  which  excess  body  fat has accumulated to the extent that it may have a negative  effect on health. Obesity increase the likelihood of various diseases and conditions,  particularly cardiovascular diseases, type 2 diabetes, obstructive sleep apnea, certain types of cancer, osteoarthritis and depression
OBJECTIVE:
To clarify the effect of  work place stress , physical activity and eating behavior as  determinants of obesity.
SUBJECTS AND METHOD:
A cross-sectional study with an analytic element, was conducted  in eight  hospitals and  primary health care  centers in al-Najaf city selected by a convenient  non randomized sampling technique  during the period from 1st of April 2018 through 31  December 2018. The total sample of study was 350 medical and paramedical staff .a self rated questionnaire was filled by participants regarding their work place stress , physical activity and eating behavior, weight and height was measured and BMI was calculated .
RESULT :
the rate of obesity was 10.3% and the rate of overweight was 42.3% . The study show that there is no significant association between workplace stress and eating behavior  with obesity while significant association found between obesity and physical activity
CONCLUSION:
Physical activity has an important role in the prevention of obesity , greater percentage of participants have normal BMI, greater percentage of  participants have controlled eating.  greater percentage of participants have low physical activity.
 

Evaluation of the Plane Shaped Flap in Reconstruction of Congenital Hand Syndactyly

Haider Abdulkareem Jasim; Sabah Hasan Naji

Iraqi Postgraduate Medical Journal, 2021, Volume 20, Issue 4, Pages 319-326
DOI: 10.52573/ipmj.1970.170475

ABSTRACT:
BACKGROUND:
Time consuming, scar contracture, web creeping is risks with reconstruction by skin graft.  dorsal metacarpal flaps minimize these complications however they still occur. This study is based on                    a plane-shaped advancement flap on the dorsum of the hand and a traction device for webspace to prevent contraction and creeping.
THE AIMS:
To evaluate the primary closure after releasing of tight syndactyly  and minimizing creeping and contracture of Webspace
PATIENTS AND METHODS:
From January 2018 to May 2019 ten patients (10 Webspaces), 3 females and 7 males, age ranged               (1-19) have congenital tight hand syndactyly (3 complexes, 5 simple incomplete,2 simple complete) .
RESULTS:
Average time of operation was 60 min  , primary closing of all incisions was done . one of the ten patients  had hypertrophic scar at donor site of the flap. furthermore , four patients had web creeping ,one of them had epidermal sloughing of the flap, the others  had creeping  .
CONCLUSION:
Dorsal advancement plane-shaped flap is helpful in reconstruction tight syndactyly However, it needs precise dissection . Some patient haven’t compliance with  traction devices so it isn’t corresponding for every patient
 

Facial Canal Defect During Mastoidectomy for Chronic Suppurative Otitis Media

Fatimah Abbas Abed; Yaseen Adeeb Sakran

Iraqi Postgraduate Medical Journal, 2021, Volume 20, Issue 4, Pages 227-331
DOI: 10.52573/ipmj.1970.170476

ABSTRACT:
BACKGROUND:
The facial nerve is characterized by the long bony canal that makes it vulnerable to injury during otologic surgery. Facial canal defect could be found as an anatomic variant or due to longstanding inflammation that causes bone erosion.
AIMS OF THE STUDY:
Determination of the incidence and location of facial canal defect and identification  of association between facial canal defect  and other intraoperative pathological findings.
PATIENTS AND METHODS:
A case series study of eighty-four patients with chronic suppurative otitis media who underwent mastoidectomy  in Al-Yarmouk Teaching Hospital through a period from October 2017 till October 2018. Data were collected regarding the intraoperative finding of facial canal defect, its location and associated pathological findings which include lateral semicircular canal erosion, dural exposure and ossicular erosion.
RESULTS:
This study included (38) males and (46) females, their ages ranged from five to fifty-eight years. The incidence of facial canal defects was (20.2%). The tympanic segment was predominantly involved (82.4%).There was a statistically significant correlation between facial canal defect and lateral semicircular canal erosion (p<0.006).
CONCLUSION:   
The incidence of facial canal defect was 20.2%, mostly located in the tympanic segment. The presence of lateral semicircular canal erosion was significantly correlated with facial canal defects.
 
 

Transperitoneal Laparoscopic Ureterolithotomy and Ureteroscopic Laser Lithotripsy for Treatment of Proximal Ureteral Stones, a Comparative Study

Mohammed Noori AL-Mosawi; Ammar Majeed Mahdi

Iraqi Postgraduate Medical Journal, 2021, Volume 20, Issue 4, Pages 332-337
DOI: 10.52573/ipmj.1970.170477

ABSTRACT:
BACKGROUND:
Laparoscopic as a minimally invasive treatment is continuosly gaining place in the treatment of urinary stones,mainly replacing open surgery,it is mostly recommended ror large impacted stones.
OBJECTIVE:
To compare the safety, efficacy, operative time, postoperative hospital stay, and complications rate of transperitoneal laparoscopic ureterolithotomy and ureteroscopic holmium laser lithotripsy for treatment of upper ureteral stones, equal to or larger than 15 mm in longest diameter.
PATIENT AND METHODS:
Forty-two patients with upper ureteral stones of 15 mm or larger in longest diameter were included in this study. Eighteen patients were treated by transperitoneal laparoscopic ureterolithotomy and 24 patients by ureteroscopy using semi-rigid ureteroscope with Holmium laser lithotripsy. Operative time, intraoperative complications, stone-free rate, postoperative complications, postoperative hospital stay and post-operative auxiliary treatment were compared in both groups.
RESULTS:
The mean stones size was comparable in both groups, it was 20.5 ± 6.8 mm in Ureteroscopy group and 20.3 ± 6.7 mm in laparoscopic group, (P. value > 0.05).The mean operative time was significantly shorter in ureteroscopy group, 46.3 ± 27.3 minutes compared to 66.4± 19.1 minutes in laparoscopic group. Regarding the Patients in laparoscopic group needed longer hospital stay with a mean time of 2.2 ± 0.4 days, while in ureteroscopy group, the meantime of hospitalization was 1.1 ± 0.45 days. The stone free rate in laparoscopic group was 100%, compared to 62.5% in ureteroscopy group giving a statistically significant difference, (P. value = 0.003), and the ancillary treatment was needed in 37.5% of patients treated by ureteroscope. Postoperatively in ureteroscopic group, three patients had gross hematuria, while only one Patients in laparoscopic group had pyelonephritis, however, no significant difference in frequency of post-operative complications between both groups, (P. value> 0.05).
CONCLUSION:
Transperitoneal laparoscopic ureterolithotomy has a higher stone-free rate, but longer operative time and hospital stay compared to ureteroscopic laser lithotripsy for the treatment of upper ureteral stone 15 mm or larger in longest diameter.
 
 

Painless Labor: Comparison between Patient Controlled Epidural Analgesia and Continuous Epidural Analgesia

Enas Abd Al Jabbar Yonis; Ayad Abbas Salman

Iraqi Postgraduate Medical Journal, 2021, Volume 20, Issue 4, Pages 338-343
DOI: 10.52573/ipmj.1970.170478

ABSTRACT:
BACKGROUND:                                                                                     
 Patient-controlled epidural analgesia has been considered as superior to continuous epidural infusion for labor pain control.
AIM OF STUDY:
The aim   was to establish     the efficacy of Patient Controlled Epidural Analgesia for control of labor pain   and improve the quality of analgesia.
 METHODS:
This study was done on 20 patients; they were given bolus of 10 ml of   0.125% bupivacaine +2 Mg /ml fentanyl then divided into: Group A can put the device to deliver 5ml of 0.125% bupivacaine +2Mg /ml fentanyl with lockout interval 20 min; Group B had the PCA system to deliver continuous infusion of 10 ml /hr. In each group if patient still suffer from pain, patients were received additional dose of 5ml of same solution.
RESULTS:          
Data showed that total amount of LA in group A was lower than group B    (18.44ml versus 20ml in 1st hr., 2.5ml versus 10ml in 2nd hr.). Regarding additional     boluses, CIEA group needed more extra boluses of LA at 20, and 60 mints (5.0ml versus 1.0ml, 4.0 ml versus 0.5ml).  CONCLUSION:
 The use of PCEA associated with lower doses of local anesthetic with   better quality of analgesia and maternal satisfaction.
 
 

Tattoo Practice Among Students in Babylon University

Mustafa Muhammed Ali Wahhudi; Waleed Arif Al-Ani

Iraqi Postgraduate Medical Journal, 2021, Volume 20, Issue 4, Pages 344-349
DOI: 10.52573/ipmj.1970.170479

ABSTRACT:
BACKGROUND:
Tattoo is the introduction of colored ink into the skin, and considered a form of body art for centuries. Its prevalence is rising among adolescents and young adults, mainly in western societies despite being linked to certain health risks.
AIM OF THE STUDY:
To assess the characteristics of tattoo practice among college students, and to highlight its association with certain characteristics of the students.
METHODS:
The study is a cross-sectional study conducted on college students in Babylon University from January 2019 through June 2019. Data were collected using an anonymous self-administered questionnaire based on Armstrong Team Tattoo Attitude Survey (ATTAS).
RESULTS:
The study included (1932) students with a mean age of (21.05 ± 1.69) years, majority being females (70.3%). Tattoo practice was present in (8.3%) of them, with significantly higher proportion among males (P<0.001). Tattoo was significantly more prevalent among students with tattooed family members and friends (P<0.001), odds ratio=3.09 for family members with tattoos and 5.19 for friends with tattoo.
CONCLUSION:
The study demonstrated the significant role of friends and families in the practice of tattoos, with friends having the highest role. Majority of students performed their first tattoo before college.
 
 

Bone Mass Loss in Postmenopausal Women with Early-Stage Breast Cancer (I, II, III) Treated with Aromatase Inhibitors

Maher Jabbar Salih; Sundus Abd Al Hassan Al Obaidi; Huda Ameen Rasheed

Iraqi Postgraduate Medical Journal, 2021, Volume 20, Issue 4, Pages 350-354
DOI: 10.52573/ipmj.2020.170480

ABSTRACT:
BACKGROUND:
Adjuvant hormonal treatment with aromatase inhibitors for postmenopausal women with early-stage breast cancer is associated with relatively few side effects but it may cause bone mass loss which can be detected with a dual-energy x-ray absorptiometry scan.
AIM:
In this study, we evaluate the skeletal effects of aromatase inhibitors in postmenopausal women with early-stage breast cancer.
PATIENTS AND METHODS:
This is an observational retrospective case-control study enrolled 70 postmenopausal women with               early-stage breast cancer on adjuvant aromatase inhibitors and 70 postmenopausal control women,               the two groups were compared regarding the prevalence and severity of bone mass loss by using                   the DXA scan of their lumbar spine.
RESULTS:
Bone mineral density was significantly lower in breast cancer cases (mean T score was (-2.50 ± 1.01) compared to the control group (mean T score was (-2.12 ± 0.79) with significant (p-value =0.014), also 60%of breast cancer cases were osteoporotic compared to 32% in the control group (p-value =0.005). Based on univariate analysis, breast cancer was associated with 2.79 folds increased probability of osteoporosis
CONCLUSION:
A significant proportion of our breast cancer patients who used aromatase inhibitors were osteoporotic.
 
 

Evaluation of Outcomes Associated with the Use of Screwable Basal and Compressive Immediately Loaded Dental Implants (Comparative Study).

Ahmed Faris Khazaal; Waleed Khalil Ismael

Iraqi Postgraduate Medical Journal, 2021, Volume 20, Issue 4, Pages 355-360
DOI: 10.52573/ipmj.1970.170481

ABSTRACT:
BACKGROUND
The use of immediately loaded basal dental implants in the treatment of partial or completely edentulous patients is one of the new methods; this method was invented to avoid pre-implant surgical procedures to decrease treatment time, cost, and surgical morbidity.
AIM OF THE STUDY:
This study aimed to evaluate the primary stability of basal and compressive dental implants by the use of periotest M and the evaluation of complications of these implants.
MATERIAL AND METHODS:   
A total of (158) dental implants were used in (31) patients, basal and compressive DI was sued and the primary stability of each implant was determined by the use of periotest M. the entire DI was loaded immediately and followed up for six months.
RESULTS:
There was a significant correlation between the primary stability and DI dimension, (p>0.05),                      a significant increase in bone resorption in correlation to time of implant insertion. 
CONCLUSION:
 Within the limitation of this study, the use of a greater dimension of basal DI increases the primary stability, and the survival of basal and compressive immediately loaded DI was accepted (98.11%).
 
 

Differentiation between Ovarian Endometriotic Cysts and Functional Hemorrhagic Cysts on Magnetic Resonance Imaging

Raad Hefdhi AbedTwfeq; Nawaf Saad Jawad

Iraqi Postgraduate Medical Journal, 2021, Volume 20, Issue 4, Pages 361-367
DOI: 10.52573/ipmj.2020.170482

ABSTRACT:
BACKGROUND:
Ovarian functional hemorrhagic and endometriotic cysts are frequently seen on ultrasound examinations. Magnetic resonance imaging plays a major role in their differentiation based on different imaging characteristics.
OBJECTIVE:
Investigating magnetic resonance imaging signs to differentiate endometriotic from functional hemorrhagic cysts.
PATIENTS AND METHODS:
A prospective descriptive study of 66 cystic hemorrhagic ovarian lesions, conducted in X-ray Institute, Medical City, Bab Al-Mua’dam, Baghdad/Iraq from September 2018 to December 2019. Lesions were inspected for the presence of T2 shading, dark spot, and dark rim signs. Standard of reference was either histopathological analysis or follow-up ultrasound imaging.
RESULTS:
Of 66 hemorrhagic lesions, 39 were endometriotic cysts and 27 were functional hemorrhagic cysts. T2 dark spots were only seen in 19 of 39 endometriomas. T2 shading was seen in 34 of 39 endometriotic cysts and 8 of 27 functional hemorrhagic cysts. Twenty-four of 39 endometriotic cysts and 12 of 27 hemorrhagic cysts showed the dark rim sign.
CONCLUSION:
High sensitivity of the shading sign for diagnosing endometriomas. Identification of dark spots within endometriomas increases specificity and accuracy for their diagnosis. Dark rim sign is also useful for differentiation between endometriomas and functional hemorrhagic cysts.
 
 

The Role of Calretinin Immunohistochemistry in Detection of Ganglion Cell in Hirschsprung Disease

Hawazin Hazim Thanoon; Nadwa Subhi Alazzo

Iraqi Postgraduate Medical Journal, 2021, Volume 20, Issue 4, Pages 368-372
DOI: 10.52573/ipmj.2020.170483

ABSTRACT:
BACKGROUND:
Hirschsprung’s disease is a developmental abnormality of enteric nervous system characterized by lack of ganglion cell and neural hypertrophy in the Meissner and Auerbach’s plexuses within variable length of the colon, the Calretinin Immunohistochemistry is one of the newer methods overcome difficulties in diagnosis of Hirschsprung’s disease especially immature ganglia in neonates in submucosal plexus.
AIM OF STUDY:
This study was performed to evaluate the diagnostic value of Calretinin immunohistochemistry in                 the Hirschsprung’s Disease diagnosis.
MATERIALS AND METHOD:
A retrospective and prospective case series study at the period from (Jan2018-Jan2020) included a total 50 formalin-fixed paraffin-embedded blocks of distal colonic and rectal incisional biopsies from infant and young children patient who suspected with Hirschsprung’s disease, The study was undertaken in the department of pathology, collage of medicine/ University of Mosul, a clinicopathological data including (age, gender, site, type of surgical procedure) were obtained from patients' files This study was performed by using the primary antibody of Calretinin.
RESULTS:
The study done on 50 cases their age from 1 day to 14 years. The universal sensitivity in this study to diagnose presence or loss of enteric ganglia by calretinin immunostaining was 90% and the specificity is 100% with positive and negative predictive value of 100% and 97 % respectively.
CONCLUSION:
Calretinin marker considered as a reliable, valuable marker in Hirschsprung disease diagnosis and carry high sensitivity and specificity.
 
 

The Role of Desmin in Assessing and Staging of Urothelial Carcinoma

Aseel Abdullah Fadhil; Hatem Abdulmajeed Al-nuaimi

Iraqi Postgraduate Medical Journal, 2021, Volume 20, Issue 4, Pages 373-379
DOI: 10.52573/ipmj.2020.170484

ABSTRACT:
BACKGROUND:
Pathological stage of urothelial carcinoma is the most important factor in determining the prognosis and the mode of therapy. Desmin antibody is used to stage urothelial carcinoma by distinguishing the muscular invasion from desmoplasia and differentiating muscularis mucosa from muscularis proprial invasion.
AIM OF THE STUDY:
To evaluate the usefulness of Desmin expression in differentiation muscularis mucosa from propria invasion and assess muscular invasion in urothelial carcinoma.
MATERIAL AND METHODS:
A retrospective study was done on 40 cases with urothelial carcinoma from the histopathology department of Teaching Hospitals and private laboratories in Mosul city, starting in January 2018 till July 2020. Their mean age was 62.1 years. All cases stained by desmin antibody.
RESULTS:
It was found that the high-grade Urothelial carcinoma is predominant, which is composed of 80%. Desmin can distinguish the muscularis mucosa from propria by at least one level of difference in the strength of the staining intensity.
CONCLUSION:
Desmin marker helps assess the stage of urothelial carcinoma by the differentiation between muscular layer of the bladder wall.
 
 

Undiagnosed Isolated Systolic Hypertension in Adult; Profile and Associated Factors

Alaa Ali Salih; Nuha Fadhel Mousa

Iraqi Postgraduate Medical Journal, 2021, Volume 20, Issue 4, Pages 380-388
DOI: 10.52573/ipmj.2020.170485

ABSTRACT:
BACKGROUND:
Isolated systolic hypertension is defined as Systolic blood pressure ≥140 and a Diastolic blood pressure <90mm Hg. The rate of isolated systolic hypertension increased with increasing age in both sexes, isolated systolic hypertension, more than any other hypertension subtype, increases the risk for stroke and coronary heart diseases and is associated with many complications.
OBJECTIVE:
To assess the prevalence of isolated systolic hypertension among the adult population in Baghdad.
METHODS:
 A cross-sectional study using a convenient sample from the outpatient clinic in Baghdad aged (18-60) year. Data was collected using a questionnaire as a direct interview, with measurements of weight, height and blood pressure.
RESULTS:
A total of 800 adults, were included in the final analysis. Males constituted about 52.1% of the study population. The prevalence of undiagnosed isolated systolic hypertension was 11.4%. Four factors were found to be significant independent risk factors. Age (increasing one year will increase the risk of isolated systolic hypertension by (OR=1.03), illiteracy (OR=1.4), BMI (OR=1.08), and male gender (OR=1.77).
CONCLUSION
Undiagnosed Isolated systolic hypertension is common and increased with age in both men and women. And more common among males with association with low education and BMI.            
 
 

Knowledge of Hypertensive Patients Attending Al- Imamein Kadhimein Medical City Regarding Follow- Up Visits

Nibras Hamid Hussain; Reem zeki Mohammed; Ghaith Sabri Mohammed

Iraqi Postgraduate Medical Journal, 2021, Volume 20, Issue 4, Pages 389-398
DOI: 10.52573/ipmj.2020.170486

ABSTRACT:
BACKGROUND:
Hypertension is a challenge for public health professionals all over the world and it is often poorly controlled in clinical practice and to achieve control, hypertensive patients should actively participate in the plan of management through being educated and monitored at follow-up appointments.
AIM OF THE STUDY: 
To shine a light on a sample of hypertensive patients, tracing knowledge about follow-up visits practicing, and identifying the factors that influence their practice.
PATIENTS & METHODS:
A cross-sectional study was carried out on 300 outpatient hypertensive patients aged eighteen years and above of both sexes who were known to be hypertensive for not less than one year and on antihypertensive treatment, attended Al- Imamein Kadhimien Medical City and interviewed face to face by using a detailed questionnaire.
RESULTS:
The majority of the participants had hypertension for less than 5 years (43%), family history in   (69%), and (57.3%) had knowledge about hypertensive complications. Patients with regular visits constituted (65.7%)  whom the private sector represented the main health care provider (65.5%) of the sample. Diabetes mellitus, cardiovascular diseases, knowledge of hypertension complications and educational level were statistically significantly associated w follow-up w up visits.
CONCLUSION:
the private health sector providers were the preferred side follow-up for 2/3 of the patients. Educational level was inversely associated with regularity of visits, while diabetes and cardiovascular diseases were proportionally associated with the follow-up visit of the patient’s family and friends comprised the main source of information about hypertensive complications rather than health care providers.
 

The Role of Phlebotomy in the Prevention of Pedicled Sural Artery Flap Venous Congestion

Nuas Hassab Jafar; Ahmed Ibraheim Mualla; Ahmed Khalaf Jassim

Iraqi Postgraduate Medical Journal, 2021, Volume 20, Issue 4, Pages 399-405
DOI: 10.52573/ipmj.2020.170487

ABSTRACT:
BACKGROUND:
The lower extremities defects considered one of the most challenging, lack of tissue, exposure of vital structure(bones, tendons, blood vessles, and nevers) make flap coverage is a must,Venous congestion is one of the common consequences in lower extremities flaps,Phlebotomy is one of               the method to reduce venous congestion
OBJECTIVE:
To discuss the role of intravenous catheterization as a method of decreasing venous congestion  in reverse flow Sural artery flap used for the reconstruction of lower limb defects.
METHOD:
Eight patients were treated at Alshadeed Ghazi Alharirie hospital for variable defects in lower limb during the period from January 2018 to April 2019 all treated with reverse Sural flap , the venous drainage of these flaps was enhanced by the addition of phlebotomy tube that was removed after              the blood flow through it stops
RESULTS:
A total of eight patients were included in this study with ages ranging from 30-62 years ( 7 males – 1 female ) cause of defects was trauma ( 5 cases ) , diabetic foot ulcer ( 2 cases ) , and post burn contracture release in one patient .
the site of the defect was heel (3 cases ) , ankle ( 2 cases ) , lower leg ( 2 cases ) and lateral malleolus (1 case ) . the size of the defect was ranging from 7*8 cm to 10*9 cm .all the flaps survived with no reported case of complete or partial flap necrosis , only one patient had mild skin necrosis of about 1 cm in width  of distal margin of the flap which was held with secondary  intention .
CONCLUSION:
Intravenous catheterization of lesser saphenous is a simple and safe method for prevention of venous congestion of distally based Sural artery flap , intensive nursing care is needed and it is associated with less complications.
 
 

The Impact of Serum Zinc Levels on Children with Acute Gastroenteritis

Furat Ghadhban Abdul-Azeez; Saja Baheer Abdulwahhab; Mohammad Fadhil Ibraheem

Iraqi Postgraduate Medical Journal, 2021, Volume 20, Issue 4, Pages 406-410
DOI: 10.52573/ipmj.2020.170488

ABSTRACT:
BACKGROUND:
Diarrhea is the leading cause of morbidity and mortality in children in developing countries. Acute-onset diarrhea is usually a self-limited disease; however, acute infection can have                            a protracted course.     Zinc is an essential nutritional element, with a broad spectrum of biological activities in humans; this element plays an important and vital role in the physical development of digestive and immune systems.  Zinc deficiency is common in children from developing countries due to lack of intake of animal foods, high dietary phytate content, inadequate food intake, and increased fecal losses during diarrhea.
OBJECTIVE:
To assess serum zinc level in children with acute gastroenteritis.
PATIENTS AND METHODS:
We conducted a cross-sectional study on 53 patients who presented with acute gastroenteritis for less than 14 days duration admitted to casualty and general ward units at Children Welfare Teaching Hospital, their age ranged (6months-15years) from 1st   of April  2018 to 31st of October 2018.  A detailed history and examination were done for all cases. A special questionnaire was designed for the purpose of the study. Blood samples for complete blood count, C-Reactive Protein, total serum protein and serum zinc level measurement were obtained from patients at admission Serum samples of the patients for measurement of zinc levels were collected in tubes free of trace elements and stored at (−20°C) until measurement. Zinc concentrations were determined by atomic absorption spectrophotometer. 
RESULTS:
Fifty-three children with acute gastroenteritis were included in the study (40 males and 13females), their age was between 6 months-15 years. The median duration of diarrhea (4 ± 2.7) days and mean serum zinc (86.2± 26.6). A total of 18 (34%) children had low serum zinc levels.
The mean serum zinc seen was lower in patients with duration of diarrhea   < 5 days than patients with duration of diarrhea ≤ 5 days; the result is statistically significant in both groups p-value > 0.05. There were no significant differences in demographic and clinical characteristics between patients with normal zinc levels and those with zinc deficiency.
CONCLUSION:
 The serum zinc in children with gastroenteritis has revealed a significantly decreased level.
 
 

Neutrophil-To-Lymphocyte and Platelet-To-Lymphocyte Ratios in Pregnant Diabetic Patients: A Hospital-Based Study

Sura Mohammed Salah; Shahla Kareem Alalaf

Iraqi Postgraduate Medical Journal, 2021, Volume 20, Issue 4, Pages 411-417
DOI: 10.52573/ipmj.2020.170489

ABSTRACT:
BACKGROUND:
Diabetes in pregnancy has a major health risk to the mother and the fetus. Neutrophil-to-lymphocyte ratio (NLR) and the platelet-to-lymphocyte ratio (PLR) were shown to be as important markers of inflammation in neoplasms, cardiac diseases and diabetes-associated complications.
OBJECTIVE:
To estimate the mean Lymphocyte, Neutrophil, Platelet, PLR, NLR in diabeticand non-diabetic pregnant women and to identify the correlation between NLR and PLR with each type of diabetes in pregnancy.
PATIENTS AND METHODS:
A case control study was conducted to determine the relationshipbetween (PLR) and (NLR) in 2 groups of pregnant women; in Diabetic Centre and outpatient clinics, Maternity Teaching Hospital, Kurdistan region, Iraq from 21st February 2019 to 15th September 2019. Study included 100 pregnant women 24-36 weeks gestation after exclusion of cardiovascular risk factors and underlying chronic inflammatory conditions. Group 1 included 50 diabetic women having positive 75g-OGTT(gestational DM) or known cases of type 1 or 2 diabetes mellitus. Group 2 were control group having negative 75g-OGTT .
RESULTS:
The neutrophil count was significantly higher in the diabetic group .No significantdifferences were detected between the two study groups regarding the platelets (p = 0.225), lymphocytes (p = 0.251), NLR (p = 0.121), PLR (p = 0.784) except for the difference between type II diabetes and the control group where the mean NLR among type II diabetics was 3.86 and that of the control was 3.16 (p = 0.029).
CONCLUSION:
We could only find significant difference in terms of NLR in type 2diabetes mellitus when compared to the comparison group and in terms of PLR in type 2 diabetes mellitus when compared to the gestational diabetes group.
 

cloud computing cloud computing cloud computing

YASIR Mohammed Hasan HAMANDI

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

cloud computing cloud computing cloud computing cloud computing cloud computing cloud computing cloud computing cloud computing cloud computing cloud computing cloud computing cloud computing cloud computing cloud computing cloud computing cloud computing cloud computing cloud computing cloud computing cloud computing cloud computing cloud computing cloud computing cloud computing cloud computing cloud computing cloud computing cloud computing cloud computing cloud computing cloud computing cloud computing cloud computing cloud computing cloud computing cloud computing cloud computing cloud computing cloud computing cloud computing cloud computing cloud computing cloud computing cloud computing cloud computing cloud computing cloud computing cloud computing cloud computing cloud computing cloud computing cloud computing cloud computing cloud computing cloud computing cloud computing cloud computing cloud computing cloud computing cloud computing cloud computing cloud computing cloud computing cloud computing cloud computing cloud computing cloud computing cloud computing cloud computing cloud computing cloud computing cloud computing cloud computing cloud computing cloud computing cloud computing cloud computing cloud computing cloud computing cloud computing cloud computing cloud computing cloud computing cloud computing cloud computing cloud computing cloud computing cloud computing cloud computing cloud computing cloud computing cloud computing cloud computing cloud computing cloud computing cloud computing cloud computing cloud computing cloud computing cloud computing cloud computing cloud computing cloud computing cloud computing cloud computing cloud computing cloud computing cloud computing cloud computing cloud computing cloud computing cloud computing cloud computing cloud computing cloud computing cloud computing cloud computing cloud computing cloud computing cloud computing

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.

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 Validity of Beck Depression Inventory –Short Version in Depressed Patients Diagnosed According to ICD10

Abdul-Rasoul Al-Yasiri; Yasir S. AbdKarkosh

Iraqi Postgraduate Medical Journal, 2013, Volume 12, Issue 4, Pages 603-613

ABSTRACT:
BACKGROUND :
Beck Depression Inventory (often abbreviated asBDI) is an instrument to measure the severity and depth ofdepression symptoms. BDI was developed in a novel way for its time by collating patients' verbatim descriptions of their symptoms and using these to construct a scale which could reflect the intensity or severity of a givensymptom.
OBJECTIVE:
To measure the validity of Beck depression Inventory short version using ICD 10 criteria for major depression as a gold standard
METHOD AND PATIENTS :
The study was carried out in IbnRushd and Baghdad Teaching Hospitals. The sample was selected purposely among patients diagnosed to have major depressive disorder according to the ICD- 10 criteria for major depressive disorder. For each patient a clinical interview was done using the ICD 10 criteria for major depressive episode after being given beck depression inventory – short version in a paper
RESULTS :
The overall result indicates ‘fair to good’ agreement between both Beck and ICD-10 suggesting that Beck Depression Inventory is valid in assessing the degree of severity of depression
CONCLUSION:
Beck Depression Inventory short version (13 item ) is adequate in assessing the severity of depression in patients with ICD-10 diagnosis of depression

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

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.

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.

Publisher: The Iraqi Board for Medical Specializations

Email:  ipmj2000@yahoo.com

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

Managing Editor: prof. Yasir M.H. Hamandi

Print ISSN: 1608-8360

Online ISSN: 2706-9893

Keyword Cloud

Related Journals