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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Viral load, T-Cells Count, and T-cells SARS-CoV-2 Cross-Reactivity Constitute a Triad Governing the Varied Prognosis of COVID-19

Ahmed Sahib Abdulamir; Rand Riadh Hafidh

Iraqi Postgraduate Medical Journal, 2021, Volume 20, Issue 1, Pages 0-0
DOI: 10.52573/ipmj.2020.167818

The novel coronavirus disease, COVID-19, impose a challenge on scientists and physicians in terms of understanding the phases of viral pathogenesis and host immunopathogenesis that lead to the fatal complications of the disease. Three pillars have been thought to play essential role in determining the prognosis of COVID-19, namely the viral load of SARS-CoV-2, the count and functionality of T lymphocytes and the crossreactivity of T lymphocytes with common cold coronaviruses. Collectively, these three factors might constitute a triad governs the time-based and phase-based progression of COVID-19
patients. This review discusses the role of this triad in COVID-19 and presents the so far accumulated knowledge and research that justify the central role of this triad of factors in disease prognosis. Understanding the factors control disease progression is most important in helping physicians to treat the multi-phased host-microbe disease.

Clinical Manifestations of Ocular Toxoplasmosis at a Referral Center in Iraq

Ahmed Fadhil Abdulhadi

Iraqi Postgraduate Medical Journal, 2021, Volume 20, Issue 1, Pages 1-7
DOI: 10.52573/ipmj.2020.167819

BACKGROUND:
Ocular toxoplasmosis is an important cause of posterior uveitis worldwide including Iraq.
OBJECTIVE:
To study the clinical manifestations of ocular toxoplasmosis at a referral center in Iraq.
PATIENTS AND METHODS:
Nine months prospective case series study was performed in the outpatient clinic at Ibn Al Haetham teaching eye hospital in Baghdad, Iraq. The diagnosis was mainly clinical supported by serological tests.
RESULTS:
In this study 20 patients were diagnosed with Ocular toxoplasmosis. Primary active, recurrent & an inactive diseases were reported in: 8 patients (40%), 7 patients (35%) & 5 patients (25%) respectively. Unilateral disease was seen in 13 patients (65%), while bilateral disease was seen in 7 patients (35%). The macula was involved in 15 eyes (55.5%). Visual acuity at presentation was: ≤ 6/36 seen in 15 eyes (55.5%). Complications –reported at a rate of (75%)- were include: High IOP, macular edema, optic disc swelling, Choroidal neovascularization & branch retinal vein oclusion.
CONCLUSION:
The commonest type of presentation of ocular toxoplasmosis seen in this study was the primary active retinitis, followed by recurrent disease. Poor visual outcome seen at the end of treatment course was mainly due to macular involvement.

Evaluation of Maternal Serum Ischemia Modified Albumin in Ectopic Pregnancy

Alaa Nadhim Hameed; Ayla Khether Ghalib

Iraqi Postgraduate Medical Journal, 2021, Volume 20, Issue 1, Pages 8-16
DOI: 10.52573/ipmj.2021.167820

BACKGROUND:
An ectopic pregnancy is defined as the implantation of a pregnancy outside the normal uterine cavity. Serum ischemia-modified albumin (IMA) and adjusted IMA appear to be significantly increased during pathological pregnancies.
AIM OF THE STUDY:
To compare the level of IMA in ectopic and normal pregnancies, thus understanding the association between oxidative stress and the incidence of ectopic pregnancy.
METHODS:
A case-control study that included 80 women; 38 of them with ectopic pregnancy, and the other 42 were healthy pregnant women. Patients with systemic diseases, a history of smoking, the use of antiinflammatory drugs and antioxidants were excluded from the study. Serum IMA was measured using enzyme-linked immunosorbent assay (ELISA) for all participants.
RESULTS:
Means of IMA and adjusted IMA in women with ectopic pregnancy were significantly higher than that in women with normal pregnancy.
CONCLUSION:
There is an association between oxidative stress and ectopic pregnancy

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 .

The Correlation of Remission Induction Therapy with Plasma Vascular Endothelial Growth Factor Level in Acute Myeloid Leukemia Patients

Raghad Falah Al-Khawaja; Haithem Ahmed Al-Rubaie

Iraqi Postgraduate Medical Journal, 2021, Volume 20, Issue 1, Pages 27-32
DOI: 10.52573/ipmj.2021.167822

BACKGROUND:
Angiogenesis seems to be important for leukemogenesis and susceptibility to intensive chemotherapy, and high levels of vascular endothelial growth factor (VEGF) is detected in acute myeloid leukemia (AML) patients
AIM OF THE STUDY:
To assess the correlation of plasma VEGF level with the response to remission induction therapy in adult AML PATIENTS.
PATIENTS AND METHODS:
An analytical cross-sectional study performed on thirty adult patients with newly diagnosed AML. Plasma VEGF level measured by ELISA in all patients twice, before and after chemotherapy.
RESULTS:
The VEGF level was significantly higher in AML patients, at presentation, than control group with median level of 88.13 pg/mL and 49.26 pg/mL, respectively (P=0.002). The median VEGF level decreased after chemotherapy in patients who achieved complete remission although not statistically significant (P=0.071). Whereas the level increased significantly after treatment in patients who failed to response to induction therapy, from 66.27 pg/mL to 165.37 pg/mL (P= 0.025).
CONCLUSION:
Plasma VEGF level was high in adult AML patients at presentation and increases significantly after induction therapy in AML patients who responded poorly to treatment. However, in patients who achieved complete remission the level normalize after therapy, although statistically insignificant.

Measurement of Axial Length by Applanation Ultrasound Relative to Optical Biometry in Normal Eye

Zainab Hussain Ali; Suzan Abdulmuhsin Abdulkareem

Iraqi Postgraduate Medical Journal, 2021, Volume 20, Issue 1, Pages 33-38
DOI: 10.52573/ipmj.2021.167823

BACKGROUND:
The precision of axial length measurement has great impact on successful cataract surgery and refractive outcome besides its diagnostic role of many ophthalmic conditions. There are various methods for axial length measurement which differ in their operating principle and technology beside the difference in their advantage and limitation.
AIM OF STUDY:
To compare the axial length measurement performed with optical biometry IOLMaster 500(Carl-Zeiss Meditec,Jena, Germany) with those obtained by applanation ultrasound (A-Scan biometer AL-100) in three groups.
METHODS:
207 eyes of 104 candidates with age range (20-40 year) were included. These candidates divided into three groups according to axial length; group 1 (22 - 24 mm), group 2 (24.1 – 26 mm) and group 3 (26.1– 28 mm). Axial length was measured in three groups, firstly by optical biometry then by applanation ultrasound by the same examiner.
RESULTS:
The axial length measured by IOLMaster was longer than by applanation ultrasound in all groups. The mean differences were (0.15mm, 0.15mm and 0.2 mm) in three groups respectively, which were statistically significant p-value < 0.05. Bland-Altman plots shows there is good agreement between measurements of two devices for all groups.
CONCLUSION:
The results show optical biometry provided longer axial length than applanation ultrasound with hypermetropic shift (0.35D-0.5D) by applanation ultrasound in normal eye.

Interphase Fluorescence in Situ hybridization Analysis of 17p13.1 and 11q22.3 Deletions among CLL Patients

Shaymaa Al-Thahir

Iraqi Postgraduate Medical Journal, 2021, Volume 20, Issue 1, Pages 39-45
DOI: 10.52573/ipmj.2021.167832

BACKGROUND:
Chronic lymphocytic leukemia (CLL) is a B‐cell neoplasm. It is the most frequent adult leukemia in European countries, comprising up to 30% of all adult leukemias with male predominance. Detection of a 17p13.1 deletion (loss of TP53) or 11q22.3 deletion (loss of ATM), by fluorescence in situ hybridization (FISH), is associated with a poorer prognosis.
OBJECTIVE:
This study aims to analyze the frequency of cytogenetics abnormalities among CLL patients.
PATIENTS, MATERIALS AND METHODS:
This study enrolled 30 adult patients presented with chronic lymphocytic leukemia visiting Baghdad teaching hospital/hematology center lab/cytogenetic unit-Baghdad /Iraq during the period extending from Mar. till Nov. 2020.The patients were diagnosed on the basis of standard clinical (Lymph node involvement and / or hepatosplenomegally), hematological and immunophenotypic criteria for diagnosis of B-CLL. Interphase FISH technique was performed on peripheral Blood samples using XL ATM/TP53 dual-color probe.
RESULTS:
We studied 30 CLL patients by I-FISH technique to detect the occurrence of cytogenetic abnormalities, eighteen (60%) had one or more cytogenetic abnormalities; Eleven (36.7%) had 17p- (including 2 with 17p- and 11q- in separate clones), Five (16.7%) had 11q-, and Two (6.7%) of patients had clonal 17p-/11q-. Twelve (40%) had neither 17p- nor 11q-. There was no statistically significant clinico pathological correlation with these cytogenetic abnormalities; p-value >0.05.
CONCLUSION:
The cytogenetic abnormalities including 17p-, 11q- and clonal 17p-/11q- among CLL patients occur within the reported figures worldwide. There was no statistically significant clinico pathological correlation with these cytogenetic abnormalities.
 

Evaluation of Protein C and Protein S in Pregnant Females with Preeclampsia

Dafar Kamil Saleh; Subh S. Al Mudallal

Iraqi Postgraduate Medical Journal, 2021, Volume 20, Issue 1, Pages 46-52
DOI: 10.52573/ipmj.2021.167825

BACKGROUND:
Preeclampsia (PE) is a multisystem progressive disorder characterized by the new onset of hypertension and proteinuria. Women with PE have been shown to be at increased risk of venous thromboembolism (VTE).
OBJECTIVE:
To evaluate the levels of protein C and protein S among females with PE, and todetermine whether there is relationship between deficiencies of these proteins and PE severity.
SUBJECTS AND METHODS:
A total of 30 pregnant women with PE and other 30 normotensive age-matched healthy pregnant women in their third trimester of pregnancy were enrolled in this case-control study.  Beside blood pressure and general physical examination of each participant, peripheral venous blood sample were tested for complete blood count (CBC) prothrombin time (PT) activated partial thromboplastin time (APTT), protein C and protein S.
RESULTS:
Out of 30 patients, there were 8 patients 26.67%) who had protein C deficiency compared to only 1 pregnant woman (3.33%) among the control group with a significant difference. Likewise, the frequency of protein S deficiency was 20% among patients, while none among controls had such deficiency. Mean plasma level of protein C and protein S in preeclmaptic women was 79.07±21.94% and 68.73±13.19%, respectively which was significantly lower than that of women with normal pregnancy (90.0± 14.96% and 78.67±10.17%, respectively). Furthermore, 50% of women suffering from protein C or protein S deficiency experienced severe PE while 95.45% and 91.67% of women with sufficient protein C and protein S, respectively displayed mild form of the disease.
CONCLUSION:
Both protein C and protein S significantly reduced in pregnant women with PE and are associated with the severity of the disease. 
 

Bladder and Prostate Sonomorphology as Non Invasive Method for Assessing the Lower Urinary Tract in Patient with Symptomatic Bladder Outlet Obstruction Due to Benign Prostate Enlargement

Ali Abdulihsan Thanun; Usama Sulaiman Alnasiri

Iraqi Postgraduate Medical Journal, 2021, Volume 20, Issue 1, Pages 53-57
DOI: 10.52573/ipmj.2021.167826

BACKGROUND:
Measurement of the bladder weight, bladder wall thickness and intravesical prostatic protrusion can be done by using ultrasound which is a simple, non-invasive and less complex, which may predict bladder outlet obstruction in patient with benign prostatic hyperplasia.
PATIENTS AND METHOD:
Across sectional comparative study conducted inUrology outpatient department at Ghazi al-Hariri hospital for surgery specialties during the period between the first of March 2017 till the end of July 2018, a sample of 47 men aged 50 years or older with LUTS/BPH grouped in 2 groups according to urodynamic results: patients with bladder outlet obstruction and patients patient without outlet obstruction.
RESULTS:
In this study, we observed that bladder wall thickness, bladder weight and intravesical prostate protrusion were higher in bladder outlet obstruction group as compared to non- bladder outlet obstruction group with significant accuracy, sensitivity and specificity.
CONCLUSION:
Ultrasonographic measurements of bladder wall thickness, ultrasound estimated bladder weight and intravesical prostate protrusion are good parameters for the diagnosis of symptomatic bladder outlet obstruction due to benign enlargement of the prostate and they are easy to measure, with no complications, less time consuming and cost effective.
 

''Efficacy and Safety of Polyacrylate Polyalcohol Co-polymer (Vantris) Injection Material in the Endoscopic Treatment of VUR in Children: 3 Years of Prospective Follow Up

Muthanna Habeeb Abid; Abdullah Amir Kadhum

Iraqi Postgraduate Medical Journal, 2021, Volume 20, Issue 1, Pages 58-66
DOI: 10.52573/ipmj.2021.167827

BACKGROUND:
To evaluate the safety, efficacy and durability of Vantris injection over a period of 3 years.                                                                                                                                        
PATIENTS AND METHOD: 
From 2015 to 2018 we followed 40 patients {male 14, female 26} with a mean age of 4.2±3.4 years (mean ± SD) underwent endoscopic Vantris injection therapy for treatment of primary vesicoureteral prospectively by voiding cystourethrogram at 3months, 1 year and 3 years. Those 40 patients comprising 70 refluxing renal unit (RRU), were unilateral in 10 patients and bilateral in 30 patients. Those were grade II in 10 RRU, grade III in 35 RRU and grade IV in 25 RRU. The volume of injected Vantris material was 0.8ml (range 0.4-1.2 ml) per refluxing unit. The patients were followed. Ultrasound was used at 1 week, 1 month and yearly for 3 years.
RESULTS:                                                                                                                                         
All patients completed 3 years follow up by voiding cystourethrogram.  At 3months VCUG 1 was done and shows: 10/10 RRU of grade II, 32/35 RRU of grade III and 23/25 RRU of grade IV show complete resolution of reflux, Success rate is 92.85%. At 1year VCUG 2 was done and shows: 10/10 RRU of grade II, 32/32 of grade III and 21/23 of grade IV show complete resolution of reflux, Success rate is 96.92%. At 3years VCUG 3 was done and shows: 10/10 RRU of grade II, 32/32 of grade III and 21/21 of grade IV show complete resolution of reflux, Success rate is 100%. The overall success rate is 63/70 (90%).    
CONCLUSION:
Endoscopic injection of Vantris material for treatment of vesicoureteral reflux in children is very effective, safe and durable, and can be considered as first line treatment of grade Ⅱ-Ⅳ vesicoureteral reflux.
 

The Evaluation of Complications of Titanium Mesh Reconstruction in Orbital Floor Fractures

Ghufran Majid Hayder; Waleed Khalil Ismael

Iraqi Postgraduate Medical Journal, 2021, Volume 20, Issue 1, Pages 67-71
DOI: 10.52573/ipmj.2021.167828

BACKGROUND:
The facial symmetry is a specific measure of bodily symmetry and it influences judgements of aesthetic traits, therefore special attention and care must payed during orbital fracture treatment to consider every detail in the scenario of surgical reconstruction. Many materials have been used for treatment of orbital bones fractures and titanium mesh is widely used implant for this purpose therefore it worthwhile to study it.
AIM OF STUDY:
Evaluate the complications of using titanium mesh in the treatment of orbital floor fractures.
MATERIALS AND METHODS:
The study included 13 patients (11 males and 2 females) presented to Oral and Maxillofacial Surgical Department in Al-Yarmook Teaching Hospital Iraq/ Baghdad in the period from January 2018 to June 2019 with traumatic orbital floor fracture and they underwent reconstruction with titanium mesh.
RESULTS:
The results showed that the most common cause for trauma was road traffic accident (53.8%). Preoperative diplopia found in 12 patients (92.31%) followed by persistent diplopia found in only one (7.69%). Preoperative enophthalmos was (61.5%) in eight patients, six of them improved after treatment and returned to the normal condition but only two had postoperative enophthalmos with less severity.
CONCLUSION: 
The reconstruction of orbital floor using titanium mesh was successful in most of the cases and the resulted was good and satisfactory aesthetic and functional results.
 

Comparison of Accuracy Between CT Versus MRI in Staging of Muscle Invasive Bladder Carcinoma

Mohammed Noori Al-Musawi; Anas Mohammed Al-obaidi

Iraqi Postgraduate Medical Journal, 2021, Volume 20, Issue 1, Pages 72-78
DOI: 10.52573/ipmj.2021.167829

BACKGROUND:
Transitional cell carcinoma of the bladder is one of the most widely recognized cancers affecting the genitourinary tract  and it is the second most common cancer in Iraqi male population .Cross sectional imaging studies assume a significant role in the staging of this cancer , also the prognosis of  the patients with bladder carcinoma worsens with higher stage and accurate preoperative radiological staging is required to increase cancer free  survival for patients submitted for radical cystectomy.
OBJECTIVE:
To compare the accuracy of computed tomography and magnetic resonance imaging for staging of muscle-invasive bladder cancer.
PATIENTS AND METHODS:
Twenty patients were included in the study hnd undergone staging for their muscle invasive bladder cancer by the use of computed tomography scan and magnetic resonance imaging at least two weeks of their last trans-urethral resection of tumour, the radiological staging was compared to the staging of the histopathological reports of the radical cystectomy of the included patients.
RESULTS:
The staging accuracy of the computed tomography was 93.8%, sensitivity 88.8%, specificity 90.2%, while magnetic resonance imaging accuracy of staging was 71.30%, sensitivity 45.8%, specificity 81.70%. Accuracy increased with advancing stage.
CONCLUSION:
It is concluded that computed tomography staging is more accurate than magnetic resonance imaging tumor staging in patients with muscle invasive bladder cancer, with comparable results in lymph node staging.
 

Evaluation of Gamma Knife Effect on Patients with Pituitary Adenoma

Mohammed Talib Razuki; Yasir Moahammed Hasan Hamandi

Iraqi Postgraduate Medical Journal, 2021, Volume 20, Issue 1, Pages 79-90
DOI: 10.52573/ipmj.2021.167830

BACKGROUND:
Pituitary adenomas are common benign brain tumors which account for 15% of all primary brain tumors & 25% of benign brain tumors. It's treatment modality includes medical management and surgery either transcranial or trans-sphenoidal. In recent years, gamma knife radiosurgery has emerged as a treatment modality in the management of pituitary adenoma especially for those cases who have residual tumor and/or those who are not candidate for surgery.
 PATIENT AND METHODS:
This prospective and retrospective study was conducted on 132 pituitary adenoma patients (54 males and 78 females) with a mean age of 45.6 years. Patients were of four groups, 67 with  prolactinoma, 10  with  somatotroph adenoma, 22 with Cushing disease (ACTH releasing), and 33 with non-functional adenoma. Before       performing the gamma knife treatment, a pre-MRI examination was done to these pituitary adenoma patients, then the post-MRI examination was done after 6 months, 1 year and 1.5 year of gamma knife treatment as well as clinical evaluation by examining the type of secretion and hormonal laboratory investigation with visual field assessment.
RESULTS:
In our study, the most pituitary adenoma group treated with gamma knife was prolactinoma patients (67), with a size of treatment ranging from 2-55 mm, showing 88.05% tumor necrosis; with hormonal level normalization reaching to 82.08%. In the (10) growth hormone releasing adenoma patients, the size of treatment ranged from 5-48 mm, with (90%) tumor necrosis, and (90%) hormonal level normalization. In the (22) ACTH-releasing adenoma patients, the size treated ranged from 3-29 mm, with tumor necrosis of (86.36%), and (81.81%) hormone level normalization, whereas in the (33) non-secretory type of adenoma, the size of treatment ranged from 18-67 mm and the tumor necrosis was 93.93%.
CONCLUSION:
 It can be concluded from this study that gamma knife is an effective and safe option to treat pituitary adenomas by it's low incidence of both morbidity and mortality rate; the tumor necrosis is the highest in non-secretory type when the dose was above 18 grey, but the peri-tumoral edema was found in prolactinoma when the dose of irradiation was above 22 grey.
 

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.
 

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 .

Focal Dermal Hypoplasia )Goltz Syndrome(

Luay Abdulla Al-Nouri

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

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

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

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

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

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

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.

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.

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.

Pulmonary Function Test in Cement Workers in Iraq

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

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

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

“Cytomegalovirus Seroprevelance in Iraqi Pregnant Women”

Sajed Nader; Mohammed Ayad

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

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

Publisher: The Iraqi Board for Medical Specializations

Email:  ipmj2000@yahoo.com

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

Managing Editor: Prof. Abdul Munem AL- Dabbagh

Print ISSN: 1608-8360

Online ISSN: 9893-2708

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