Keywords : KEY WORDS


Outcomes of Gamma Knife Surgery in the Treatment of Patients with Metastatic Brain Tumors

Iraqi Postgraduate Medical Journal, 2019, Volume 18, Issue 1, Pages 1-9

BACKGROUND:
Cerebral metastases are by far the most common intracranial tumors in adults. gamma knife
radiosurgery has arguably been the most important advancement in the management of metastatic
brain tumors since the 1980s.
OBJECTIVE:
To evaluate the effectiveness of gamma knife radiosurgery as a treatment of metastatic brain
tumors.
METHODS:
This is a prospective study (the first trial in Iraq) of 27 patients (42 tumors) of brain metastasis
between March 2016 and October 2017. Imaging follow up done in 6 months and 12 months,
clinical follow up done in 3 weeks and 3 months.
RESULTS:
In the first six months 81.0% of the MBTs were regressed or remain stable in size. After 3
months post GKS, 81.5% patients showed neurological improvement. 82.4% of the patients<65
years old survive for 12 months and 85% of patients with KPS>70 survive for 12 months.
CONCLUSION:
The routine blood investigations, the gender and the location were of no significance on patients’
general outcome or the tumor/edema response to gamma knife. Presence of extracranial
metastasis, single or multiple MBTs found to have important effect on patients’ survival.

Gamma Glutamyltransferase as a Biomarker for Acute Coronary Syndrome

Iraqi Postgraduate Medical Journal, 2019, Volume 18, Issue 1, Pages 43-51

ABSTRACT :
BACKGROUND:
GGT ( gamma- glutamyl transferase ) enzyme is found on the surface of various cells and plays a
role in the catabolism of glutathione which is known as one of the major anti oxidants,
OBJECTIVE:
Of this study : was to emphasize the changed GGT values as anew biochemical marker for acute
coronary syndrome
METHOD:
Type of study is a case – control study. The study population: We enrolled 50 patients with acute
coronary syndrome who had been admitted to ccu unit in Merjan Teaching hospital, measurement
of serum gamma- glutamyl transferase level using gamma- glutamyl transferase was measured by
enzymatic method using the Abbott Architect C16000 autoanalyser and compared to the serum
gamma- glutamyl transferase level of the 50 control group , the period of the study is 6 months.
Both groups will under go an exclusion criteria for all causes that may lead to a high gammaglutamyl
transferase level mainly hepatobiliary diseases , alcohol history, diabetes mellitus , and
drugs that affect the gamma- glutamyl transferase level .
RESULT:
Of the study: showed that gamma- glutamyl transferase level is elevated in all patients with
documented acute coronary syndrome after exclusion of other factors which cause elevation of
gamma- glutamyl transferase in comparism with the control .
CONCLUSION & RECOMMENDATION:
This study depicts association of gamma- glutamyl transferase with acute coronary syndrome in
population from Babylon governorate & Larger community based studies are needed to establish
the role of gamma- glutamyl transferase in development of the commonly mentioned risk factors
of acute coronary syndrome. We recommend the use of GGT as a biomarker within the 4 days
events of acute coronary syndrome .

Assessment of the Improvement of Global and Segmental Diastolic Dysfunction after Coronary Arteries Revascularization

Iraqi Postgraduate Medical Journal, 2019, Volume 18, Issue 1, Pages 18-29

ABSTRACT:
BACK GROUND:
With respect to cardiovascular performance at rest and exercise, diastolic function is of equal
importance to systolic function, which is the ability of the ventricle to fill at low left atrial pressure and
diastolic HF have hospitalization rates similar to those with systolic dysfunction
OBJECTIVE:
To assess the effect of successful coronary revascularization on segmental LV diastolic dysfunction and
the effect of this segmental improvement on global diastolic function.
METHODS:
patients with diastolic LV dysfunction and ischemic heart disease that are documented by coronary
angiography were selected randomly in a prospective interventional study at Ibn Al-Bitar Hospital For
Cardiac Surgery from June 2012 till April 2013 and followed up to one month post coronary
revascularization with Doppler echo-parameters and tissue myocardial velocities for any Improvement
in global or regional diastolic dysfunction.
RESULTS:
Twenty nine ischemic left ventricular segments of total 43 segments with diastolic dysfunction showed
improvement in diastolic function one month after successful revascularization.
CONCLUSION:
Segmental diastolic dysfunction can be improved with revascularization of the stenotic coronary artery
supplying that segment.

Experience in Pediatric Pre-Adolescent Laparoscopic Cholecystectomy in Erbil

Iraqi Postgraduate Medical Journal, 2019, Volume 18, Issue 1, Pages 59-61

ABSTRACT:
BACKGROUND:
Gallstones in children are rare but can become a potentially serious condition [1,2]. Symptomatic
cholelithiasis that is requiring surgery in children has been increased in tendency over the last 10
years. The incidence of cholelithiasis in children ranges from 0.13 to 1.9 % and when compared
with the adult population , the risk of cholelithiasis incidence is assessed to be as 10–15 % . The
experience of pediatric surgical centers is estimated to be very scarce (3,4) . Contemporary
Laparoscopic Cholecystectomy is considered as the gold standard procedure in the management of
gallbladder diseases in both adults and children . Children that are considered to be a candidates for
surgery should be operated in pediatric surgery clinics experienced in minimally invasive
techniques (3) .
OBJECTIVE:
Pediatric laparoscopic cholecystectomy has not been evaluated in Iraq , here is an evaluation of
the procedure for 29 cases is presented mainly to study its application in this group of patients.
PATIENTS AND METHODS:
This is a preliminary study of 29 cases of pediatric laparoscopic cholecystectomy performed in
Erbil city in the period from 2011 to 2017. Age range was 5 months -11 years, 21 males & 8
females . Three of them were obese & one overweight . Both , three millimeter & 5 mm ports were
used , 4 ports were inserted .
RESULTS:
Out of 29 cases, 21 (72.42 %) were males & 8 (27.58 %) were females, ranging from 5 months –
11 yrs . Twenty – five of the cases were electively operated on . Oral feeding started after 6 hrs ,
patients were discharged after 8 hrs except two patients who stayed for 36 hrs , mean hospital stay
was 13 hrs and 42 min . The mean operative time was 31 min (range from 20 min to 60 min) . The
was laparoscopic cholecystectomy performed by single specialist pediatric surgeon. All cases were
done as day case surgery except for the emergency cases. The time of hospitalization ranged from
8 hrs to 3 days. There were no intra operative complications that require reoperation such as injury
to the common bile duct or other viscera, bile leakage or vascular injury.
CONCLUSION:
Laparoscopic surgery is a safe procedure in children for excising the gall bladder . Age of the
patient is not a contraindication to operation , and LC may be performed even in young children
with symptomatic gall bladder disease with low morbidity . it should therefore be considered as the
procedure of choice in pediatric patients (10,11) .

Internet Addiction Disorder and Its Determinants among a Sample of Medical Students in Baghdad; 2017

Iraqi Postgraduate Medical Journal, 2019, Volume 18, Issue 1, Pages 68-75

ABSTRACT:
BACKGROUND:
Internet has become an important part of our daily life, despite a lot of beneficial services available
on the internet, excessive use may lead to negative consequences. College students are the most
at risk group
OBJECTIVE:
This research aimed at estimating the prevalence of internet addiction disorder and trying to find out
its determinants among Medical College Students in Baghdad..
PATIENTS AND METHODS:
This cross sectional questionnaire survey was conducted on a sample of Al-Kindy Medical College
Students in Baghdad using a self-administered questionnaire, information collected from 263 students
from April through May 2017.
RESULTS:
The study showed that the Prevalence rate of internet addiction disorder among Al-Kindy Medical
College Students was 49 %.A statistically significant relation had been found between internet
addiction score and hours spent online daily, using social network applications and online games, and
daily hours spent online (p<0.05).
CONCLUSION:
Internet addiction is common among Al-Kindy Medical College Students. Spending more hours
online per day, using social network applications and games were among the determinants of internet
addiction disorder.

MRI Finding of Cartilaginous Endplates Herniation of Lumbar Spine in Patient with Low Back Pain

Iraqi Postgraduate Medical Journal, 2018, Volume 17, Issue 4, Pages 328-334

ABSTRACT:
BACKGROUND:
Magnetic resonance imaging (MRI) provides a noninvasive assessment of the lumbar spine. Little is
thought about the MRI characteristics of cartilaginous endplate (CEP) and CEP herniation on the
ground that their normal thickness is only 0.6mm, making it hard to perceive at routine MRI
examinations
OBJECTIVE :
To study the reliable magnetic resonance imaging findings suggested cartilage endplate herniation in
lumbar spine.
PATIENTS AND METHODS:
This prospective study was conducted on 46 patients with low back pain in the MRI unit of Al-
Imamein Alkadhmein Medical City, Baghdad, Iraq between September, 2016 and August 2017.
Inclusion criteria: adult patients with lumbar disc herniation proved by MRI with surgical prove of
cartilage end plates herniation. Exclusion criteria include: patients with previous back surgery,
history of spinal tumor and the general contraindications to MRI. Sagittal and axial T1-weighted
spino-echo image and sagittal and axial T2 weighted spine echo images were obtained. Statistical
analysis using SPSS version 23, the level of significance (p value) was set as ≤ 0.05.
RESULT:
Forty six patients with low back pain were included in this study, the mean age of 44±9 years, 26
patients were females and 20 patients were males.The CEP herniation was detected by MRI among
52.2% of patients with back pain. There was a highly significant association between CEP and
increased age of the patients, back pain radiated to both limbs, L4-5 defect site, modic changes and
lumbar posterior marginal nodes (p value 0.01, 0.004, 0.02, 0.03 and <0.001 respectively). No
significant differences between patients with CEP herniation and those without CEP herniation
regarding posterior osteophytes, dorsal vertebral cornal defect, heterogeneous signal intensity and
posterior corner and mid endplate irregularities. There was a highly significant association between
lumbar posterior marginal nodes and CEP herniation (p<0.001).
CONCLUSION:
CEP herniation is more prevalent among advanced age and at lower lumbar level. The most common
MRI signs related to CEP herniation were modic changes in mid endplate and lumbar posterior
marginal nodes.
.

Enoxaparin versus Unfractionated Heparin in Elective Percutaneous Coronary Intervention; Efficacy and Safety Study

Iraqi Postgraduate Medical Journal, 2018, Volume 17, Issue 4, Pages 340-347

ABSTRACT:
BACKGROUND:
Since long time, unfractionated heparin has been used as standard anticoagulant
for percutaneous coronary intervention(PCI).however, recently several studies showed that intravenous
enoxaparin safety and effectiveness is similar to that of unfractionated heparin.
OBJECTIVE :
To assess the safety and practicity of enoxaparin compared with un fractionated heparin in elective PCI
using drug eluting stents (DES).
METHODS:
In this prospective, randomized trial, at the cardiac unit of Ashty hospital in Erbil city, from July 2014
to February 2016, we included 300 patients undergoing elective PCI. 150 patient received enoxaparin
0.6 mg per kilogram of body weight, the other 150 patient received unfractionated heparin 100 u per
kilogram of body weight adjusted for activated clotting time.
The primary end point is the incidence of bleeding (minor or major). While the mortality and the
incidence of acute coronary events within 24 hours after PCI was the secondary end point.
RESULTS:
There was reduction, however statistically insignificant (p value>0.05) in the rate of major and minor
bleeding in Enoxaparin group in the first 24 hours as compared with unfractionated heparin (4 % vs.
5.25%; absolute difference –1.25).The acute coronary events and death rate was similar.
CONCLUSION:
In elective PCI using DES, a single intravenous bolus of Enoxaparin at a dose of 0.6 mg per kilogram
was at least as safe as effective as unfractionated heparin with simpler use and faster indwelling sheath
removal.
.

A Study of Adiponectin/Leptin Ratio in Adult Males with Metabolic Syndrome

Iraqi Postgraduate Medical Journal, 2018, Volume 17, Issue 4, Pages 355-359

BACKGROUND:
Metabolic syndrome is a disorder of energy utilization and storage. It is a multi-component disease
brought on by a combination of life style and environmental factors, with some populations
exhibiting a genetic predisposition and type 2 diabetes. It is marked by abdominal obesity, elevated
levels of triglyceride, low levels of HDL (good) cholesterol, high blood pressure and high blood
sugar levels. Metabolic syndrome is a significant risk factor for the development of both type 2
diabetes and heart disease, also associated with fatty liver, and polycystic ovary syndrome.
Recently two adipocytokines secreted from visceral adipose tissue leptin and adiponectin, have
been recognized as key regulators of various metabolic disorder.
OBJECTIVE:
The objective of this study was to use the adiponectin to leptin ratio as a parameter and a lab index
to predict metabolic syndrome across adult males.
METHOD:
A total of 82 adult males with mean age of (38.47 + 9.27) were included in the study. Fifty eight
(58) adult males were the metabolic syndrome group depending on the presence of any 3 out of 5
of the National Cholesterol Education Program Adult Treatment Panel III (NCEP ATPIII) criteria
which include the following: (central obesity ≥ 102cm, triglyceride ≥150 mg/dl, HDL-Cholesterol
˂40 mg/dl, blood pressure ≥ 130/85 mmHg and fasting serum glucose ≥100 mg/dl) as compared to
twenty four (24) healthy adult males as the control group.
RESULT:
The findings showed that adiponectin/ Leptin ratio is significantly lower in metabolic syndrome
adult males as compared to healthy adult males.
CONCLUSION:
In conclusion data indicate that adiponectin/leptin ratio is a plausible index for detecting the
presence of metabolic syndrome in adult males.

Effect of Umbilical Cord Abnormalities on Fetal Heart Pattern Leading to Operative Delivery

Iraqi Postgraduate Medical Journal, 2018, Volume 17, Issue 4, Pages 360-365

ABSTRACT:
BACKGROUND:
Umbilical cord abnormalities may be associated with fetal heart rate irregularities this might
change the mode of delivery from vaginal delivery to cesarean delivery and may be responsible for
adverse perinatal outcomes.
OBJECTIVE:
To verify the association between umbilical cord abnormalities and fetal heart irregularities that
lead to urgent cesarean delivery.
MATERIALS AND METHODS:
One hundred and six full term singleton pregnant women were enrolled in this study, 51 of them
developed non reassuring fetal heart rate (Abnormal CTG) and emergency cesarean delivery was
done for them, those represent the study group, the other 55 women had reassuring CTG and
delivered vaginally, those represent control group. Umbilical cord and the neonate were examined
after delivery for abnormality. The data obtained were fixed on questionnaire papers and then
subjected to analysis.
RESULTS:
Umbilical cord abnormalities were present in higher significant rate (43.1%) in emergency
cesarean delivery group than vaginal delivery group. Although single umbilical cord abnormalities
was present more than multiple umbilical cord abnormalities but the latter associated significantly
with increase rate of cesarean delivery (P value is 0.05). Nuchal cord was present in (31.3%) of
women of study group and in (16.4%) of control group. The most fetal heart abnormality found
was fetal deceleration (96.1%) and most commonly was late deceleration (42.8%).
Newborns with multiple umbilical cord abnormalities had significantly lower weight and lower
Apgar scores than those with single cord abnormalities, P value 0.018, 0.037 respectively.
CONCLUSION:
Umbilical cord abnormalities are associated with increase rate of cesarean delivery because of fetal
heart rate irregularities. The most common abnormality is umbilical cord entanglement around the
fetal neck.
Multiple umbilical cord entanglement are responsible significantly for increased cesarean rate and
adverse perinatal outcomes.

Prevalence of Viral Hepatitis (B and C) in Pediatric Hemodialysis Centers in Baghdad

Iraqi Postgraduate Medical Journal, 2018, Volume 17, Issue 4, Pages 366-372

ABSTRACT:
BACK GROUND:
Viral infection (hepatitis B and C) is a public health problem, especially in high risk patients,
including the patients with chronic kidney disease on hemodialysis.
OBJECTIVE:
To find out the prevalence of hepatitis B virus and hepatitis C in children on haemodialysis unit in
three paediatric haemodialysis centers in Baghdad.
PATIENTS AND METHODS:
This is a retrospective study which was carried out for six months data collection from (Jan. 2017 to
December 2017) in three haemodialysis centres (children welfare hospital, Ibn al-Baladi Hospital for
pediatric and central teaching hospital of pediatric) in Baghdad; all patients from (April 2013 to
December 2017) at least six months on haemodialysis were included in study records, reviewed and
analysed. Information's including demographic characteristics, history of blood transfusion, history of
hepatitis B vaccination, serological investigations before starting of haemodialysis and serial monthly
investigations of virology. The positive ELISA test for hepatitis B surface antigen (HBsAg) and
hepatitis C antibody (HCV Ab) was recorded. The real time polymerase chain reaction (RT_PCR) had
been done to confirm positive cases, follow up of antibody titer and in suspicious cases also done.
RESULTS:
Total number 178 of patients; 87 (49%) male and 91(51%) female. The overall prevalence of hepatitis
C antibody (HCV Ab) positive patients were 24 (13.4%), while prevalence of hepatitis B surface
antigen (HBsAg) positive patients were 2(1.1%); seroconversion to hepatitis C antibody positive after
hemodialysis were 14 (7.9%), while seroconversion to hepatitis B was 0 (0.0%) .
CONCLUSION AND RECOMMENDATION:
Hepatitis C viruses' infection are not uncommon among hemodialysis patients in Baghdad. Blood
transfusion and hemodialysis are risk factors for Hepatitis C viruses' infections. Infection control
within dialysis units is of paramount importance.

Low Cholesterol as a Risk Factor for Spontaneous Intracerebral Hemorrhage

Iraqi Postgraduate Medical Journal, 2018, Volume 17, Issue 3, Pages 278-284

ABSTRACT:
BACKGROUND:
Epidemiological studies indicate a higher incidence of intracerebral hemorrhage among persons with low total serum cholesterol level.
OBJECTIVE:
To examine the prospective relationship of total serum cholesterol with a subsequent intracerebral hemorrhage in an Iraqi population sample.
PATIENTS AND METHODS:
A case-control study was performed to assess the relationship between spontaneous intracerebral hemorrhage (ICH) and low serum cholesterol. Eighty patients were admitted, from April 2007 to April 2008, to both Baghdad Teaching Hospital and Sulaimaniyah General Teaching Hospital with a diagnosis of spontaneous ICH. All the patients aged 50 or more years. After the initial review for exclusion criteria, 62 patients were enrolled. The other patients were excluded because of secondary causes of hemorrhages. Brain CT scan was done at the radiology department of both hospitals and read by radiologists. Fasting serum lipid profile was evaluated by the laboratory staff of the hospitals.
RESULTS:
It was noticed that the cholesterol values fall acutely after hemorrhage. Mean total cholesterol was significantly lower within 48 h (total cholesterol 1TC1) and 1-2 weeks (total cholesterol 2TC2) than in 3 months (total cholesterol 3TC3), following hemorrhage. In addition, no significant change between TC1 and TC2 groups was noticed, though TC1 values proved to be somewhat higher. A significantly increased proportion (42%) of hemorrhage cases had TC3 values that were in the sex specific lowest quintile of the control group (20%). Dividing the cases according to likely etiology demonstrated similar overrepresentations within the hypertensive and non-hypertensive subgroups.
CONCLUSION:
Our data in patients with proved spontaneous ICH confirm the population based observation that individuals with the lowest cholesterol levels are at increased risk of ICH.

Spectrum of Congenital Anomalies of the Kidney and Urinary Tract in Children

Iraqi Postgraduate Medical Journal, 2018, Volume 17, Issue 3, Pages 291-296

ABSTRACT:
BACKGROUND:
Congenital anomalies of the kidney and urinary tract comprise a wide range of structural malformations that result from defects in the morphogenesis of the kidney and/or urinary tract
OBJECTIVE :
Study the types of renal anomalies. Study their clinical presentations, age of presentation, way of diagnosis, and complications.
PATIENTS AND METHODS:
A descriptive study was conducted from 1st January 2015 till 1st January 2016. Patients were collected from 4 pediatric nephrology centers. Data included: age of diagnosis, type of renal anomaly, radiological methods of diagnosis, clinical presentation and associated complications, family history of congenital anomalies and consanguinity.
Thorough physical examination was done to all children. Investigations send were Blood urea, Serum creatinine , urinalysis, urine culture, imaging study were documented.
RESULTS:
In this study 160 patients were included. Males were more affected than females 1.54:1. Most of the patients diagnosed at >1- ≤ 5 age group, 78 patients (48.8%). Most of the patients had negative family history, 124 (77.5%), and most of their parents were not consanguine (58.1%). Vesicoureteral reflux (VUR) was the commonest anomaly detected in 67 patients (41.9%), followed by Renal agenesis in 24 patients (15.0%).
Abdominal Ultrasound was the commonest radiological method used for diagnosis in 152patients (95.0%), followed by voiding cystourethrogram (VCUG) in 80 patients (50.0%).
Urinary symptoms were most common presentation in 93patients (58.1%). A higher complication was UTI (62.5%).
CONCLUSION:
The commonest renal anomaly was VUR, followed by Renal agenesis, then PUJ, These renal anomalies were mostly diagnosed at >1-≤ 5 age group. Males exceeded the number of females, and the majority of patients were diagnosed initially by ultrasound
Most common presentation was urinary symptoms. The most prominent complication was UTI
.

Serum Vitamin D3 Levels in Women with and without Uterine Fibroids

Iraqi Postgraduate Medical Journal, 2018, Volume 17, Issue 3, Pages 239-248

ABSTRACT:
BACKGROUND:
Uterine leiomyomas are the most common benign tumours of the female genital tract. They are a major source of morbidity for women and a frequent indication of gynecological surgery. Understanding the etiology of uterine fibroids remains incomplete. Vitamin D may be an unrecognized risk factor for their development.
OBJECTIVE:
To assess serum vitamin D3 levels in women with and without uterine fibroids and to identify whether serum vitamin D3 levels correlate with the severity of uterine fibroids disease.
METHODS:
This prospective case- control study involved 150 women in their premenopausal state who presented at the outpatient gynecology clinic at AL-Yarmook Teaching Hospital, Baghdad-Iraq. They were arranged into two groups; the control group consisted of 75 healthy women without uterine fibroids confirmed by ultrasound examination. The remaining 75 women, had at least one fibroid lesion of 2cm3 in volume or larger confirmed by transvaginal/ transabdominal ultrasound examination, represented the study group. All women enrolled in the study had similar demographic background. For each case woman, total uterine volume, and total volume of all existing fibroids were measured. Serum vitamin D3 levels were measured for all participants by ELISA method. Statistical analysis was performed to compare serum vitamin D3 levels across groups of women with and without uterine fibroids and to assess the correlation of serum vitamin D3 levels with uterine fibroids burden.
RESULTS:
Serum vitamin D3 levels were significantly (p=0.0001) lower among women with uterine fibroids compared to the control group with a mean value (15.81±8.64) ng/ml in women with uterine fibroid and (34.25±8.07) ng/ml in the control group. A significant negative correlation was found between serum vitamin D3 levels and the increase in number of uterine fibroids (r=-0.623, p=0.0001) and the increase in total uterine fibroids volume (r=-0.742, p=0.0001).
CONCLUSION:
According to the present study, lower serum vitamin D3 levels are significantly associated with the occurrence of uterine fibroids and serum vitamin D3 levels inversely correlate with both uterine fibroids number and total uterine fibroids volume.

Emotional Response and Beliefs of a Sample of Women Attending Baghdad Teaching Hospital Regarding Miscarriage

Iraqi Postgraduate Medical Journal, 2018, Volume 17, Issue 3, Pages 232-238

ABSTRACT:
BACKGROUND:
Although the cause of recurrent pregnancy loss is unknown in the majority of cases; advanced maternal age, chromosomal abnormalities, uterine abnormalities and infections could all be potential causes of miscarriage. Miscarriage is a common problem and could affect the women’s psychological wellbeing in the short term and possibly in the long term.
OBJECTIVE:
To describe the awareness of women age (15-45) years old regarding beliefs and emotional impact of miscarriage.
SUBJECTS AND METHOD:
A descriptive cross-sectional study was carried out on the total of 393 women with age from 15-45 years old attending gynecology, obstetrics and family planning departments in Baghdad Teaching Hospital in Baghdad/Iraq during the period from 14th of January 2016 to 15th of April 2016.
RESULTS:
393 women have been or still pregnant, 171 of those 393 women had a history of miscarriage; giving the prevalence of (43.5%) for women reporting a history of miscarriage. The prevalence of miscarriage in women age 40-45 years old was (38.0%). In this study (63.7%) of women satisfied about the medical care they received after abortion. The beliefs of the respondent about the causes of miscarriage showed that a large number agreed that sexual intercourse during pregnancy (36.4%) and past use of oral contraception (33%) may all be causes for miscarriage, (81%) believed that stressful event was a cause of miscarriage, (58%) knew that pregnancy loss was the result of genetic abnormalities, (46.4%) believed that having had a sexually transmitted disease in the past was the cause of miscarriage, and (68.4%) of women who had experienced a miscarriage reported that they would find a miscarriage to be extremely upsetting, equivalent to the loss of a child.
CONCLUSION:
There are some misperceptions about the factors associated with miscarriage. Many women had emotional distress after miscarriage which was perceived as a loss of a child.

Intraoperative Complications of Primary Anterior Cruciate Ligament Reconstruction Using Quadriple Hamstring Tendon Graft (Semitendinosus and Gracilis ): Measures of Avoidance

Iraqi Postgraduate Medical Journal, 2018, Volume 17, Issue 3, Pages 297-306

ABSTRACT:
BACKGROUND:
Anterior cruciate ligament reconstruction is widely done orthopedic procedure, during this procedure there is potential risk for development of complications, which need to be dealt with or better to be prevented by specific measures.
OBJECTIVE:
To avoid intra operative complications during anterior cruciate ligament reconstruction using hamstring muscles graft in order to reduce incidence of the graft failure due to technical error.
PATIENT AND METHOD:
prospective cohort study for patient who has undergone primary anterior cruciate ligament reconstruction surgery using hamstring graft by same surgical team during the period from 2016-2017. History, examination and investigations were done for all patients and surgery was done under general anesthesia or spinal anesthesia. Specific rehabilitation program was instructed to all patients. Intra operative complications might be encountered during anterior cruciate ligament reconstruction surgery which includes: cartilage injury, Bleeding, Screw breakage, Screw mal direction and graft harvest complications. Identification of the measures to avoid these complications was crucial in this study.
RESULTS:
Fifty four patients who underwent primary anterior cruciate ligament reconstruction with mean age 27.7. Fourteen patients (26%) developed complications. Seven patients had cartilage injury (13)% , (2/54) patients had bleeding (3.7)% , (2/54) patients had developed screw breakage (3.7)% , screw mal direction (1.9)% was encountered in (1/54) patient and (2/54) patients had sustained premature graft cutoff short (3.7)%.
CONCLUSION:
Complications of anterior cruciate ligament reconstruction may occure at any stage of operation, avoidness of these complications is important step in improving the functional outcome and the surgeon need to be aware about it and how to avoid them.

Cervical Spinal Cord Lesions in Multiple Sclerosis: Comparison among Different Magnetic Resonance Imaging (MRI) Sequences

Iraqi Postgraduate Medical Journal, 2018, Volume 17, Issue 3, Pages 271-277

ABSTRACT:
BACKGROUND:
Multiple sclerosis (MS) is a chronic inflammatory, demyelinating and neurodegenerative disease of the brain and spinal cord. The cervical spinal cord is commonly affected in multiple sclerosis ,as many as 90% of MS patients which is often associated with an increase in clinical disability. Though rarely seen in other diseases, asymptomatic lesions of the spinal cord can be present in MS and may help lead to the correct diagnosis. Since the integration of MR imaging into the International Panel (McDonald) criteria in 2001,there is increasing international effort to standardize MR imaging protocols.
OBJECTIVE:
To evaluate MRI imaging protocols for detection of cervical spinal cord multiple sclerosis lesions using 1.5 T MRI scanner.
PATIENTS AND METHODS:
A cross sectional analytical study was conducted at Al-Yarmouk Teaching hospital in Baghdad city. Thirty-one known as MS Patients were examined. from October 2016 till December 2017 by Phillips Achieva Nova Dual 1.5T using a SENSE Neurovascular coil .All patients. underwent sagitta1 T2-turbo spin echo(T2-TSE), Sagittal proton density-turbo spin echo(PD-TSE), sagittal short tau inversion recovery-turbo-spin echo(STIR-TSE )and axial T2-fast field echo(T2-FFE).Comparison was done between the sequences in the means of detectability, conspicuity and number of lesions.
RESULTS:
Total patients were (31),22 were females and 9 were males .The female to male ratio was (2.4:1). The patient ages ranges between 20-61 years with a mean of age of about 38 years.
Mean Lesion to Cord Contrast Ratio (mean LCCR) of STIR and T2WI MR imaging was lower than PD imaging [p value < 0.01].Despite of STIR and T2WI had comparable LCCR (mean= 0.39), STIR imaging had expressively better Lesion Contrast to Noise Ratio (LCNR) [P value < 0.01]. PD had better LCNR (mean=48.8) as compared to T2 and STIR [p value<0.001].
PD-TSE sequence detected a large number of spinal cord lesions as compared to T2-TSE and STIR-TSE sequences [110 vs. 76 , 76; respectively . P value < 0.001].
CONCLUSION:
PD-TSE improves overall lesion detection ,delineation, conspicuity and edge definition, however it cannot give precise cord morphological data, but it prove to be the sequence of choice in cervical MS plaque detection as it has the higher lesion contrast ,and it is beneficial in overcoming artifacts seen in both STIR and T2-TSE.
STIR-TSE have good signal to noise ratio, although have higher CSF flow artifacts.
.

Patterns of Infant Feeding Practices in the First Six Months of Life in Fatema AL- Zahra Hospital in Baghdad

Iraqi Postgraduate Medical Journal, 2018, Volume 17, Issue 3, Pages 211-219

ABSTRACT:
BACK GROUND:
Breastfeeding is of great benefits to the baby and mother in so many ways. Breastfeeding has been found to provide a measure of protection against the attacks of ear infections, upper respiratory infections, and gastrointestinal disorders. Breastfeeding has an emotional benefit by initiation of bonding between mother and baby .Knowledge of when and why women discontinue breastfeeding is of great important when make a plan aimed at increasing both the initiation and duration of breastfeeding.
OBJECTIVE :
This study was conducted to, 1. detect Patterns of breastfeeding practice during the first 6 months of life, 2.identify the age at when bottle feeding started, and 3.to verify the causes to start bottle feeding .
METHODS:
Parents of 1000 infants seen during a routine visit at the Breastfeeding consultation Clinic (BCC), in the outpatient department in Fatema Al Zahra hospital were interviewed by the researchers from 1st of July 2016 to 30th of June 2017 . The mothers were asked about , the mother's age ,job, and education, infant`s age, Sex, birth order, type of feeding, when to start formula, and why. Inclusion criteria were: women, between 16-40 years who came with their infants for vaccination, and had delivered during the last 12 months.
RESULTS:
It was observed that breast feeding was maintained at a high level (more than 64.6%) throughout infancy while exclusive breast feeding showed a rapid decline. The rate of exclusive breast feeding at 6th month was 28.3%. The birth order of the infant, and mother`s age, job, and education were important factors determining exclusive breast feeding rate.
The most common causes for adding bottle feeding were, milk insufficiency in 25.2 % of cases, Mother`s pregnancy in 19.9 %, and Infant`s crying after feeding in 14.2%.
The advice of starting bottle feeding were recommended by family in 18.9% of cases , by Pediatrician in 29.1 %, by Gynecologist in 3.2 % of cases , and in 48.6 % of cases the mothers start bottle feeding by her opinion.
CONCLUION:
Breast feeding as such was maintained at a high level for the first 12 months of life while the practice of exclusive breast feeding(EBF) was much lower . Mother's age, job, and education have an impacts on exclusive breastfeeding rate. Medical personnel and family have great role in continuation of EBF and breastfeeding.
The most common causes for adding bottle feeding, were, milk insufficiency , Mother`s pregnancy and infant`s crying after feeding.
.

Time From Giving Reversal to Train of Four 90 %: A Comparison Between Inhalational Anaesthesia and Propofol

Ali Mohammed Kareem Naji; Reem Abbas Naem; Iyad Abbas Salman

Iraqi Postgraduate Medical Journal, 2018, Volume 17, Issue 2, Pages 114-120

ABSTRACT:
BACKGROUND:
The train-of-four (TOF) ratio should return to at least 90% to exclude potentially clinically significant postoperative residual block. The time gap between clinical recovery (subjective) until objective recovery (i.e. TOF ratio has returned to _0.90) can be considered “the potentially unsafe period of recovery
OBJECTIVE:
To determine the time difference (from giving the reversal drugs till reach TOF90% readings by acceleromyography) between patients maintained on propofol and those maintained on halothane.
PATIENTS AND METHOD:
A prospective clinical trial study100 females underwent caesarian section divided into inhalational anaesthesia group (maintained on inhalational anaesthesia-halothane) and propofol group (maintained on propofol infusion after delivery of the baby till the end of operation) then recovery is monitored using acceleromyography.
RESULT:
Times from giving reversal of the muscle relaxant till extubation and time from giving reversal till reading of TOF90% were significantly lower in propofol group than in inhalational group.
CONCLUSION:
Patients maintained on propofol was extubated earlier than those maintained on inhalational anaesthesia also needed less time to reach TOF90% i.e. inhalational anaesthesia augment muscle relaxation more than propofol.
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Assessment of Iron Deficiency in Pregnant Women by Using Soluble Transferrin Receptor - Ferritin Index

Jaffar Nouri Jaffar Alalsaidissa; Sarah Kanaan Alwan

Iraqi Postgraduate Medical Journal, 2018, Volume 17, Issue 2, Pages 164-169

ABSTRACT:
BACKGROUND:
Iron deficiency could have an adverse effect on the health of pregnant women and their fetuses. In present, no marker could be considered as the ideal for the detection of Iron deficiency anemia in pregnant women. Some authors suggested that soluble transferrin receptor-ferritin index could be a promising marker for iron deficiency during third trimester of pregnancy.
OBJECTIVE:
To study the value of soluble transferrin receptor - ferritin index as a marker for iron deficiency during third trimester.
PATIENTS AND METHOD:
A cross-sectional study conducted at the Antenatal clinic in Al Zahra’a maternity and children hospital and Baquba Teaching Hospital in Diyala province /Iraq, during the period from 17th march 2016 to the end of March 2017, seventy pregnant women were included in the study. Hemoglobin, CBC, HCT, MCV, and RDW-CV were tested by using automated device. Serum Ferritin and Transferrin receptor was tested by using ELISA kit,
RESULT:
The mean age of the women was 28.3 ± 6.5 (range: 16 – 48) years . Iron deficiency anemia was reported in 32% of the studied group. Serum Iron and Ferritin were significantly lower in iron deficiency anemia group than normal group, (P<0.05). Soluble Transferrin receptor (sTfR) and sTfR- ferritin index were significantly higher in iron deficiency anemia group than the normal group (P<0.05).
CONCLUSION:
S. ferritin is excellent predictor of IDA and had higher sensitivity, specificity and accuracy rates than sTfR and sTfR-F index. Additionally, the validity parameters of sTfR-F index were higher than that of sTfR.
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Using Single Dose Systemic Dexamethasone Pre Operatively for Postoperative Pain as Part of Multimodal Analgesia in Laparoscopic Cholecystectomy

Mohammad Shakoor Mugheer; Bashar taha Enad; Hassan Sarhan Haider

Iraqi Postgraduate Medical Journal, 2018, Volume 17, Issue 2, Pages 183-187

ABSTRACT:
BACKGROUND:
Pain after laparoscopy occurs for various reasons and a range of treatment have been suggested for the reduction in pain. There are reports that local anesthesia infiltration, removal of remaining carbon dioxide, administration of anti-inflammatory analgesia before surgery and dexamethasone are effective in post operative pain management. Recently multimodal analgesia methods, where a combination of the above methods are used, are recommended for their effectiveness.
METHOD:
Eighty patients aged 20-60 years; ASA class 1 &2;undergoing laparoscopic cholecystectomy under general anesthesia were studied and divided into two groups: Group S(n = 40) received dexamethasone 8 mg before induction ; Group N received 2ml normal saline before induction. We measure the degree of pain of both groups with VAS at 1,3,6&24 hours after surgery.
RESULTS:
VAS score of Group S were lower than that of Group N during 24 hours after laparoscopic cholecystectomy and analgesia consumption of Group S were lower than that of Group N.
CONCLUSION:
A single dose of dexamethasone (8mg) intravenously given before induction was effective in reducing postoperative pain after laparoscopic cholecystectomy with multimodal analgesia.
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Blood Glucose Level Intraoperatively and Effect on Recovery from General Anesthesia in Non-Diabetic Recipient in Renal Transplant Surgery

Bushra khalid Altamimi; Alaa Hussein Altaiee; Raghad Hannon Alsudani

Iraqi Postgraduate Medical Journal, 2018, Volume 17, Issue 2, Pages 109-113

ABSTRACT:
BACKGROUND:
Blood glucose increment during surgery is part of stress response, this increment is due to insulin dysfunction and glucose production and hyperglycemia increases complications.
OBJECTIVE:
Assess glucose level change intraoperatively and effect on recovery in non-diabetic recipients in renal transplant surgery.
PATIENTS AND METHODS:
52 patients from 1-1-2016 to 1-3-2017 In renal transplant center. all with standardized anesthetic technique, monitoring of blood glucose pre-induction and every half hour, soluble insulin start to be given for patient when blood glucose reach 200mg/dl as 1 unit for each 10 mg above 200 and recovery assessed using aldrete score.
RESULT:
There is variable increase in blood glucose among patients, 39/52 above 110 mg/dl at pre induction,1 patient was 276mg. 18/52 had 200-250 mg at least once among them,11patients reached 250-300mg,6 patients300-400 and 3reahed above400. 5 patients had delayed recovery with no significance relation to pre-induction level but significant to other readings, risk assessment showed more odd’s ratio for delayed recovery in high glucose reading and assessment of increment from pre-induction is a valid test for delayed recovery.
CONCLUSION:
Blood glucose measurement is mandatory in non-diabetic in renal transplant recipients.
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Rubella Immune State of A Sample of Pregnant Women at Al-Falluja City-Anbar Province

Susan abed zaidan

Iraqi Postgraduate Medical Journal, 2018, Volume 17, Issue 2, Pages 193-198

ABSTRACT:
BACKGROUND:
Rubella infection of a pregnant woman may end with serious adverse outcome depending on gestational age at time of infection. Congenital rubella infection may cause various disabilities in addition to increased risk of many diseases in future life. Vaccination in childhood is an effective method of prevention of this disease.
OBJECTIVE:
To assess susceptibility of a sample of pregnant women in Falluja city to rubella infection.
SUBJECTS AND METHODS:
From May to August 2017, 95 pregnant women attending private clinic in Falluja city were included in cross sectional study to assess rubella IgM and IgG antibodies using ELISA kits and ELFA technique respectively.
RESULTS:
None of the pregnant women found to have IgM antibodies. Rubella IgG serum level varies from 0- 400 IU/ml. Of 97 pregnant women included in this study, 23 (24.2%) were non-immune to rubella having IgG level less than 10 IU/ml. There was no significant association between age, parity or history of previous abortion with IgG level.
CONCLUSION:
Congenital rubella infection is a probable hidden health problem. Routine screening of pregnant women and vaccination of susceptible women after delivery should be applied in all health care institutions.

Operative Treatment by Plate and Screws Versus Conservative Treatment of Closed Displaced Fracture of the Mid Third of Clavicle in Adults: Comparative Study

Sadik A. Al-Muktar; Mohammed Rageeb; Ghadeer H. Majeed; Mohammed S. Al- Edanni

Iraqi Postgraduate Medical Journal, 2018, Volume 17, Issue 2, Pages 145-151

ABSTRACT:
BACKGROUND:
Clavicle fractures are common injuries in young active individuals, the mid third of the clavicle is most commonly fractured part(80% of clavicle fracture)
OBJECTIVE:
To compare the outcomes of operative and non operative management of displaced and or comminuted closed fracture of the mid third of clavicle in young adults
PATIENTS AND METHODS:
This prospective observational study of 24 patients of fracture of the mid third of the clavicle was conducted in Alkindy teaching hospital from July 2015 to January 2017 and divided into two groups; one managed by operative treatment with plate and screws and the other by non operative sling immobilization after taking the consent and the patients were seen at 2, 4, 6 weeks,3, 6, and 9 months
RESULTS:
The mean time of functional recovery in the operative group was 3.75 weeks while in the non operative group was 8.09(P value=0.005) which is highly significant, the mean time of fracture healing(radiological union) in the operative group was 14.25 while in the non operative group was 28.72 with P value 0.005 which is statistically highly significant, there was no significant differences between the two groups in the range of movements although the adduction was better in the operative group but not significant P value=0.120, the DASH score was 11.25, 22.25 in the operative and non operative group respectively which is highly significant P value=0.005.
CONCLUSION:
Operative fixation of the clavicle results in improvement in the functional outcome, shorter time of union, lower complication rate in 9 month follow up .
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Effect of Nuchal Cord on Mode of Delivery and Perinatal Outcome

Estabraq Ali; Abdulrazak Alnakash

Iraqi Postgraduate Medical Journal, 2018, Volume 17, Issue 2, Pages 137-144

ABSTRACT:
BACKGROUND:
Nuchal cord is blamed for problems that are encountered during delivery and for increased risk of adverse perinatal outcome such as fetal heart decelerations and perinatal mortality.
Study design
A case-control, prospective study.
OBJECTIVE:
To compare mode of delivery, duration of labour, and fetal outcome in pregnants with and without nuchal cord.
MATERIALS AND METHODS:
One hundred and fifty full term pregnant women were enrolled in this study, half of them were with nuchal cord (diagnosed by ultrasound and confirmed during labour) served as study group, and the remaining were without nuchal cord and served as control.
Fetomaternal outcome including mode of delivery, duration of labour, presence of intrapartum fetal heart rate irregularities, presence of meconium, fetal weight, Apgar score at 1 and 5 minutes, and neonatal care unit admission were compared in the two groups and the data were arranged on questionnaire forms and subjected to analysis.
RESULTS:
Pregnancy with Nuchal cord has 2.6 folds increase in caesarean section rate than controls (21.3%) vs. (9.3%), mainly because increased fetal heart rate irregularities (3.2 folds), and prolonged second stage of labour.
Meconium staining of liquor was more frequently seen among nuchal cord group than controls. Fetal outcome was found to be associated with higher incidence of low birth weight, low Apgar score at 1 and 5 minutes and more neonatal care unit admission in pregnants with nuchal cord.
CONCLUSION: Nuchal cord is associated with adverse perinatal outcome including low apgar scores, fetal distress and increased cesarean section rate.

Cerebellopontine Angle Tumors; Tumor Size – Outcome Relationship

Mazin S. Mohammed Jawad; Ali Abd; Ali Alshalgi

Iraqi Postgraduate Medical Journal, 2018, Volume 17, Issue 2, Pages 152-157

ABSTRACT:
BACKGROUND:
Cerebellopontine angle is an area with extremely critical structures, therefore understanding its tumors behavior with the implications on the surgical outcome will help in reduction of the possible surgical complications, eventually improves the patients quality of life.
OBJECTIVE:
Our object is to illustrate the various aspects of clinical presentation and surgical complications with linkage to the tumor size regarding cerebellopontine angle (CPA) tumors in Iraq.
PATIENTS AND METHOD:
A prospective cohort study for thirty patients at the Surgical Specialty Hospital (Al Shaheed Ghazi Al Hariri Hospital) have been studied over a 1-year period (2014 / 2015), and followed up postoperatively for 6 months. Their mean age of was 36 years. The suboccipital retrosigmoid approach has been utilized for CPA tumors removal.
RESULTS:
The most common presentation was vertigo followed by tinnitus. There were two cases (6%) of cerebrospinal fluid leak. Facial nerve function was measured by the House Brackmann (HB) system and function further classified into three categories: excellent (HB I-II), intermediate (HB III-IV), and poor (HB V-VI) outcome following surgery, showing that all cases below 20 mm tumor size have an excellent outcome and (67%) of cases with > 20 mm tumor size shows poor outcome. One death in this study (mortality rate, 3%) was due to respiratory cessation.
CONCLUSION:
A female preponderance noticed. Significant relationship between tumor size and facial nerve postsurgical functional outcome, with the larger C.P.A. tumors yield worse outcomes. Tumor size also influences the development of CSF leak and operative morbidity and mortality.
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The Prevalence of Hypothyroidism Among Patients with Beta-Thalassemia Major , Western Iraq

Sahar Jabbar Kadhum

Iraqi Postgraduate Medical Journal, 2018, Volume 17, Issue 2, Pages 170-174

ABSTRACT:
BACKGROUND:
Thyroid dysfunction is well documented in patients with thalassemia major those required frequent blood transfusions.
OBJECTIVE:
To determine the prevalence of hypothyroidism among
patients suffering from B-thalassemia major and their association with treatment protocol.
PATIENTS &METHODS:
Descriptive cross sectional study conducted in Al-Ramadi maternity and children teaching hospital from 1st of January 2013 to the 1st of January 2014. Sixty patients with thalassemia major aged 2-20 years were studied.
Age ,sex ,age of 1st blood transfusion, frequency of blood transfusion per year, doses ,duration and method of chelating agent administration were recorded .Hb level ,serum ferritin concentration and thyroid function test( T4,T3,TSH) were measured.
RESULTS:
thyroid dysfunction recorded in 8(13.3%)cases,3(5%)overt hypothyroidism,5(8.3%)subclinical hypothyroidism , mean age 19±1 years. serum ferritin level, Hb level and age of first transfusion were statistically significant in patients with thyroid dysfunction while TSB and liver enzymes levels were statistically insignificant in studied cases.
CONCLUSION:
Hypothyroidism is an important problem in thalassemia major patients. Regular annual follow- up is essential for early detection and appropriate replacement therapy . the use of effective combined chelating therapy in sufficient quantities as well as regular blood transfusion may lead to prevention of hypothyroidism in beta thalassemic patients

Treatment of Vitiligo Patients with Narrow Band Ultraviolet Light -B and Associated Predictive Factors (A Prospective Interventional Therapeutic Study)

Hayder R. Al-Hamamy; Sabeeh A. Al-Mashhadani; Manar G. Aziz

Iraqi Postgraduate Medical Journal, 2018, Volume 17, Issue 1, Pages 13-21

ABSTRACT:
BACKGROUND:
Vitiligo is a common dermatological disease with a great psychological impact on the life of individual. Narrow band ultraviolet B phototherapy has been used successfully for the treatment of vitiligo with variable results.
OBJECTIVE:
To assess the response to NB UVB and to identify factors that could predict the response to therapy.
Patients and methods:
This study is an interventional prospective therapeutic study, had been conducted in the Department of Dermatology and Venereology - Baghdad Teaching Hospital extending from October 2013 to October 2014.
Thirty two patients with vitiligo were included in the study , the ages ranged from 8- 35 (18.84±7.86) years, 22 (68.8%) females and 10 (31.2%) males, the body surface area of vitiligo ranged from 2- 60%( 23.8 ± 16.66 ), full history and physical examination , assessment of skin phenotype , daily life quality index before and after completing the 48 sessions. Narrow band phototherapy was given twice weekly, recording of the body surface area of vitiligo was done before the treatment and every 16 sessions till the end of 48 sessions. Documentation of the first response session for every patient, calculation of the total percent of reduction , the main predictive factors and the development of any side effect had been recorded.
RESULTS:
First response session ranged from 3- 20 (10th ± 4.37) ,the response of patients according to the degree of regimentation was as the following: 3 (9.37%) patients had excellent response, 6 (18.75%) patients had good response , 14 (43.75%) patients had moderate response and 9 (28.12%) patients had poor response. The age of patients and negative hair involvement had a statistically significant correlation to the total percent of reduction. The face was the area of maximum response , The side effects were tolerable and no patient discontinued the treatment due to the side effects. Daily life quality index showed a statistically significant reduction at the end of treatment.
CONCLUSION:
Narrow band is an effective treatment for vitiligo with few side effects. Age of the patients and absence of hair involvement are favorable predictive features. The face was the area of maximum response.

Efficacy of Bladder Preservation Protocols in the Management of Muscle Invasive Bladder Cancer

Usama Sulaiman Al-Nasiri; Saad Dakhil F. Daraji; Mohammed Ghanim Alwan

Iraqi Postgraduate Medical Journal, 2018, Volume 17, Issue 1, Pages 29-35

ABSTRACT:
BACKGROUND:
As an alternative to the standard of care for muscle-invasive bladder cancer, certain bladder preservations protocols should be offered to patients with significant co morbidities or for those keening intact bladder and not so compliant with cystectomy approach provided that they included in strict criteria.
OBJECTIVE:
To review the efficacy of bladder preservation therapy for muscle-invasive bladder cancer (MIBC) for selected patients by non-randomized prospective study over two years follow up period.
METHODS:
A study started from a January -2014 until October -2016, twenty eight Patients were included in combined prospective and retrospective manner; they were included within those two years. Patients were confirmed having muscle invasive disease if initial TURBT or the 2nd look TURBT specimens were showed a muscle invasive bladder cancer. All candidates included in bladder preservation strategies shared common strict inclusions criteria. Cisplatin-based chemotherapy and split- course chemo radiation therapy then was offered for all patients after radical TURBT and re assessment carried out after the 3rd cycle of chemotherapy and or 40 GY radiotherapy 3 months later, patients with response after 2nd look TUR were offered other 20 GY radiotherapy.
RESULTS:
Initial clinical response was assessed after 3 months from initial resection (after completion of 3 cycle chemotherapy). Those were subjected to preservation trial, 22(78.5 %) achieved complete response, 4(14.3%) achieved partial response, and 2(7.1%) had no response. Out of responsive group (22 patients), two patients developed recurrent pattern, one of them at first year and another one in the second year, so for over all response assessment obtained for two years there were 28 patients : Twenty patients (72%) were cancer clear, Eight patients (28%) had failed response. No mortality recorded at the study period. All recurrent cases were offered salvage radical cystectomy.
CONCLUSION:
Bladder preservation protocols in selected patients with MIBC might be an effective alternative to standard radical cystectomy with pelvic lymph nodes dissection in controlling low volume favorable invasive and high grade multifocal bladder tumors in up to 70 % of patients.
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Post Operative Complications of Surgical Treatment for Acetabular Fractures, A Case Series with Short Term Results

Ali Bakir Al-Hilli; Mohammed Hatem Salal

Iraqi Postgraduate Medical Journal, 2018, Volume 17, Issue 1, Pages 91-99

ABSTRACT:
BACKGROUND:
Acetabular fracture is a complex injury, it mostly results from a high-energy mechanism and mostly in young patients. whenever indicated surgical treatment is possible thought several surgical approaches with different fixation constructs. Many authors proved the important relation between the occurrence of postsurgical complications and the presence of associated hip dislocation, whereas the fracture type and operative approach did not prove to be significant in the occurrence of complications after surgery.
Recent studies focused on decreasing the rate of complications that follows the operative management.
OBJECTIVE:
To evaluate the complications of surgical treatment of isolated closed acetabular fractures including surgical site infection, iatrogenic nerve injury, heterotrophic ossification (HO), and femoral head necrosis (AVN) and to assess any relationship of these complications with fracture type, operative approach, and age of patients.
PATIENTS AND METHOD:
Thirty-one operatively managed acetabular fracture, 24 males and 7 females with a mean age of 37.2 years were studied over the period from October 2013 to June 2016 in Medical city complex / Baghdad with a minimum follow up of 6 months. Infection, AVN of femoral head, nerve injury and heterotrophic ossification were studied.
RESULT:
Significant relation between postsurgical complications and presence of hip dislocation at presentation was noticed while the fracture type and operative approach were insignificantly related to the complications.

Survey of Pulmonary Embolism Characteristics, A Hospital Based Study

Asaad Abdullah Abbas; Salman Hachim Al-Nuami; Basil Fawzi Jameel

Iraqi Postgraduate Medical Journal, 2018, Volume 17, Issue 1, Pages 58-64

ABSTRACT:
BACKGROUND:
Pulmonary embolism is a common complication of hospitalization and contributes to 5 to 10 percent of deaths in hospitalized patients, making it one of the leading causes of preventable hospital deaths.
OBJECTIVE:
Is to evaluate patients with pulmonary embolism admitted to Ibn Alnafees Hospital, Baghdad, Iraq.
PATIENTS AND METHOD:
Cross-sectional study in one year( 2016) , We treated 52 cases of Pulmonary embolism in Ibn Alnafees Hospital in the CCU and we collected their data on admission to the hospital on different age group, gender, sign and symptoms, investigation, predisposing factors, treatments with thrombolytic therapy and the outcome of the patient. Seven patients died after admission, two of them same of day of admission.
RESULT:
In this study, the surgery was the most common risk factor for pulmonary embolism followed by deep Venus thrombosis. However, there was no obvious risk factor present in 11.5% of cases, and 28.7% of cases had have more than one risk factor.
CONCLUSION:
The surgery was the most common risk factor for pulmonary embolism followed by deep vein thrombosis. The CT pulmonary angiography is positive in vast majority of cases, so it's useful and effective diagnostic tool for pulmonary embolism.

Parkinson’s Disease in A Kurdish Population

Omed Ahmed Muhammed; Hasan A. Al-Hamadani

Iraqi Postgraduate Medical Journal, 2018, Volume 17, Issue 1, Pages 36-44

ABSTRACT:
BACKGROUND :
Parkinson’s disease (PD) is a neurodegenerative disorder of the central nervous system characterized by resting tremor, bradykinesia, cogwheel rigidity, and impairment of postural reflexes. It appears that certain environmental factors are involved.
OBJECTIVE:
The aim of the present work is to study the age, gender, residency, family history of patients with Parkinson’s disease in Kurdish population.
PATIENTS AND METHODS:
A cross sectional survey study conducted in outpatient clinic at Shar hospital, a teaching hospital in Sulaymania city, during the period between the first of October 2014 and first of February 2015. Thirty five patients diagnosed idiopathic Parkinson’s disease by a neurologist include in this study. Data was collected in outpatient in one hospital Shar teaching hospital in Sulaymania city.
RESULT:
Mean age of patients of Parkinson’s disease 65 years, disease started in male earlier than female in Kurdish population in Sulaymania. We found that 22 cases (62.9%) of total cases were male and 13 cases (37.1%) of all cases female, male was affected more than female. Male to female ratio was (1.7:1).
There was statistically significant difference between cases who were living in urban area and who were living in rural area in regarding age but no significant difference regarding to gender.
There is statistically significant difference in family history distribution in different age groups. Patients with family history positive of Parkinson’s disease affected the disease in earlier ages.
There was statistically significant difference between age groups for smoking
CONCLUSION:
Male was more affected Parkinson’s disease than female, male with earlier ages in Kurdish population. Patients living in rural area and patients with positive family history of Parkinson’s disease affected by the disease in earlier ages.
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Evaluation of Interleukin 8, Interleukin 2 Receptor and Serum Ferritin in 60 Patients with BetaThalassemia Major: Relationship to Splenectomy

Subuh Salim AL-Mudalal; Basma Dawood Hanoon

Iraqi Postgraduate Medical Journal, 2018, Volume 17, Issue 1, Pages 6-11

ABSTRACT:
BACKGROUND:
β-Thalassemia is an inhereted hemoglobin disorder characterized by the absence or reduced synthesis of the β-globin chain. Several immunological defects can be found in patients with β-thalassaemia. Increased IL-8 level was documented in patients with β-thalassaemia and it is probably due to overstimulation of macrophages.
OBJECTIVE:
Evaluation of serum levels of IL-8, soluble IL-2 Receptor, and serum ferritin in the splenectomized and the non-splenectomized β-thalassemia major patients.
METHODS:
A cross sectional study was conducted on 60 patients with homozygous β-thalassemia major who were attending Al Karama Teaching hospital from May 2011 to Auguest 2011. Place of work was Al-Kadhmia and Al Karama teaching hospital. Patients were divided into two groups; thirty splenectomized, thirty non-splenectomized, and thirty healthy age and sex matched as control group.
RESULT:
The mean level of IL-8 was increased in both groups of thalassaemia with significantly higher in the splenectomized 333.06±255.50 pg/ml compare to the non-splenectomized 118.61±46.59 pg/ml and the control 38.39±9.52 pg/ml , P-value<0.05. The mean level of sIL-2R was not increased above the reference range in the control subjects, the non-splenectomized and the splenectomized, which was 732.96+28.96 pg/ml, 723.42±74.15pg/ml and 777.38±86.93pg/ml respectively .The mean serum ferritin level in the splenectomized was 2050.1 ng/ml which was significantly higher compared to the non- splenectomized 1212.2 ng/ml, P-value<0.05. There was significant correlation between IL-8 and serum ferritin, P-value<0.05 while there was no significant correlation between s IL-2R and serum ferritin, in both groups of Thalassaemia P value> 0.05.
CONCLUSION:
- β-thalassemia major patients had increased level of IL- 8 which was more prominent in splenectomized patients, while no increase in IL-2R levels in both groups of Thalassemia.
-IL-8 levels correlated with ferritin levels, while no significant correlation between IL-2R levels and ferritin levels in both groups of Thalassaemia.
- Splenectomized thalassaemic patients display higher ferritin levels compared to the non-splenectomized.
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The Role of Gabapentin in Prevention of Remifentanil-Induced Hyperalgesia

Bashar Zuhair Talib; Iyad Abbas Salman

Iraqi Postgraduate Medical Journal, 2018, Volume 17, Issue 1, Pages 1-5

ABSTRACT:
BACKGROUND:
Remifentanil is widely used as intraoperative analgesic. Post infusion hyperalgesia has been documented experimentally in both animal and human volunteers. Gabapentin has anti-hyperalgesic effect.
OBJECTIVE:
To evaluate the effect of single preoperative oral dose of 300 mg gabapentin in attenuation of postoperative hyperalgesia induced by remifentanil and the decrease in post-operative analgesic requirement.
PATIENT AND METHOD:
A prospective randomized clinical trial conducted in Tikrit teaching hospital/ Iraq, at 2013. It involves 60 patients who underwent appendectomy. All patients were randomly allocated into two equql groups (each of 30 patients): First controlled group (CG) didn’t pre-medicated with gabapentine and 2nd gabapentine group (GG) pre-medicated with gabapentin.
Intraoperative infusion of remifentanil was used & postoperative pain was assessed in all cases.
RESULTS:
The numerical analog scale NAS score and analgesia requirement post operatively was significantly higher in most times in the (CG) as compared with those of the (GG).
CONCLUSION:
Premedication with 300mg gabapentin orally decreased hyperalgesic effect induced by remifentanil and so decreased the pain score and the analgesic requirement postoperatively.

The Use of Rate of Increase of Intraventricular Pressure During Isovolumetric Contraction (dP/dt) in Assessment of Left Ventricular Function in Acute Coronary Syndrome

Muataz Fawzi Hussein; Samar I.Essa; Huda Jameel Ibrahim

Iraqi Postgraduate Medical Journal, 2017, Volume 16, Issue 3, Pages 324-330

ABSTRACT:
BACKGROUND:
Acute coronary syndrome (ACS) is the clinical manifestation of acutely diminished coronary arterial blood supply. The rate of increase of intraventricular pressure during isovolumetric contraction (left ventricular dP/dt) represents the rate of change of pressure during ejection.
OBJECTIVE:
The aim of this study is to evaluate the usefulness of the rate of increase of intraventricular pressure during isovolumetric contraction (dP/dt) in assessment of left ventricular function in patients with acute coronary syndrome and its relation to certain clinical and echocardiographic features.
PATIENTS AND METHODS:
The study is a cross sectional study including 50 patients with an established diagnosis of acute coronary syndrome. The study was performed in Baghdad Teaching Hospital during the period between 2/2/2013 and 5/3/2014. History was taken from all patients and recoded using a specially prepared questionnaire paper. Left ventricular internal dimensions at end diastole (LVIDd) and end systole (LVIDs) were measured using M-mode echocardiography to asses left ventricular systolic function (ejection fraction). Pulse Doppler tracing of the transmitral flow velocities and tissue Doppler image (TDI) mitral annular velocities were obtained from the apical four-chamber view to assess left ventricular diastolic function. Doppler-derived dP/dt was determined from mitral regurgitation (MR) spectral flow
RESULTS:
The study included 50 patients (31 males and 19 females, mean age of 65.26 ± 5 years). Low dP/dt values were found in 42 patients (84%). Low dP/dt values were found more in the age group (51-60 yrs) (p value < 0.05). The mean age of patients with low dP/dt (<1000) was (65.62 ± 5yrs) and that of patients with normal dP/dt (≥ 1000) was (63.38 ± 5 yrs) with no significant difference (p value > 0.05). Low dP/dt value was significantly associated with smoking and positive family history and not significantly associated with male sex, hypertension, and diabetes mellitus. No significant association was found between low dP/dt value and type of presentation of acute coronary syndrome (p value > 0.05) or ejection fraction (p value > 0.05). It was significantly associated with LV diastolic dysfunction, left atrial size, left atrial pressure, and left ventricular size (p value < 0.05).
CONCLUSION:
The use of dP/dt is useful for evaluating left ventricular function in patients with acute coronary syndrome.

Congenital Duodenal Obstruction; Review of 56 Patients

Bassam Khaleel Al-Abbasi

Iraqi Postgraduate Medical Journal, 2017, Volume 16, Issue 3, Pages 319-323

ABSTRACT:
BACKGROUND:
The incidence of neonatal duodenal obstruction has been variously estimated as 1 in 10000 to 1 in 40000 live births. Duodenum obstruction may also caused by annular pancreas and band of Ladd in association with malrotation.The detection of double bubble sign on plain radiograph of abdomen lead to suspicion of duodenal obstruction. Duodenoduodenostomy of different technique has been used to bypass duodenal obstruction.
OBJECTIVE:
To study congenital duodenal obstruction (atresia,annular pancreas and malrotation) and to evaluate and analyze the age presentation, x-ray findings and the operative findings in comparison with other studies, with emphases to the operative procedures suitable for each cause.
PATIENTS AND METHODS:
In this study patients were collected prospectively through the period between first of January 2010 to the end of January 2013 in pediatric surgical ward, at Al-Khansa teaching hospital in Mosul/Iraq. Erect abdominal x-ray was done for all patients to assess the radiological findings, while barium meal done selectively. Operative findings were evaluated in relation to the cause of obstruction, site, degree of proximal dilatation, presence of distal obstruction and other associated anomalies.
Surgical procedures were used according to the operative findings which were either diamond duodenoduodenostomy (DDD), side to side duodenoduodenostomy (SSDD), side to side duodenojejunostomy (SSDJ), Ladds procedure and Heinecke-Mikulicz (HM) or combined procedures.
RESULTS:
Fifty six patients were admitted to our center, 31male (55.5%) and 25 female (44.5%). Fourty five patients presented in the first 4 days of life (80%), 35 of them (60%) in the first 2 days, while 11 patients (20%) were delayed after the seven day of life, one patient aged one month proved to have fenestrated web. Vomiting was the main presenting symptoms in 50 patients (90%), and was bile stained in 42 patients (85%) and nonbile stained in 8 patients (15%). Erect abdominal x-ray show typical double bubble gases shadow sign in 39 patients (70%), Operative findings at time of exploration shows 36 atresia(67%) including 25 web(type one atresia), type 2 atresia in 8 patients and 3 patients with type 3 artesian. annular pancreas were detected in 11 patients(20%) and 7 patients(13%) with malrotaion. Diamond duodenoduodenostomy (DDD) was the procedure of choice in 38 patients (70%).
CONCLUSION:
The double bubble sign in erect abdominal X-ray is still diagnostic for cases with complete obstruction. High index of suspicious in patients with bilious vomiting is important for early referral, Diamond duodenoduodenostomy is very effective technique in most cases with very good post operative results.
.

Management of Liver Injury; An Experience from Baghdad Teaching Hospital

Tariq Al-aubaidi; Ahmed Mohammed; Mohannad kamel Al Bermani

Iraqi Postgraduate Medical Journal, 2017, Volume 16, Issue 3, Pages 290-297

ABSTRACT:
BACKGROUND:
The liver is the second most commonly injured organ in abdominal trauma, liver injury could be caused by trauma to abdomen, lower chest and back (blunt or penetrating injury) and may be associated with high mortality and morbidity depending on the mechanism of injury and associated injuries.
OBJECTIVE:
Discuss the types and grades of liver injury, assess treatment modalities and identify morbidity and mortality caused by liver injury.
PATIENTS AND METHODS:
This is a prospective study; included 60 patients admitted with liver injury within period of 13 months from (1st.January 2015- 31 st. January 2016) in Baghdad Teaching Hospital, Only patients who underwent operative management were included in this study. They were analyzed according to their age, gender, and mechanism of injury, site of trauma, physical examination, investigations, and details of management which include operative management.
RESULTS:
In this study, most injured patients were male 54 (90%) patients and 6 (10%) patients were female. The peak incidence of age was in those between 20-29 years, 28 (46.67%) patients while the lowest incidence was in those between 50-60 years, 2 (3.33%) patients. 52 (86.67%) patients had penetrating liver injury making it the most common type of injury and 8(13.33%) patients had blunt liver injury. The patients in this study were diagnosed by clinical examination, imaging study and exploratory laparotomy.
23 (38.33%) patients had grade II liver injury making it the most commonly encountered grade of injury while 19 (31.67%) patients had grade III as second most common grade of injury. Diaphragmatic injury was the most common associated organ injury with liver injury 30 (50%) patients. Surgical options for treatment of liver injury depend on general condition of the patients and grade of liver injury; simple suturing (hepatorrhaphy) with gelfoam was the most commonly used modality of treatment. Regarding postoperative complications, wound infection was the most common postoperative complication 8 (13.33%) patients followed by respiratory complications in 6 (10%) patients, jaundice in 5 (8.33%) patients, bile leak in 3 (5%) patients ,subphrenic collection in 3 (5%) patients ,disseminated intravascular coagulopathy (DIC) had occurred in 3 (5%) patients, bleeding occurred in 2 (3.33%) patients, hemobilia occurred in 1 (1.67%) patient and liver abscess and necrosis occurred in 1 (1.67%) patient .
CONCLUSION:
The most common grades of liver injury were grade II and grade III. The mortality rate increases with increasing the evidence of vascular injury.

Infant Sleep Practice and Sleep Environment in Erbil City

Mamoon M. Qasim; Abbas Abdulkader Alrabaty

Iraqi Postgraduate Medical Journal, 2017, Volume 16, Issue 3, Pages 298-303

ABSTRACT:
BACKGROUND:
Sudden infant death syndrome is a common cause of infant mortality below age of one year, and it is of unknown cause, but simple protective measures in the infant sleep practice and sleep environment can dramatically reduce its occurrence.
OBJECTIVE:
To study infants sleep environment and sleep practice in Erbil city.
METHODS:
This was an observational cross sectional study, random sample of 100 mother-infant pairs aged between 1 and 8 months were interviewed face to face using a questioner about infant sleep practice and sleep environment in relation to SIDS risk factors.
RESULTS:
In this study most Risky infant sleep practice detected were: lateral sleep position 39%,face covering 22%,bed sharing 42%,soft mattress 68%,bottle feeding 40% and smoke exposure 47%,the mothers had little knowledge about SIDS and no recommendations was given to them about safe infant sleep.
CONCLUSION:
There is a need to increase mothers' awareness about SIDS by public education by the health personnel at the neonatal care units and the primary health centers about SIDS and its risk factors and safe sleep recommendations to decrease its occurrence.

A Comparative Estimation of Metabolic and Hormonal Parameters Among Iraqi Hypothyroid Patients

Hind Shakir Ahmed

Iraqi Postgraduate Medical Journal, 2017, Volume 16, Issue 2, Pages 204-209

ABSTRACT:
BACKGROUND:
Thyroid hormones have a crucial physiological role to maintain balance of metabolism of body. Deficiency of iron can produce hypothyroidism. Hypothyroidism causes several lipid metabolism disorders. Visfatin and leptin are adipocytokines and have been suggested as important regulators in patients with thyroid dysfunction.
OBJECTIVE:
The aim of the present study was to estimate the circulating levels of lipids, iron, visfatin, and leptin in newly diagnosed hypothyroid patients.
PATIENTS AND METHODS:
The current study was conducted in medical city teaching hospital on 45 newly diagnosed cases of hypothyroidism aged 35-50 years and compared with 45 healthy in¬dividuals as control group during the period from June 2016 to January 2017. This study investigated the serum concentrations of lipid profile, some iron status parameters and hematological parameters, total- and free-, triiodothyronine, tetraiodothyronine, thyroid stimulating hormone, visfatin, and leptin in hypothyroid patients and compared them with the controls.
RESULTS:
There was a significant increased in serum total cholesterol and triacylglycerol in hypothyroid patients compared to the control, (P=0.001). There was a significant decreased in hemoglobin, serum iron, and ferritin while a significant increased in total iron binding capacity in hypothyroid patients compared to the control, (P≤0.05). Means value of thyroid stimulating hormone levels were significantly increased in hypothyroid patients compared to the control group. On the other hand, the levels of total- and free-, tetraiodothyronine, free triiodothyronine were significantly decreased in hypothyroid patients as compared to the control group. There was a significant increased in visfatin and leptin concentrations in hypothyroid patients compared to the control group, (P≤0.05).
CONCLUSION:
These data suggest that thyroid hormone insufficiency may lead to deficiency of iron and lipids abnormalities. Thus, estimation of iron and related parameters with lipids may be quite useful during the diagnosis and treatment of hypothyroid patients. Also, alterations in thyroid status change serum visfatin and leptin in hypothyroid patients. It is advisable to routinely investigate them for early detection allowing its early management.

The Value of the Trans-Abdominal Ultrasound in Evaluation of Neonatal Respiratory Distress Syndrome

Duraid Dahmoud; Raad H. Abed Tawfeq AL- Kayat; Tala A.AL-Awqati

Iraqi Postgraduate Medical Journal, 2017, Volume 16, Issue 2, Pages 210-217

ABSTRACT:
BACKGROUND:
Chest x-ray has been the traditional method of diagnostic evaluation of patients of neonatal respiratory distress syndrome of prematurity. Lung sonography has been lately explored as an alternative modality.
OBJECTIVE:
To evaluate diagnostic ability of trans-abdominal lung ultrasonography in detection of pulmonary manifestations of neonatal respiratory distress syndrome and compared the findings with Chest x-ray.
PATIENTS AND METHODS:
A cross section analytical study was performed at the NICU ward of Al-Yarmouk teaching Hospital; from January to august 2016, the study was done on 65 infants neonates included two groups one with neonatal respiratory distress syndrome group and other control group . Case were 50 premature newborns with neonatal respiratory distress syndrome ( gestational age from 24-35wks) and a control group of 15 premature newborns (gestational age30-35wks). The diagnosis of neonatal respiratory distress syndrome was made by clinical data and chest x-ray. The trans-abdominal lung ultrasonography was performed in all patients within the first 12 h of life.
RESULTS:
We seen that neonate are born by cesarean section 32(64%) and those neonates born by normal vaginal delivery 18(36%), while the male gender born with neonatal respiratory distress syndrome 33(66%) and female neonate with RDS 17( 34%), The trans-abdominal lung ultrasound showed 100% sensitivity,81 % specificity, The good correlation between stages of neonatal respiratory distress syndrome by lung ultrasound and chest x-ray findings
CONCLUSION:
This study show that using of an ultrasound for the diagnosis of neonatal respiratory distress syndrome is accurate and reliable tool with many advantages over other techniques as it is non-ionizing, low-cost and be performed at bedside, making this technique ideal for use in neonatal intensive care unit.
..

Amyand's Hernia in a 9-Month-Old Infant: Case Report & Review of the Literature

Ali Egab Joda; Nawzat Hussein

Iraqi Postgraduate Medical Journal, 2017, Volume 16, Issue 2, Pages 218-223

ABSTRACT:

Amyand’s hernia is defined as the presence of an appendix inside the sac of inguinal hernia whether inflamed or not, it is very rare occurring in less than 1% of patients of inguinal hernia surgery. Although it was first described three centuries ago in an 11-year-old boy by Claudius Amyand, it still continues to possess some fuzziness regarding its diagnosis & treatment because of the scarcity of its occurrence. It has variable clinical presentation according to the extent of appendix inflammation & related complications. The diagnosis of an Amyand's hernia is difficult to settled clinically. However, imaging studies are beneficial for both diagnosis and recognition of the associated complications. Here, we report a case of Amyand's hernia in a 9-month-old male infant discovered incidentally during surgery for right sided inguinal hernia in the department of pediatric surgery in the Central Child Teaching Hospital in Baghdad in which we did reduction of a normal appendix into abdominal cavity & herniotomy with high up transfixation of hernia sac.
The purpose of presenting this case report is the rare occurrence of Amyand's hernia & the possibility of encountering an unusual content of hernia sac during the repair of inguinal hernia, that is why Amyand's hernia should be taken in consideration while operating on obstructed or strangulated inguinal hernia. The surgeon need to be aware of all clinical presentations with which the Amyand's hernia may present and the suitable, individualized option of surgical treatment applied. In this paper we review the
literature on presentation of Amyand's hernia and discuss the diagnostic modalities with the current options of its surgical treatment.

Recovery and Vomiting after Pediatric Tonsillectomy with or without Adenoidectomy: Comparison between TIVA using Propofol and Thiopentone Induced Halothane Maintained Anesthesia

Hasan Sarhan; Ahmed Saeed Abdullah

Iraqi Postgraduate Medical Journal, 2017, Volume 16, Issue 2, Pages 122-128

ABSTRACT:
BACKGROUND:
Vomiting in the first few hours after recovery is considered as the main factor that delayed hospital discharge in pediatric outpatient surgery . Children having tonsillectomy with or without adenoidectomy operations have a high incidence of vomiting. Propofol has a short duration of action with rapid recovery and a proved antiemetic effect. Using propofol in total intravenous anesthesia, the incidence of vomiting is lower than the traditional thiopentone induced halothane maintained technique.
OBJECTIVE:
The aim of the study is to compare recovery characteristics and vomiting between total intravenous anesthesia using propofol as the sole anesthetic agent with the anesthetic technique using thiopentone for induction and halothane for maintenance to assess which is more suitable for outpatient pediatric surgery.
PATIENTS AND METHOD:
Forty healthy unpremedicated children, ASA Ӏ, aged 7-12 years undergoing tonsillectomy with or without adenoidectomy were randomly allocated into 2 groups. Group (1) children were induced with 2-3 mg.kg-1 propofol while group (2) children were induce with thiopentone 5-6 mg.kg-1 . Maintenance was 0.2 mg.kg-1 propofol in group (1) and 0.8% halothane in group (2). Both groups received 0.5mg.kg -1 atracurium to facilitate intubation and maintain muscle relaxation. Oxygen 100% was administered to both groups. Other treatment and procedures were standardized intra and postoperatively . Extubation time, time for spontaneous eye opening and the state of recovery after thirty minutes were compared. Results of postoperative vomiting were analyzed in the first 6 hours and beyond that.
RESULTS:
Extubation time in group (1) was 4.75 ± 0.89 minutes and in group (2) it was 8.87 ± 1.86 minutes. The time for spontaneous eye opening in group (1) was 5.5 ± 1.22 minutes and in group (2) it was 13.125 ± 1.69 minutes. Both were significantly different . Nevertheless, both groups had a comparable modified Aldrete score which consists of 10 points and a score of 8-10 is considered ready to discharge to the general care unit. All patients in group (1) had a score of 10, while 1 patient had a score of 10, 14 patients with 9 and 5 patients with 8 in group (2). The incidence of vomiting in the first 6 hours after recovery was significantly lower in group (1) as well as the incidence after 6 hours. The same is applied to the incidence of recurrent vomiting (˃ 1 attack) in the first 6 hours, while recurrent vomiting after 6 hours were comparable in both groups. The overall incidence of recurrent vomiting was 35% in group (2) and 0% in group (1).
CONCLUSION:
Despite a comparable recovery, propofol has a lower incidence of vomiting after tonsillectomy with or without adenoidectomy in healthy children than thiopentone induced halothane maintained anesthesia and is more suitable for outpatient pediatric surgery.
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The Role of Diffusion-Weighted MRI and Apparent Diffusion Coefficient in the Evaluation of Early Renal Allograft Dysfunction

Abdul Ameer A. Al-Mosawi; Raad H. Abed Tawfeq; Mustafa Rasool Hussein; Luma Khudayer Mohammad

Iraqi Postgraduate Medical Journal, 2017, Volume 16, Issue 1, Pages 35-40

ABSTRACT:
BACKGROUND:
The most common complication of allografted kidney is renal allograft dysfunction which in some cases results in graft loss, the Diffusion Weighted-Magnetic Resonant Imaging (DW-MRI) and Apparent Diffusion Coefficient (ADC) value may provide a useful insight into the underlying pathology of renal allograft dysfunction.
OBJECTIVE:
To evaluate the utility and diagnostic performance of the DW-MRI and its ADC value in patients with early renal allograft dysfunction.
PATIENTS AND METHODS:
An analytic prospective study was conducted at MRI unit of Al Shaheed Ghazi Al Hariri Teaching Hospital from February 2015 to the end of November 2015, a total of 57 cases were included in this study, they divided in to two groups; control group: including 30 cases with stable or normal renal allograft function and patients group: including 27 cases with early renal allograft dysfunction. All study cases underwent DW-MRI with b value=1000 sec/mm2. The ADC was reconstructed and mean ADC values were correlated with histopathological biopsy results which is done for all patients group to determine the underlying etiology.
RESULTS:
The mean ADC values of the patients group (1.7±0.2) *10-3 mm2/s were significantly lower (p=0.001) compared with the mean ADC values in the control group (2.2±0.1) *10-3mm2/s. The cutoff ADC value between the control group and the patients group was (2.06*10-3 mm2/s). According to the morphological appearance in DWI and ADC map we can differentiate acute tubular necrosis (ATN) cases which expressed a heterogeneous appearance/mosaic pattern from acute renal allograft rejection cases and calcinurin inhibiter (CNI) nephrotoxicity cases where both expressed a homogenous morphological pattern.
CONCLUSION:
DW-MR and its ADC were valuable in the assessment of the underlying etiology of early renal allograft dysfunction and there was a Cutoff ADC value between stable or normal renal allograft function cases and early renal allograft dysfunction.
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Immediate and Late Effect of in Vitro Low Level Helium-Neon Laser Irradiation on Human Sperm Activity

Ghassan Thabet Saeed

Iraqi Postgraduate Medical Journal, 2017, Volume 16, Issue 1, Pages 79-85

ABSTRACT:
BACKGROUND:
Sperm motility is essential in fertilization because non active or mal active sperms never reach the ovum, but the progress in the assisted reproductive techniques makes it easy for doctors to select viable sperm to be used in intracytoplasmic sperm injection thus the differentiation between viable and non-viable sperms is very important especially in sever asthenospermic samples.
OBJECTIVE:
To evaluate low level Helium Neon laser irradiation of the whole seminal sample as a method to activate mal or non-active sperms and to study and follow up the late effect of laser irradiation on the seminal samples.
MATERIALS AND METHODS:
100 samples were included in this study from patients attending seminal fluid examination lab. After digital seminal fluid examination, samples were divided in 2 parts, the first was incubated for 120min at 37C and the other was irradiated with 623.8 wave length Helium Neon laser and an output power of 2mW at 1cm distance for 10min and then examined digitally after irradiation then incubated with the first part to 120min also to be examined again with the first part.
RESULTS:
It was found that there is a significant increase in the progressive motile sperm percentage in the laser irradiated samples from about 33.6% to 41.6% (p<0.005) and also decrease in the percentage of the immotile sperms from about 44.1% to 34.4% (p<0.001). While after 120min incubation, active sperms percentage in the irradiated sample was about 43% which is higher than the non-treated part (31.6%; p<0.01) that showed also higher percentage of immotile sperms (52.8%) against (39.9%) in the treated part.
CONCLUSION:
Helium Neon laser irradiation to the whole seminal sample increase the sperms activity and decrease the percentage of immotile sperms which mean that it stimulates viable but immotile sperm to move. And also, sperms in laser irradiated samples preserved their increased activity for more than 2hours after laser irradiation.

The Association of Gestational Diabetes with Serum Ferritin

Thanaa Jameel Al-Khishali; Nada Salih Ameen; Dina Akeel Salman

Iraqi Postgraduate Medical Journal, 2017, Volume 16, Issue 1, Pages 47-56

ABSTRACT:
BACKGROUND:
Serum ferritin is the standard measurement for the body iron stores, and is the most reliable marker for iron status. During pregnancy, there is a gradual decline in serum ferritin level. However, elevated maternal serum ferritin was notified in women with gestational diabetes mellitus (GDM).
OBJECTIVE:
To investigate the association between maternal serum ferritin level and gestational diabetes.
METHODS:
A prospective case control study of 50 women with singleton pregnancy that had gestational diabetes compared to 50 healthy pregnant women. The study was performed in Baghdad teaching hospital for one year period from June 2010 through June 2011. Serum iron, total iron binding capacity, and serum ferritin level were assayed. Mean serum ferritin was elevated (95.6027±99 ng/ml) in women with gestational diabetes, compared to that in the control group (31.7213±42ng/ml).
RESULTS:
There was a statistically significant elevation of serum ferritin in women with gestational diabetes. CONCLUSION:
We concluded that there is a positive association between the elevated serum ferritin and gestational diabetes.

Patterns and Prognosis of Epileptic seizures in Children with Cerebral Palsy

Kawes O.Zangana; Muhi Kadhem Al-Janabi; Abdulla F. Ahmad; Zaher T. Gardi

Iraqi Postgraduate Medical Journal, 2017, Volume 16, Issue 1, Pages 64-71

ABSTRACT:
BACKGROUND:
Cerebral palsy (CP) is the result of non-progressive damage to the developing brain and consists of a number of clinical neurological syndromes of heterogeneous etiology. Epilepsy is known to have a higher association with cerebral palsy; 15–60% of children with cerebral palsy have been reported to have epilepsy.
OBJECTIVE:
This study was performed to determine and assess the characteristics of cerebral palsy and explore the relationship between type of cerebral palsy and patterns of epileptic seizures and to determine the associated factors, nature and prognosis of epilepsy in children with cerebral palsy.
PATIENTS AND METHODS:
Design:A prospective, hospital-based, case-control study.
Setting: RaparinPediatric Teaching Hospital, Rizgary Teaching Hospital-Neurology Department and Helina Handicap Care Centre during the period of January 2013- July 2015, Erbil, KRG, Iraq.
PATIENTS:
One hundred and twelve children had CP and seizures were studied (group1). Two control groups included 70 children had CP without seizures (group2), and 50 children had seizures without CP (group3).
The following data were ascertained: Type of CP, pattern of seizures, age, gender, age at onset of seizures, mode of delivery, history of hypoxic ischemic encephalopathy in the neonatal period, neonatal seizures, history of status epilepticus, family history of seizures, developmental delay, EEG data, image findings, use of anti-epileptic drugs, seizures control and seizures outcome. Children with febrile convulsion were excluded from this study.
RESULTS:
Spastic tetraplegia wasthe most common type of CP (29.46%, 35.71%) in group 1 and 2 respectively.Generalized tonic, clonic or tonic clonic seizures were the most common types of seizures in both groups. Unlike those who had epilepsy without CP,themajority; 57(50.89%) of patients who had epilepsy and CPdeveloped seizures in the first year of life. Twenty eight percent of caseswith epilepsy and cerebral palsy, and 88% of cases with epilepsies alone showed good seizure control by antiepileptic therapy. Children who had epilepsy and CPhad a higher frequency of; neonatal seizures44 (39.28%), developmental delay98 (87.5), abnormal brain CT scan 91(81.25%) and family history of seizures47 (41.69%). Large number of patients who had epilepsy and CP 81(72.32%) needed poly therapy while majority ofthose who had epilepsy without CP needed single therapy 60(90%).
CONCLUSION:
Cerebral palsy is associated with a higher incidence of seizure disorders, whichin a majority has its onset in the first year life.Brain imaging showed abnormal pathology in most affected children and needed poly therapy and even difficult to control.

Combat Gunshot Head Injury

Mazin S. Mohammed Jawad

Iraqi Postgraduate Medical Journal, 2017, Volume 16, Issue 1, Pages 72-78

ABSTRACT:
BACKGROUND:
Combat Gunshot Head Injury is an increasingly important issue with all its drawbacks on the health care system .
OBJECTIVE:
This study presents an evaluation of traumatic brain injury caused by gunshots and discusses possible predictive factors for the outcome of surgical intervention.
PATIENTS AND METHOD:
A prospective study performed at Al Shaheed Mohammed Al Majed hospital, Samarra, Saladin, Iraq consisted of 60 patients who underwent surgery for penetrating TBI over a 1 year period (2015 – 2016). All injuries were caused by gunshot.
RESULTS:
Mean patients’ age was 31.5 years. The Glasgow Coma Scale (GCS) score on admission was > 8 in 43 patients (71.7%) and ≤ 8 in 17 patients (28.3%). Commonest site of brain injury is the frontal lobe (28%). Ballistic trajectory through brain affects the post operative outcome with good outcome (50%) in the anteroposterior bullet trajectory plane. 5 patients (8.3%) died despite surgical management.
CONCLUSION:
Admission GCS score, bullet trajectory and ventricular involvement are the most powerful prognostic indicator with a score of more than 8, no ventricular hemorrhage, anteroposterior trajectory of bullet and lesions limited to a single lobe of the brain, have improved surgical outcomes. Early and less invasive surgery in conjunction with short transportation time to the hospital could decrease mortality rates.
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Anaesthesia for Anal Dilatation using Propofol Versus Sevoflurane in Peadiatric Patients

Sanaa Fareed Qassim

Iraqi Postgraduate Medical Journal, 2017, Volume 16, Issue 1, Pages 102-106

ABSTRUCT:
BACKGROUND:
Anal dilatation is streaching of the anal incision gently with special dilators as a part of follow up after posterior sagittal anorectoplasty (PSARP) and pull through operations in peadiatric patients . Sevoflurane has many of the features of an ideal volatile anaesthetic agent with rapid induction which make it particularly useful in children . Propofol is the most desirable intravenous agent in outpatient anaesthesia because of rapid induction and recovery.
OBJECTIVE:
Is to compare propofol with sevoflurane as a single anaesthetic agent for anal dilatation in peadiatric patients that produce more rapid turn over of cases.
Patients and methods: 50 peadiatric patients who had anal dilatation with Hegar dilators allocated into 2 groups according to the anaesthetic agent used sevoflurane (S) or propofol(P) . The variables measured are the induction time(T1) and the time needed to achieve good relaxation(T2).
RESULTS:
T1 was shorter in group P(mean 60 sec)than group S(mean 86 sec)p value0,000(highly significant),T2also shorter in group P(mean 99.5 sec)than group S(mean 121.3 sec)p value0.012(significant) so both variables measured were shorter in case of using propofol with statistical significancy.
CONCLUSION:
Propofol produces more rapid turn over of short cases than sevoflurane and with no risk of malignant hyperthermia.
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Attitudes and Stigma Towards Mentally Ill People Among Students of College of Medicine, University of Baghdad

Nesif Jasim Al-Hemiary

Iraqi Postgraduate Medical Journal, 2017, Volume 16, Issue 1, Pages 107-111

ABSTRACT:
BACKGROUND:
Stigma and discrimination towards people suffering from mental illness is still unfortunately common in our community and this can negatively affects the attitudes of medical students. Medical curricula in different medical schools were found to have less effect than expected on these attitudes.
OBJECTIVE:
To compare the stigma and attitudes between fourth and sixth year medical students (before and after their psychiatry placement) at the College of Medicine, University of Baghdad, towards mentally ill people.
SUBJECTS & METHODS:
A case control study with random samples were taken from the fourth and sixth year students. The community attitudes towards mental illness questionnaire was used to rate attitudes and stigma amongst both groups of students. Independent sample's t test was used to compare between both groups. P value ≤ 0.05 was considered significant.
RESULTS:
A total of 106 students from fourth year and 107 students from the sixth year had participated in this study, male to female ratio was 0.3:1 and 0.9:1 respectively. Mean age was 21.5±0.8 for the fourth year and 23.7±0.7 for the sixth year. Majority of students were from Baghdad city (92.45% of 4th year and 89.72% of 6th year) .Crowding index was almost similar between both groups. Stigma was not significantly different between fourth and sixth year students (p =0.1). Authoritarianism was significantly higher among sixth year students (p=0.02), while other subscales (benevolence, social restrictiveness, and community mental health ideology) were not significantly different (P value was 0.6, 0.08, and 0.2 respectively). Crowding index had no effect on stigma and other community attitudes towards mentally ill (CAMI) subscales.
CONCLUSION:
Stigma and attitudes towards mentally ill people were the same in fourth and sixth years' students. It seems that psychiatry curriculum did not help in changing attitudes of students towards mentally ill people.
.

Wilms' Tumor in Children (Clinical Features & Management) An Experience in Child Central Teaching Hospital

Raghad Dawood Najem

Iraqi Postgraduate Medical Journal, 2017, Volume 16, Issue 1, Pages 1-8

ABSTRACT:
BACKGROUND:
Wilms tumor is one of the most common nephrologic paediatric tumors, a retrospective study of 24 patients had wilms tumor were reviewed from clinical and epidemiological point in the oncology unit of Child Central Teaching Hospital for the period (June 1st 2004 to June 1st 2010).
OBJECTIVE:
To find out the main clinical features, diagnosis,treatment modalities and outcome of children with wilms tumor admitted to central teaching hospital.
PATIENTS AND METHODS:
Records of 24 cases were collected and analyzed as aretrospective study done in oncology unit in central teaching hospital over 6 year period from June 1st2004 to June 1st 2010
RESULTS:
Patients included 13 males and 11 females; the mean age at presentation for males was 3.7 years and 2.5years for females,male to female ratio was 1.18:1 .
Asymptomatic abdominal mass was the most common presenting feature in 24 patients (100%) followed by haematuria in 7patients (29.2%), hypertension in 3 patients (12.5%), congenital anomaly(which was hemihypertrophy of the Lt. side) in 1patient (4.2%) & other presenting features including: fever, weight loss, nausea, vomiting, abdominal pain in 15 patients (62.5%).
The tumor was left sided in 14 (58.3%) patients, right sided in 8 (33.4%) patients & bilateral in 2 patients (8.4%).
Stage III wilms tumor was the commonest histopathological type in 7 patients (29.2%).
The overall survival was (41.6%); the overall mortality rate was (16.7%); infection and sepsis were the main causes of death in 2 patient (8.3%).We had 4 patients died ,2 of them due to infection &sepsis , other 2 patients cause of death not reported.
CONCLUSION:
The study showed the clinicodemographic fates of patient with wilms tumor were similar to other studies but still infection &sepsis were common causes of death in advanced stages because of delayed referral in most cases.

Intracorporeal Pneumatic Lithotripsy for Treatment of Vesical Stone in Children

Esam M. Abd; Dhia A. Kareem

Iraqi Postgraduate Medical Journal, 2017, Volume 16, Issue 1, Pages 30-34

ABSTRACT:
BACKGROUND :
Pediatric vesical stones constitute 30% of all urinary tract stones in the developing countries. Management of pediatric urolithiasis has evolved from open surgery to minimally invasive techniques
OBJECTIVE :
To evaluate the efficacy and safety of using pneumatic lithotripsy in the treatment of vesical stone in pediatric age group.
PATIENTS AND METHODS:
Forty children (2 female and 38 male) with bladder calculi were evaluated in this prospective study and managed by transurethral pneumatic cystolithotripsy at the department of urology in Al-Ramadi Teaching Hospital during the period January 2010 through December2012. The age ranged between 2 years and 10 years with a mean age of 4.6 years. Bladder stone size ranged from 8mm to 17mm ,plain X-ray kidney, ureter and bladder (KUB) revealed that 28 patient's calculi were radiopaque and 12 patient's calculi were radiolucent , History and physical examination were performed. Laboratory investigations included complete blood count, blood urea, serum creatinine and urine analysis. Radiological examination included plain X-ray kidney, ureter and bladder (KUB) ,ultrasound and Excretory urogram (EU). transurethral pneumatic lithotripsy of bladder stone was done using semi rigid 9FR ureteroscope, after initial cystoscopy, Stone was fragmented with pneumatic lithoclast probe (3mm tip, storz). After completing the procedure 8-12 FR urethral Foley catheter was passed. Foley catheter was removed after 24-72 hours .
RESULT:
After one session of cystolithoclast, 92.5% (37) children became stone free. The mean operative time was 41.575 minutes with a range of (35-75 min).In this study the complications included significant hematuria in 5 patients (12.5%), urine retention in one patient (2.5%), and residual stone in 3 patients (7.5%) .
CONCLUSION:
Pneumatic lithotripsy using ureteroscope appears to be an effective and safe treatment method for bladder stone in children.
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Thymectomy in Myasthenia Gravis

Abdul Ameer Mohsin Hussein; Mohanad AbdulAmeer

Iraqi Postgraduate Medical Journal, 2017, Volume 16, Issue 1, Pages 86-91

ABSTRACT:
BACKGROUND:
Thymectomy is a good option for the treatment of patients with myasthenia gravis (MG).
OBJECTIVE:
To show the effect of thymectomy as treatment for patients with myasthenia gravis.
PATIENT AND METHODS:
A retrospective study of 75 patients admitted to AL-Hariri martyr hospital from January 2010 to December 2014. They were reviewed using special form included patients' (age, sex, hospitalization period, CT-findings, preoperative medication, respiratory care unit (RCU) admissions, plasmapheresis sessions, number of drains in operation, complications post operatively, type of surgery, histopathological findings) with their symptoms being staged according to Osserman classification. All patients managed with trans-sternal thymectomy and extensive tissue removal of the thymus and fatty tissue around it.
RESULTS:
From 75 patients, 33% achieved complete remission, 27% had partial improvement, 32% with no changes and 8% got worse. 45 patients (60%) are between 20ys and 40ys with female predominance and good responses to surgery. 30 patients (40%) are above 40 with less improvement after thymectomy. Patients with severe symptoms (32 patients) appear to improve. This is also true in patients underwent thymectomy and the histopathological findings of thymic follicular hyperplasia (35 patients).
CONCLUSION:
Trans-sternal thymectomy is a safe treating method for patients with myasthenia gravis. Age, sex of the patients and presence or absences of thymoma are significant predictors. Patients with severe symptoms and those with a biopsy of thymic follicular hyperplasia improve remarkably.

Arthroscopic Screw Fixation Versus Arthroscopic Subchondral Bone Drilling In Osteochondritis Dissecans(OCD) of the Knee

Majed Aswad Alsaad; Mahmoud Kh. Yassen

Iraqi Postgraduate Medical Journal, 2017, Volume 16, Issue 1, Pages 92-97

ABSTRACT: BACKGROUND: Osteochndritis Dissecans is relatively rare disorder commonly affect adolescent males, non weight bearing area of the medial femoral condyle is the most common site. OCD is a radiological diagnosis with MRI sensitivity about (97%). Non operative treatment indicated in juvenile form and stable type. Operative intervention indicated in adult form and unstable lesions.
OBJECTIVE: To the postoperative clinical knee functional outcome between arthroscopic screw fixation and arthroscopic subchondral bone drilling in OCD. PATIENTS AND METHODS: A retrospective comparative non randomized study was performed on 10 patient (8 males and 2 females) with adult form of OCD. The patients were divided into 2 groups( A and B), each group consisting of 4 males and 1 female. All patients in group( A) underwent arthroscopic screw fixation, and all patients in group (B) underwent arthroscopic subchondral bone drilling. After 3, 6 and 12 months follow up, the 2 groups were compared preoperative and postoperative according to Lasholm Score changes. RESULTS: In both groups ( A and B), the difference in improvement of the clinical knee outcome postoperatively better than preoperatively according to Lasholm Score( P value less than 0.001) which was statistically significant, and the difference in improvement in group (A) better than in group (B) postoperatively, P value < 0.001 which was statistically significant. CONCLUSION: Arthroscopic screw fixation in OCD has statistically better clinical knee functional outcome than arthroscopic subchondral bone drilling, and it is recommended to do arthroscopic screw fixation if possible. .

Maternal Height and ‘Shoe Size’ as Predictors of Intrapartum Complications in Labor with Occiput Posterior Malposition

Shatha Sami; Wisam Akram; Faten Shalal

Iraqi Postgraduate Medical Journal, 2016, Volume 15, Issue 4, Pages 506-511

ABSTRACT:
BACKGROUND:
Although most women have anormal labour and birth, there are sometimes complication occurring due to multiple factors,occiput posterior postion represent achallenges in diagnosis,labour& intrapartum complication care
OBJECTIVE:
To evaluate maternal height and shoe size correlates with complications associated with occiput posterior ma position during labor.
Type of the study; case control
METHODS:
A total of 45 primigravida women with android pelvis were chosen versus 45 with gynecoid pelvis according to clinical pelvimetry,Their shoe size and height were recorded. In addition women in both groups were scrutinized for occiput posterior and labor complications associated with condition including secondary arrest of dilatation, deep transverse arrest and cesarean for failed assisted vaginal delivery. Labor duration with regard to the first and second stage was also recorded for both groups and linked to shoe size and maternal height.
RESULTS:
The odd ratio for secondary arrest of dilatation, deep transverse arrest and failed assisted vaginal delivery were significantly higher among women with android pelvis than gynecoid ; 4.8, 5.6 and 4.5, respectively. A significant correlation between shoe sizes, maternal height versus duration of the first and second stage; P Value is P < 0.0001. Cluster analysis showed that women with shoe size between 37 cm to 40 cm are most likely to have intrapartum complication and failed assisted vaginal delivery. The rate of complications was higher in the android group than control gynecoid pelvis.
CONCLUSION:
Some correlation could be concluded between maternal shoe size and possibility of cesarean section for deep transverse arrest among women with android pelvis. However due to the anthropometric variations among women the results of this study could only be applied to patients covered by AL Yarmook Teaching Hospital including south and west of Baghdad city. Further studies are required to have better understanding of this vital subject.

CD71Expression Pattern in Lymphocytes Among Rheumatoid Arthritis Patients

Haider Faisal Ghazi; Asmaa Baqir Al-Obaidi; Jaffar Nouri Jaffar Alalsaidissa

Iraqi Postgraduate Medical Journal, 2016, Volume 15, Issue 4, Pages 446-451

ABSTRACT:
BACKGROUND:
Abnormal lymphocyte activation status have been described in rheumatoid arthritis. Suggesting an increased need for iron as a source of energy.
OBJECTIVE:
To evaluate the cellularexpression pattern ofTransferrin receptor(CD71)proteinin the peripheral blood lymphocytes,
PATIENTS &METHODS:
This study involved forty-six rheumatoid arthritis patients 42 female and 4 male, age ranged from 25-66 years collected from AL-Kadhemia teaching hospital were examined and compared with 17 healthy control individuals of similar ages. Lymphocytes were separated from peripheral blood samples,the assessment of their cellular expression of cluster of differentiation 3 and CD71by immunofluorescent staining method.
RESULTS:
The results showed abundant accumulation of CD3 T lymphocytes in the peripheral circulation of rheumatoid arthritispatients in comparison with controls with increased transferrin receptor expression in rheumatoid arthritisgroup (p<0.001).Furthermore,the diffuse pattern was not significant (0.280), lower percentage of intercellular pattern among RA patients (21.31±16.23) than controls (45.43±12.95) with highly statistical significant difference (p<0.001). While, membranous pattern was higher among RA patients (51.22±28.43) than controls (23.77±18.57) with highly statistical significant difference (<0.001).
CONCLUSION:
This study demonstrate increased expression in CD71 with membranous expression pattern amongrheumatoid arthritis patientsthan thatcontrols, suggesting its important role in up taking transferrin from blood as a source for energy.
.

Surgically Treated Ankle Fracture, Danis – Weber Type C: A Short Term Functional Outcome

Wissam Khaidhyer Baidi; Ali Bakir Al-Hilli

Iraqi Postgraduate Medical Journal, 2016, Volume 15, Issue 4, Pages 397-405

ABSTRACT:
BACKGROUND:
Fractures of the ankle are fairly common injuries. Large comparative studies that have evaluated long-term functional outcome of operatively treated ankle fractures are lacking.
OBJECTIVE:
This study is performed to analyse the functional outcome of gender, weight and age of patient with Weber C in the early follow up time.
PATIENTS AND METHODS:
This retrospective review of 18 patients (13 males and 5 females), age ranges between 19-78 years (average 38.9 years) with Weber type C ankle injury that were treated by open reduction and internal fixation in Medical city Complex from October 2013 to February 2014. All patients were followed up for a mean time of 15.5 months (12- 30 months) after index surgery. The body mass index (BMI) of all patients ranges from 19.9-36.7 (mean 27.4), of these patients, 6 (4 females and 2 males) had BMI more than 30 (mean 33.5), the other 12 patients had BMI of less than 30 (mean23.4). Outcome measurements were determined using the Olerud and Molander scoring system and Linear Analogue Scale for all patients.
RESULTS:
According to the (OMAS) scoring system, there were 12 patients had excellent outcome, 3 had good, 2 had fair and one patient had poor results.14 patients of less than 50 years their average OMAS score was 82.8, while those of more than 50 years 57.5 (P value =0.001); LAS score for patients less than 50 years average score was 8.07 while those more than 50 years was 5.5 (P value =0.0007).Male gender in this study was 13 patients, average OMAS score was 91.5, and average LAS was 9, female patients were average scored 40 and 3.6 by OMAS and LAS respectively. (P value=0.0022).Regarding the BMI, patients of less than 30 had average OMAS score 85 and LAS score 8.25. On the other hand, patients who had more than 30 BMI had average OMAS 61.6, and average LAS 6. (P value =0.0001).
CONCLUSION:
The early follow up time shows better results in male gender, younger age group, and non-obese patients. A long follow up time is required for this type of injury in order to base the evidence of these parameters and to evaluate the functional outcome.

Body Surface Area and Sheath Size as a Risk Factors for Vascular Complications After Coronary Angiography Via Femoral Approach

Salah Mahdy Majeed; Ali Mohammed Jawad; Haithem Ahmed Al-Rubaie; Zahraa Akram Thabit; Saad kadhum Kareem; Manal Madany A. Qader; Shatha Sami; Wisam Akram; Faten Shalal; Mustafa Nema; Mudher Al-Khairalla

Iraqi Postgraduate Medical Journal, 2016, Volume 15, Issue 4, Pages 481-485

ABSTRACT:
BACKGROUND:
Vascular complications have been recognized as an important factor in morbidity after diagnostic and percutaneous coronary interventions.
OBJECTIVE:
This study sought to evaluate vascular body mass index and sheath size as risk factors for vascular complications after diagnostic coronary angiography via femoral approach.
PATIENTS AND METHODS:
This historical prospective cohort study was carried out from February 2012 till January 2013, at the Iraqi Center for the Heart Disease. A total number of 2400 patients underwent 3600 procedures, diagnostic coronary angiography (2196) and PCI(1404) via their common femoral arteries.
Result: Body surface area > 2m2 is a statistically significant factor for vascular complications, and <1.6m2 is also an important statistically significant risk for vascular complications.
The results of the current study according to sheath size show:- during the diagnostic coronary angiograph procedures, sheath size 5F was the least(n=34), in which no reported vascular complications. Sheath size 6F (n = 1661) with (75) 4.5% complicated vs. (1586) 95.5% didn’t, sheath size 7F used among (501) patients, vascular complications developed in (171) 34.1% vs. (330) 65.9%. In comparison between the incidence of vascular complications among sheath sizes (6F, 7F) vs. 5F the P value < 0.001 for both.
During the PCI procedures, sheath size 6F was used among (140) patients, with vascular complications in one patient (0.7%). 7F used among (1219), with vascular complications in (115) 9.4%, and 8F used in (45) patients with vascular complications in (45) 100%. By using 6F as a referent, sheaths 7F&8F were statistical significant(p

Keywords

KEY WORDS: body surface area
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sheath size
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vascular complications.

The Role of Alpha Blockers in the Treatment of Children with Voiding Dysfunction

Dhia A. Kareem; Omar A. Hassan

Iraqi Postgraduate Medical Journal, 2016, Volume 15, Issue 4, Pages 459-464

ABSTRACT:
BACKGROUND:
Voiding dysfunction is an important problem in chil¬dhood due to its relatively high prevalence and the fact that it may cause upper urinary tract dete¬rioration with renal scarring. Pharmacological therapy is considered as one of the important measures to improve bladder emptying ,Several reports have supported the effectiveness of α-blockers in treating voiding dysfunction in children.
OBJECTIVE:
To evaluate the safety and efficacy of using selective alpha blocker therapy for children with voiding dysfunction.
PATIENTS AND METHODS:
A prospective study conducted from January 2011 to December 2013 in Al- Ramadi teaching hospital. 24 children with mean age 9.9 years had voiding dysfunction. Patients were evaluated by history, clinical examination, laboratory investigations, radiological examination, cystoscopy and urodynamic study. Treatment was initiated with doxazocin (selective α-adrenergic blocker) 0.03 mg/kg body weight and increased according to the response, but not more than 2mg, patients were followed monthly for 12 months.
RESULTS:
24 children (16 patient male and 8 female), all patients had high postvoiding residual volume and abnormally low maximum flow rate. 18 patients (75%) had vesicoureteral reflux and hydronephrosis, after the starting of doxazocin 20 patients (83%) showing improvement in their symptoms. Upper tract dilatation improved in 12 patients (66%), Mean postvoiding residual volume reduced by 72.7% of the pretreatment mean PVR (p = 0.0001),The increment in the maximum flow rate was 68.4% (p 0.0001) from the pretreatment maximum flow rate. Failure rate was reported in 4 patients(16%) subjectively and 6 patient (25%) objectively. No patients was reported to had any serious side effects to doxazocin.
CONCLUSION:
Selective α-blocker therapy seems to be well tolerated in children and appears effective for improving symptoms and bladder emptying in various pediatric voiding disorders.

Effect of Pressure Support Ventilation Usage at the End of Surgery on the Recovery from General Anesthesia in Extra Peritoneal Surgery

Raghad Hannon Shinen ALSudani

Iraqi Postgraduate Medical Journal, 2016, Volume 15, Issue 4, Pages 437-440

ABSTRACT:
BACKGROUND:
Recovery speed and quality from general anesthesia has been proposed as possible measure of quality of anesthesia. Recovery is affected by many factors; patient status, drugs used, surgical procedure and time of it.
OBJECTIVE:
To assess the effect of using pressure support ventilation at the end of surgery on the recovery from general anesthesia in extra peritoneal surgery.
METHODS AND RESULTS:
100 patients had enrolled in study from 1st/11/2014 till 20th/1/2016 in medical city complex hospitals.
All patients were received general anesthesia with endotracheal tube and same anesthetic management and considering score of 10/10 from modified aldrete criteria as aim in recovery. Patients were divided into two groups:
50 patients had received pressure support ventilation at end of surgery.
Other 50 patients had continued with muscle relaxant and controlled mechanical ventilation.
RESULT:
Patients with support ventilation had shorter recovery time 11.8 min than those with controlled ventilation 17.7min,this was statistically significant P value was 0.000 and clinically of importance by decreasing recovery time and decrease use of reversal of muscle relaxant.
CONCLUSION:
Pressure support ventilation at the end of surgery enhances recovery and decrease time of stay recovery site.
.

Rapid Sequence Induction using Rocuronium in Adult Patients

Ahmed Mohammed Hussein; Hasan Sarhan; Ahmed Saeed Abdullah

Iraqi Postgraduate Medical Journal, 2016, Volume 15, Issue 4, Pages 429-436

ABSTRACT:
BACKGROUND:
Several studies using rocuronium as an alternative to suxamethonium for endotracheal intubating conditions in rapid sequence induction are available in literature, all claiming obvious advantages, but intubating conditions after suxamethonium and rocuronium have not been assessed in our hospitals yet.
OBJECTIVE:
The aim of this study was to assess the efficacy of rocuronium for rapid sequence induction by comparing the endotracheal intubating conditions with suxamethonium, following induction with sodium thiopentone as the sole induction agent in elective, otherwise healthy, adult patients.
MATERIALS AND METHODS:
The patients were divided into two groups, each consisting of 40 patients: group A patients received rocuronium bromide 0.6 mg/kg IV, and group B patients received suxamethonium chloride 1.5 mg/kg IV. In both groups, jaw relaxation and vocal cord relaxation were considered for atraumatic laryngoscopy at 60 seconds . Induction of anesthesia achieved with thiopentone as a sleeping dose for all patients.
RESULTS:
All the patients in the suxamethonium group have excellent intubating conditions, while in the rocuronium group, 90% of the patients were excellent and 10% were good regarding the intubating conditions. CONCLUSION:
It is concluded from this study that intubation can be performed under good to excellent conditions at 60 seconds after a bolus dose of rocuronium of 0.6 mg/kg. The result of this study indicates that this nondepolarizing neuromuscular blocking agent may be considered as a valuable alternative to suxamethonium for rapid sequence induction, i.e., within 60 seconds, even after induction with thiopentone as the sole anesthetic agent.

Variability of Vertical and Horizontal Facial Measurements Among the Population of Basrah

Zuhair F Fathallah; Nada H Al-jassim; Nawal M Abdullah

Iraqi Postgraduate Medical Journal, 2016, Volume 15, Issue 4, Pages 419-428

ABSTRACT:
BACKGROUND:
Anthropometry is the systematic quantitative representation of the human body, it is used to measure the absolute and relative variability in size and shape of the human body. Scientists were studying this knowledge in medicine for both diagnosis and treatment.
The people of Basrah are a mixture of Semites, Arian, and there are the mixed group result from interracial marriages.
OBJECTIVE:
To quantitatively measure the human face in different ethnic groups of local population and to identify the differences between individuals of different races and sexes, also to identify the differences between the people of Iraq and other people worldwide.
MATERIAL AND METHODS:
This study is a cross sectional study conducted in Basrah governorate. The data was randomly collected for the period from February to July 2013, from 1000 Iraqi adults (526 females and 474 males) living throughout Basrah governorate. They were between the ages of 18- 40 years, and had to meet certain criteria. This sample was used to create a database for statistical analysis.
RESULTS:
The results show that the measurements of the three sections and four sections facial profile are unequal as stated by neoclassical canons. The ears are longer than the nose. There are slight differences between the intercanthal distance (ICD) and alar width. The palpebral fissure length is equal to the ICD. The mouth width is 1.4 times the nose width. The facial width (zy- zy) is 3.4 times the nose (alae) width.
CONCLUSION:
There are differences in facial measurements, although slight, between different ethnic groups in Iraq, and between Iraqi population in general and the population of other countries, therefore, aesthetic measurements applied to all races are inapplicable. These slight differences could be attributed to interracial marriages and or environmental effect.

CD49d as Prognostic Marker in B-Cell Chronic Lymphocytic Leukemia in Correlation with the Expression of CD38, ZAP-70 and Clinical Binet Stage

Ali Mohammed Jawad; Haithem Ahmed Al-Rubaie; Zahraa Akram Thabit

Iraqi Postgraduate Medical Journal, 2016, Volume 15, Issue 4, Pages 486-492

ABSTRACT:
BACKGROUND:
Chronic lymphocytic leukemia (CLL) is a heterogeneous disease with highly variable clinical course and outcome. A number of clinical and biological features have been used to separate patients with CLL into subgroups with different prognoses. CD49d, CD38 and ZAP-70 expressions have shown to independently predict prognosis in CLL.
OBJECTIVE:
To assess the expression of CD49d in CLL patients and correlates them with CD38 and ZAP-70, and with clinical Binet staging.
PATIENTS AND METHODS:
This study was conducted on 30 newly diagnosed CLL patients. Diagnosis was based on lymphocyte count of > 5×109/L and immunophenotyping. The expression of CD49d, CD38 and ZAP-70 were investigated using four-color flow cytometer.
RESULTS:
The expression of CD49d, CD38 and ZAP-70 were detected in 60%, 56.7% and 30% of patients, respectively. The correlations between the expression of CD38 and both CD49d and ZAP-70 were both statistically significant (P= 0.002). A higher significant correlation was found between CD49d and ZAP-70 (P= 0.001). There was a statistically significant relationship between CD49d expression and Binet staging (P =0.035), while no significant relations were found between both CD38 and ZAP-70 and Binet staging (P >0.05). CD49d was more sensitive (76.5%) than the other two markers in prediction the intermediate and advanced stage with accuracy of 70%.
CONCLUSION:
CD49d expression was higher than that of CD38 and ZAP-70 and was significantly correlated with both of them. The adverse prognostic impact of CD49d was demonstrated by higher expression levels in intermediate and advanced-stage patients. CD49d has the highest sensitivity and accuracy with considerable specificity when compared with CD38 and ZAP-70, rendering CD49d a reliable biomarker for prognostication of CLL.

Orbital Hydatid Cyst: An Easier and Safer Removal Through Anterior Orbitotomy Approach

A Hadi Al Khalili

Iraqi Postgraduate Medical Journal, 2016, Volume 15, Issue 4, Pages 385-388

ABSTRACT:
BACKGROUND:
Hydatid Cyst of the Orbit is a rare manifestation even in endemic areas. It presents as a silent proptosis with or without visual function impairment. Many surgical procedures have been implemented for cyst removal including transcranial, lateral orbitotomy, tansmaxillary sinus, rhinotomy, and anterior orbitotomy. Post-operative complications endangering visual function and locally were reported with some of these approaches.
A new simple, easy, and quick procedure was improvised with no significant complications. The procedure is described in details.
.

Dynamic Hip Screw Versus Proximal Femoral Nail in the Treatment of Stable Intertrochanteric Fractures

Mohammed Hatem Salal

Iraqi Postgraduate Medical Journal, 2016, Volume 15, Issue 4, Pages 406-412

ABSTRACT:
BACKGROUND:
Intertrochanteric fracture is a common injury among older age group , it occupy a high percentage of fragility fractures admitted to the casualty department , lots of methods have been used over decades. Dynamic hip screw (DHS) was the gold standard technique since its invention, however after introduction of the proximal femoral nail (PFN) to the markets in the 90s, this represented a major turning point in the management of intertrochanteric fracture especially the unstable ones.
OBJECTIVE:
To compare the results of DHS versus PFN in the management of stable intertrochanteric fractures.
PATIENTS AND METHODS:
Prospective study included 35 patients who underwent operation by either DHS or PFN, all patients sustained stable intertrochanteric fracture and operated within one week. Closed reduction was done in all patients, PFN cases were done through small incisions under fluoroscope guidance, while DHS cases were operated through standard lateral approach. Patients were assessed according to intraoperative parameters of blood loss, duration of surgery and postoperative parameters regarding partial and full weight bearing, amount of shortening in mm, rate of union, functional score using palmar and proud score , rate of infection and implant complication.
RESULTS:
Significant differences were noted regarding blood loss and weight bearing in favor of PFN, while duration of surgery was less in DHS. No significant differences were noted regarding other parameters.
CONCLUSION:
The study revealed significant difference in favor PFN regarding blood loss, weight bearing and shortening.
.

A New Assessment Tool to Predict Stone Free Rates in Ureteroscopic Laser Lithotripsy

Ayad Aziz Al Naymi; Saad Dakhil F.Daraji

Iraqi Postgraduate Medical Journal, 2016, Volume 15, Issue 3, Pages 316-320

ABSTRACT:
BACKGROUND:
Holmium: YAG laser lithotripsy shows a high successful rate in fragmentation of ureteric stones , The S.T.O.N.E. Score is a novel assessment tool to predict stone free rate (SFR )in patients undergoing Ureteroscopic Lithotripsy( URS).
OBJECTIVE:
To develop a user friendly system (S.T.O.N.E. Score) to quantify and describe stone characteristics provided by computed axial tomography scan to predict ureteroscopic lithotripsy outcomes and to evaluate the characteristics that are thought to affect stone free rate.
PATIENTS AND METHODS:
The S.T.O.N.E. score consists of 5 stone characteristics: (S)ize, (T)opography (location of stone), (O)bstruction, (N)umber of stones present, and (E)valuation of Hounsfield Units. Each component is scored on a 1-3 point scale. The S.T.O.N.E. Score was applied to 50 ureteroscopic procedures performed , patients with anatomical abnormalities such as duplicated ureters, horseshoe kidney, ureteral strictures and renal failure were excluded from the study, postoperatively patient were evaluated by KUB,U/S and CT scan to assess stone free status.
RESULTS:
The mean patient age was( 37.3± 12.5 )year. 58% were male patients and 42% were female patients. mean stone size was13±3.9. Stones locations: 20(40%)stones were located in the lower ureter,13(26%) in the mid ureter ,17(34%) in the upper ureter. Mean operative time was 26.9±18.3 minutes. The overall SFR was 84%. Results of stone size on percent of stone destruction was very significant (p-value=0.001). Also the results of stone location on percent of stone destruction was very significant (p-value =0.002). whereas hydronephrosis, stone number, stone HU unite were not significant(p-value 0.8, 0.54, 0.61. respectively ). Results of stone score with SFR was significant (p-value 0.003).
CONCLUSION:
The S.T.O.N.E. Score is a new assessment tool to predict SFR in patients who require URS for the surgical therapy of ureteral disease. The features of S.T.O.N.E. are relevant in predicting SFR with URS. Stone size, location were statistically significant factors in multivariate analysis. The S.T.O.N.E. Score establishes the framework for future analysis of the treatment of urolithiasis .

Evaluation of Significance of Prolonged Liquefaction Time of Semen in Hypofertile Men

Siddeek B Mar

Iraqi Postgraduate Medical Journal, 2016, Volume 15, Issue 3, Pages 328-333

ABSTRACT:
BACKGROUND:
Until now most of the references adopt a sixty-minute liquefaction time as a guideline for normality in general semen analysis. During the last twenty years of interest in these patients, we found that there is a correlation between primary hypofertility, prolonged liquefaction time and therefore delayed conception worthy for this study. This study represent a clinical biometric case series on (284) patients consulting an outpatient urology clinic with primary hypofertility during the last ten years in Mosul.
OBJECTIVE:
To signify the impact of prolonged liquefaction time of semen on fertility potential of primary hypofertile men, including its relation with the delay of conception and other semen parameters.
PATIENTS AND METHODS:
Married males who are sexually healthy supposed to have healthy partners with no pregnancy who were not using any method of contraception. Patients should give their semen for analysis in the laboratory by masturbation. All patients should have at least two separate samples to be analyzed, with not less than 7 days apart. Collected data included age in years and duration of delayed conception in months. Semen parameters collected were: volume in milliliters (ml), liquefaction time in minutes, concentration (density) in millions/milliliters, motility in percentage, and morphology in percentage.
RESULTS:
The mean age of people in our sample was 29.7 years, mean volume of semen was 2.9 ml, mean liquefaction time was 26 minutes, the mean sperm density was 32.9 millions/ml, while the mean activity percentage was 31.2%, the mean percentage of the normal sperms was 61.9% and the mean duration of delay in conception was 33.7 months. There was a very highly significant correlation of prolonged liquefaction time with impaired motility, and morphology, and a significant correlation with sperm concentration. Also there was a linear positive relationship between prolonged LT in minutes and delayed conception in months, but it was more prominent in those hypofertile men who failed to conceive for ≥ 36 months.
CONCLUSION:
The prolonged liquefaction time has a possible role as a cause of delay in conception in hypofertile men, and has a significant relationship to defects in other semen parameters.

Ministernotomy in Off-Pump Coronary Artery Bypass Surgery

Jabbar Jasim AL-Tai

Iraqi Postgraduate Medical Journal, 2016, Volume 15, Issue 3, Pages 303-307

ABSTRACT:
BACKGROUND:
Ministernotomy is a new suergical producer which is decrease invasiveness of suergical treatment coronary arteries insuffecince and there are several advantages over standard poceduer.
OBJECTIVE:
Patients with isolated lesions of the proximal left anterior descending artery (LAD) have been demonstrated to benefit more from surgical treatment than percutaneous coronary interventions (PCI). However, with the less invasiveness of PCI, the majority of the patients have been referred for this latter procedure. We report here on the inferior ministernotomy approach for the treatment of patients with single LAD lesions, with off-pump anastomosis of the left internal thoracic artery graft.
METHOD:
Fourteen patients, consecutively operated on using this technique with the LITA graft anastomosed to the LAD, were examined. The mean age of the patients was 56.7 ± 10.1 years. The length of the skin incision varied from 8 to 10 cm and only the distal sternum was split lengthwise. The anastomosis was facilitated with the use of an Octopus-3 stabilizer .
RESULTS:
All patients had satisfactory postoperative outcomes, the length of postoperative hospital stay ranged from 2 to 6 days (median 3 days). No ECG changes or enzymatic rises were seen in this series. One patient was re-admitted for wound infection.
CONCLUSION:
The ministernotomy approach allows safe accomplishment of off-pump LAD grafting, providing the long-term benefits of using the LITA.
KEY WORDS: ministernatomy,left internal thoracic artery(LITA),off-pump.

Prevalence of CT Scan Findings in Patient with Traumatic Brain Injury with Respect to Glasgow Coma Scale

Ihssan Subhi Nema; Yasir Mohammed Hamandi; Hashim Hassan Abed; Wasan Ismail Majeed Al-Saadi

Iraqi Postgraduate Medical Journal, 2016, Volume 15, Issue 3, Pages 259-265

ABSTRACT:
BACKGROUND:
Traumatic brain injury (TBI) contribute to a significant mortality and substantial morbidity. CT is
essential for identifying lesions requiring urgent intervention & those that require observation and
non surgical management .
OBJECTIVE:
To assess the prevalence of CT findings with respect to the severity of TBI & to find out the
relation between the age of the patient & the severity of TBI.
PATIENTS AND METHODS:
100 patients with TBI evaluated by brain CT. All age groups with Glasgow coma scale (GCS) of
less than 15 were included.The abnormal CT findings were evaluated & recorded. The findings were
further correlated with the patient`s age & the GCS score
RESULTS:
Eighty percent of the cases had mild TBI, 6% had moderate TBI and 14% had severe TBI. Ninety
three percent had closed type of injury . Twenty four percent of the patients had normal CT scan ,
all of them had mild TBI . The most common CT findings in mild TBI cases were subgalial
haematoma(SGH) & calvarial skull fracture, with minority of cases had cerebral contusion , fracture
base of skull , diffuse cerebral oedema & intracranial haemorrhage . Two third of patients with
moderate TBI had subarachnoid haemorrhage(SAH) & cerebral contusion, 50% had diffuse
cerebral oedema, calvarial skull fracture,& 1/3 had Subdural haematoma & fracture base of skull.
More than half of patients with severe TBI had calvarial skull fracture, fracture base of skull,
cerebral contusion, SAH, with lower prevalence of diffuse cerebral oedema,and intracranial
haemorrhage.
CONCLUSION:
The lower the GCS score, the more significant CT findings,predominantly fracture base of skull,
subarachnoid haemorrhage and diffuse cerebral oedema.
KEY WORDS: traumatic brain injury, computed tomography, glasgow coma scale.

Clinicopathological Findings of IgA Nephropathy in Children and Adolescents; (Multicentn Study)

Qutaiba A. Hussein; Ammar A. Hussein; Alaa M. Neamah; Hasanein H. Ghali

Iraqi Postgraduate Medical Journal, 2016, Volume 15, Issue 3, Pages 338-343

ABSTRACT:
BACKGROUND:
IgA nephropathy (IgAN) is the most common lesion found to cause primary glomerulonephritis throughout most developed countries of the world. Patients may present at any age, but there is a peak incidence in the second and third decades of life.
OBJECTIVE:
To study the demographic, clinical and laboratory findings of IgAN patients including children and adolescents.
METHODS:
The medical records of 30 patients with IgAN were retrospectively reviewed and assessed. Patients enrolled in this study were between 1-18 years old diagnosed as IgAN in the period from January 2010 to the end of December 2012 being treated and followed in the main three centers of treating cases of pediatric nephrology in Baghdad (Al-karama teaching hospital, Central Child Teaching Hospital and Baghdad Medical City) that receive referral cases from all Iraqi governorates.
RESULTS:
The total number of cases enrolled in this study was 30 patients, with males being 19 and females being 11. The male to female ratio was 1.72:1. Family history of chronic renal disease was found in 10 patients (33%). History of pharyngitis was found in 16 patients (53.3%). Macroscopic hematuria was found in 24 patients (80%), followed by edema in 18 patients (60%), and followed by hypertension in 15 patients (50%). The most common laboratory findings among study group was microscopic hematuria (29 patients, 96.7%), followed by proteinuria in 22 patients (73.3%). Renal biopsy was done for all patients for the diagnosis of IgAN. The distribution of histopathology staging system was: Stage (1) 14 patients, Stage (2) 8 patients, Stage (3) 5 patients, Stage (4) 2 patients and Stage (5) 1 patient (46.7%, 26.7%, 16.7%, 6.7% and 3.3% respectively). The study showed that 24 patients were found to have IgA deposited solely (80%). Out of the total 12 patients presented with hematuria, nine of them (75%) showed stage 1 disease on histopathology study. Two patients were noticed to have other associated autoimmune diseases, one with hepatitis and another with ulcerative colitis.
CONCLUSION:
Further studies in large number of patients are needed in order to confirm the findings in this study and to establish the best therapeutic choice for IgAN. The need for immunofluorescence examination of the renal biopsies in suspected cases is recommended.

Evaluation of Holmium YAG laser Lithotripsy in Ad-Diwaniyah Teaching Hospital

Montadhar Hameed Nima; Ali Hamdan Fahad; Mohammed Ali Gadhban

Iraqi Postgraduate Medical Journal, 2016, Volume 15, Issue 3, Pages 344-349

ABSTRACT:
BACKGROUND:
In this study we evaluate the efficacy and safety of ho:yag laser lithotripsy via rigid ureteroscopy as primary treatment modality of ureteric ston in our institute stones parameters,stone free rates and complications rates were evaluated
OBJECTIVE:
To evaluate holmium YAG (yttrium aluminum garnet) laser lithotripsy via semi rigid ureteroscope in management of ureteric calculi in Ad-Diwaniyah teaching hospital.
METHODS:
From October 2013 to October 2014, 100 patients with ureteric calculi were included in this study. Calculi were approached with 9.5 Fr. Semi rigid ureteroscope and fragmented with holmium YAG laser system (Stone light AMS).
The following parameters were assessed: success, failure, and complications rates in addition to patient’s age, sex, stone size and site. Cases of failure of introduction of the ureteroscope or those with small stones retrieved by grasper only were excluded from the study. Termination of the procedures because of perforation or retropulsion were considered as failure.
RESULTS:
Sixty five males and 35 females were included with a mean age of (39±3) years (range 20-60). Fifty eight patients (58%) had lower ureteric stone, 25 patients (25%) had mid ureteric stone and 17 patients (17%) had upper ureteric stone. Mean stone size was 10.61 mm (range 7-20mm).
Overall success rate was 96% which was more for the lower than upper ureteric stone. Failure occurred in 4 patients (4%), 2 of them due to retropulsion and the other 2 patients due to ureteric perforation.
Apart from ureteric perforation and retropulsion, complications were minor and were amenable to conservative treatment.
CONCLUSION:
Holmium YAG laser lithotripsy is a minimally invasive, highly effective safe method for treatment of ureteral calculi.

Magnetic Resonance Urography Plus, Abdominal Radiograph in Acute Calculus Ureteric Obstruction

Zeid Hamed Abbas; Mohammed Abd Kadhim; Thaair A. Kameel Alkhuzaie

Iraqi Postgraduate Medical Journal, 2016, Volume 15, Issue 3, Pages 279-287

ABSTRACT:
BACKGROUND:
About 2-3% of the population experiences an attack of acute ureteric colic during their lifetime,
and 67%-95% caused by ureteric calculi. Magnetic Resonance Imaging (MRI) can rapidly
demonstrate both the presence and the level of ureteric obstruction.]
OBJECTIVE:
To study the diagnostic accuracy of MRI (alone and in combination with plain abdominal
radiograph) in detecting acute ureteric calculus obstruction compared to unenhanced Computed
Tomography (CT).
PATIENTS AND METHODS:
A cross sectional comparative study was conducted on a total of 48 patients suspected to have
acute ureteric calculus obstruction, at the radiology department in AL-Imamain AL-Kadhemain
Medical city, during the period from March to November 2015. Patients underwent MRU then
unenhanced abdominal CT, and plain abdominal radiograph. The sensitivity, specificity, positive
predictive value, negative predictive value and overall accuracy of MRU findings were obtained in
comparison to CT findings regarding ureteric dilatation and its level, stone detection and perirenal
fluid and fat stranding.
RESULTS:
Of the 48 patients imaged with both CT and MRU, 4 of them showed no evidence of obstruction
on any imaging modality, and 44 of them had a final diagnosis of acute calculus ureteric
obstruction. Regarding the detection of ureteric dilatation in MRU, in comparison to CT, the
sensitivity = 100%, specificity = 80%, the positive predictive value (97.72%), the negative
predicative value (100%), and overall accuracy (97.9%). The detection of ureteric stone by MRU
(when combined with plain abdominal radiograph) in comparison to CT, the sensitivity = 95.45%,
specificity = 100%, the positive predictive value (100%), the negative predicative value (66.66%),
and over all accuracy (95.8%). The detection of peri-renal fluid by MRU in comparison to CT, the
sensitivity = 96.66%, specificity = 72.22%, positive predictive value (85.29%), the negative
predicative value (92.85%), and overall accuracy (87.5%).
CONCLUSION:
MRI when combined with plain abdominal radiograph was nearly as accurate as unenhanced spiral
CT in acute calculus ureteric obstruction. Also the MRI was more sensitive than unenhanced CT
in detecting the secondary signs of upper urinary tract obstruction, as perirenal fluid.

Hypomagnesemia During Early Post Renal Transplantation Period

Hasanain Mohamed Ali; Mustafa Rasool Hussein; Sahban Almallah; Mohammed Hannon Al Sodani

Iraqi Postgraduate Medical Journal, 2016, Volume 15, Issue 3, Pages 308-315

ABSTRACT:
BACKGROUND:
In renal transplantation, hypomagnesemia is a frequent disturbance associated with the use of calcineurin inhibitors (Cyclosporine and Tacrolimus) and sirolimus. They may cause obligatory renal loss and decrease transcriptional expression of the Mg transporter in the distal collecting tubule.
OBJECTIVE:
Evaluation of serum Magnesium in patients during the first four days post renal transplantation and to find any correlation with different variables.
PATIENTS AND METHOD:
A cross sectional descriptive study was performed at Nephrology and Kidney Transplantation Center- Medical City-Baghdad, Iraq from first of January, 2012 to first of December, 2012. Serum Magnesium was followed in forty patients underwent renal transplantation during the first four days post transplantation. Other variables also was studied to find any correlation with serum Magnesium, include (age, sex, duration dialysis of , calcineurin inhibitors (types and dose) , diabetes mellitus, loop diuretics, urine volume . electrolytes (serum Potassium and s. Calcium) and s.creatinine .
RESULT:
The mean serum Magnesium was (2.87 ± 0.5 mg/dl ) pre transplantation, on 1st day it was (2.3±0.49) and 4thday (2.31±0.67). The mean Post transplantation serum Magnesium was significantly lower than pre transplantation, (P<0.01). Serum Magnesium had statistically significant direct correlation with serum Potassium and s.creatinine and statistically significant inverse correlation with s. Calcium and urine volume. It was significantly lower in those using loop diuretics at 1st day post-transplant (P=0.039). Tacrolimus was associated with lower serum Magnesium level than cyclosporine.
CONCLUSION:
Serum Mg post transplantation was significantly lower than pre transplantation level, and sometime may reach to significant hypomagnesemia. This was significantly correlated with S.K , S.Ca, and S Creatinine,

Clinical Evaluation of Overnight Oximetry Monitoring of High Risk Patients for Obstructive Sleep Apnea

Mustafa Nema; Mohammed Shakir Hasan; Basil Fawzi Jameel; Qasim M Sultan

Iraqi Postgraduate Medical Journal, 2016, Volume 15, Issue 3, Pages 372-378

ABSTRACT:
BACKGROUND:
Obstructive sleep apnea (OSA) is a condition of sleep related pharyngeal collapse, in which recurrent episodes of upper airway occlusion occur during sleep causing diminution (hypopnea) or cessation of airflow (apnea) in the pharynx provoking arousals and sleep fragmentation, resulting in daytime sleepiness.
Oximetry alone is very valuable tool in the diagnosis and management of OSA, it can identify most cases allowing referral for continuous positive airway pressure (CPAP) treatment.
OBJECTIVE:
To evaluate the overnight oximetry monitoring as a swift and accessible
PATIENTS AND METHOD:
Cross sectional study of 20 patients, 12 males and 8 females with high probability of OSA, attended to respiratory clinic in Baghdad teaching hospital suffering from excessive daytime sleepiness, they were clinically evaluated plus using overnight oximetry as an objective testing method.
RESULTS:
The study sample was 20 patients, 12 males (60%), 8 females (40%), mean age 48 years, mean BMI 45.6 Kg/m2, female mean BMI 53.1 Kg/m2, male mean BMI 37 Kg/m2, and mean basal Po2 saturation 89.6 %.
Desaturation index (DI) show significant correlation with AHI, BMI, and gender, while no significant correlation with age. AHI show significant correlation with baseline SPO 2 and gender, and no correlation with BMI and age.
CONCLUSION:
Desaturation index assessed by nocturnal pulse oximetry maintain its utility as a screening method in the recognition of obstructive sleep apnea in obese patients with high clinical pretest suspicion. DI when combined with appropriate clinical evaluation could be used as an initial diagnostic test for OSA.
.

Feasibility and Efficacy of Percutaneous Nephrolithotomy, Initial Experience

Ammar Fadil Abid

Iraqi Postgraduate Medical Journal, 2016, Volume 15, Issue 3, Pages 334-337

ABSTRACT:
BACKGROUND:
Renal stone disease is common in Iraqi population and percutaneous nephrolithoyomy present a minimal access for large stone a substitute for traditional open surgery
OBJECTIVE:
We are presenting our first experience in percutaneous nephrolithotomy )PCNL( in terms of renal access, stone free and to evaluate the other aspects such as the need of auxiliary procedures in a center without prior experience in this field.
MATERIALS AND METHODS:
We evaluate all the PCNL performed in period of two year. A series of perioperative and post-operative details were recorded. All PCNL were performed in prone position.
RESULTS:
The first 55 PCNL cases were included in the study. Out of 55 patients, 16 were women and 39 men. Their mean age was 35.5 years (range 11-65) and means stone diameter were 23.5 mm ± 8.9. A successful renal access achieved in 87.3 % (48) cases with stone fragmentation. Procedures were performed over two year Dec.2013-Dec. 2015. Of fifty five patients 4 cases with single functioning kidney, and eleven cases with PCNL on same side of previous scar of pyelolithotomy. Stone free rate was 82%. Co morbidities included 8 hypertensive, 3 diabetics, one systemic lupus erythematosus and two with elevated blood urea.
Morbidity and complications following PCNL are dominated by access failure in 12.7 % (n= 7); intraoperative bleeding in 3.6 % (n=2), urinary leakage in one patient, ureteric colic in 5.4 % (n=3) hydrothorax 1.8 % (n=1). None of these patients experienced post-operative bleeding, No mortality
CONCLUSION:
PCNL can be learned by urologists who do not have the support of an experienced colleague without endangering patient safety.

Eye Complications in Children and Adolescent with Type 1 Diabetes Mellitus

Rajaa Mohsin Shadhan; Munib Ahmed Alzubaidi; Najah Kadhim Alquraishy

Iraqi Postgraduate Medical Journal, 2016, Volume 15, Issue 2, Pages 132-139

ABSTRACT:
BACKGROUND:
Diabetes mellitus is characterized by hyperglycemia and glycosuria and is an end point of a few disease processes. The most common type occurring in childhood is type 1 DM, which is accompanied by chronic and dangerous micro vascular changes affecting most body systems, especially the eye, leading to cataract and diabetic retinopathy. Diabetic retinopathy without appropriate management is emerging as one of the leading causes of blindness. Therefore, it is necessary to identify relevant risk factors, improve the early diagnosis and management of diabetic retinopathy to reduce the risk of blindness.
OBJECTIVE:
To estimate the presence of eye complications (cataract and retinopathy) among children and adolescent with type1 diabetes mellitus and to study the effect of various factors on their occurrence.
PATIENTS AND METHODS:
This study was carried out over nine months period(from first of May till the end of January) at Children Welfare Teaching hospital/Medical City .It included 150 children who had type1diabetes mellitus for at least 4 years in children with pre pubertal onset of diabetes and two years in children with pubertal onset .History was taken, physical examination and investigations were done, then ophthalmological examination looking for eye complications (cataract or retinopathy) performed by ophthalmologist. Statistical analysis done using T test, Chi square, P value <0.05 regarded as statistically significant
RESULTS:
This study included 150 patients with type 1 diabetes mellitus, their age ranges from 4.5 - 19 years, with duration ranges from 2-18 years. Female to male ratio was 1.8:1.Out of 150 diabetic patients, 24/150 (16%) had eye complications, 9 (6%) of them had retinopathy while other 15 (10%) had cataract .The age of all patients who had eye complication was >10 years which is highly significant (P value: 0.009) and the incidence of eye complications increases with increasing duration of diabetes (p value 0.04). Twenty two (14.7%) female and two (1.3 %) male had eye complications, which is highly significant (P value: 0.002). HbA1c >10 in 17/24 (70.8%) patients with eye complications. there were significant association between the presence of eye complications and macroalbuminuria (p value: 0.02), and limited joint mobility (p value: 0.001) .out of 24 patients with eye complications, 16 (66.6%) patients had short stature and 7(4.7%) patients had celiac disease.
CONCLUSION and recommendations:
The incidence of eye complications (cataract and diabetic retinopathy) increases with increasing age and duration of diabetes and it is more common in female and it is associated with the presence of other chronic complications (LJM, nephropathy and short stature).So screening all patients with type 1 DM according to the guidelines is required for early detection and treatment of eye complications using new methods like fundal photography.

Noncompliance With Antihypertensive Drugs Among Patients with Essential Hypertension in Sulaimani City

Omed H.K Hawrami; Manar Hisham Abdulla

Iraqi Postgraduate Medical Journal, 2016, Volume 15, Issue 2, Pages 140-147

ABSTRACT:
BACKGROUND:
Hypertension is a common chronic disease in Iraq, noncompliance with medications is one of the most important reasons for uncontrolled hypertension.
OBJECTIVE:
This study was designed to detect the percentage and the causes of noncompliance with antihypertensive drugs among the study sample.
PATIENTS AND METHODS:
A cross-sectional study was conducted during the period from August 1st 2012 to February 28th 2013, at four primary health care centers in Sulaimani city, 309 patients were included in the study. Non compliance was tested by using self reported Morisky- Green adherence scale.
RESULTS:
54.7% of the patients were non compliant with the antihypertensive drugs, ( 55%males and 45% females), Statistically significant factors were: young age( 62.5%), female gender (63.3%), low educational level (80.5%), being unemployed (71.7%), duration of hypertension > 10 years( 65.2%), and when the source of medication was from health care centers (75.6%).
CONCLUSION:
A significant percentage of the patients were non compliant with their anti-hypertensive drugs, the main causes of non compliance were patient, physician, and drugs related, respectively.

C-Reactive Protein Profile Among Acute Stroke Patients

Hayder Kadhum Hassoun; Husain Salih Abass; Taki Tiraihi

Iraqi Postgraduate Medical Journal, 2016, Volume 15, Issue 1, Pages 7-12

ABSTRACT:
BACKGROUND:
C-reactive protein (CRP) is an inflammation marker, which has been implicated in stroke severity, response to stroke, or a mixture of both.
OBJECTIVE:
This study has been conducted in order to clarify early CRP essay in relation to the type of acute stroke (ischemic and hemorrhagic), onset duration, severity, stroke disability and carotid stenosis.
METHODS:
A cross sectional randomized study included 50 patients with stroke (23 male and 27 females: mean age 54.7 + 10.3 years). They were classified into having ischemic or hemorrhagic strokes, deficit in less or more than 12hrs (within 24 hrs), large or small size infarction, severe or non-severe disability and severe or non-severe carotid stenosis.
RESULTS:
There is more significant association of C-reactive protein with the ischemic (82.4%) than the hemorrhagic types (56.3%).There is significant association of CRP positivity in relation to the late onset duration of the deficit (> 12 hrs: 85.2%) in comparison to the early onset (≤ 12hrs: 60.9%). C-reactive protein level showed statistically significant association with the size of infarction (CRP is positive in 91.3% of the large size versus 63.6% of the small size). There is significant association of CRP level in relation to carotid stenosis (68.8% in severe stenosis versus 31.2% in non-severe ones). The short-term disability was significantly associated with CRP level (CRP is positive in 83.8% with severe disability versus 57.8% with the non-severe one).
CONCLUSION:
High CRP level at the admission of the acute stroke patient is more associated with the ischemic type, the late onset, the large size infarction, severe disability and severe carotid stenosis.

The Prevalence of Dysautonomia in Chronic Inflammatory Demyelinating Polyradiculoneuropathy

Hasan Azeez Al-Hamadani; Muhannad kamil hamid; Basheer Hussein Salman

Iraqi Postgraduate Medical Journal, 2016, Volume 15, Issue 1, Pages 1-6

ABSTRACT :
BACKGROUND:
Chronic inflammatory demyelinating polyradiculoneuropathy (CIDP), an immune-medaiated disorder of peripheral nerves and nerve roots. Dysautonomiais has not been studied deeply and many question not answered.
OBJECTIVE:
To estimate the prevalence of dysautonomia in chronic inflammatory demyelinating polyradiculoneuropathy in a group of Iraqi patients .
METHODS:
A cross sectional study of 23 patients fulfilled the diagnostic criteria for definite chronic inflammatory demyelinating polyradiculoneuropathy underwent autonomic function in cross sectional study which has been done in Al-Imamain Al-Kadhmiyain Medical City from December 2008 to November 2010 to detect any abnormalities in sympathetic and parasympathetic autonomic nervous systems tests.
RESULT:
This study includes 23 patients diagnosed with CIDP, 12 patients (52%) were male and 11 patients (48%) were females. Twenty patients had autonomic dysfunction, either clinical or subclinical or both.Eighteen of 20 patients (90%) had abnormal autonomic function tests, 16 of 20 patients (80%) symptomatic, and 14 of 20 Patients (70%) symptomatic with abnormal autonomic function tests. Abnormal autonomic function tests were found in 18 of 23 patients with CIDP (78%). In 8 patients (44%), abnormal results were limited to parasympathetic function test. Five patients (28%) abnormal results were limited to sympathetic function test. Five patients (28%) exhibited dysfunction in both systems.
CONCLUSION:
The findings in this study suggest high frequency of clinical and subclinical dysautonomia and parasympathetic system more likely affected than the sympathetic nervous system in patients with chronic inflammatory demyelinating polyradiculoneuropathy.

Experience with Autologous Pericardial Patch Closure of Ventricular Septal Defect

Jabbar Jasim AL-Tae

Iraqi Postgraduate Medical Journal, 2016, Volume 15, Issue 1, Pages 58-60

ABSTRACT:
BACKGROUND:
Conventionally,VentricularSeptal Defects(VSDs) are repaired with synthetic patch-Dacron(polyetheylene terephthalate) or Goretex(expanded polytetraflouroethylene).Recently,we began using glutaraldehyde-treated autologous pericardial patch to repair VSDs.We review our experience.
OBJECTIVE:
In this study,we are evaluating the result of closure of VSD by pericardial patch instead of synthetic patch.
MATERIALS AND METHOD:
BetweenGanuary 2009 to April 2014,60 children had their VSDs repairewith glutaraldehyde-treated autologous percardium.There were 20 males and 40 females, aged between 2 years and 12 years with amedian age of 4 years.The diagnosis was isolated VSD in 49 patients,multiple VSD in 3:Tetralogy of Fallot(TOF) in 8 patients The chest was opened by median sternotomyincision.After establishing cardiopulmonary bypass,a strip of pericardium was harvasted from patient and fixed in 0.6% glutaraldehyde for about 25 minutes.It was then washed out with 0.9% saline solution.The defect was repaired with 4/0 suture using a continous suture technique.
RESULTS:
There was no hospital mortality. Postoperative echocardiogram reveald trivial leaking in 10 patients.Follow up was for 3 to 6 months(mean 2 months). No patient required reoperation for residual VSD.
CONCLUSION:
Glutaraldehyd-treated autologous pericardium is an exellent material for surgical patch closure of VSD.It is easily available and does not require sterilization.

Antioxidant and Anti-Inflammatory Effect of Fruit Juice of Annona Muricata L (Soursop) During Ischemia Reperfusion Injury in Rats

Mustafa Taha Mohammed; Sarah Isam Abbas

Iraqi Postgraduate Medical Journal, 2016, Volume 15, Issue 1, Pages 118-123

ABSTRACT:
OBJECTIVE:
The study included knowledge The chemical components of the Soursop juice and determine whether Soursop prevents ischemia-reperfusion induced brain injuries in rats.
METHODS:
The chemical components of the prepared fruit extract were detectedits components of glycosides, proteins....etc and we were Determination of trace element and the estimation of the biochemical parameters: Blood samples were harvested from the rats,. Serum IL-10,Adiponectin and oxidative stress levels of Malondialdehyde ( MDA) and Glutathione ( GSH )were estimated.
RESULTS:
The results showed that the extract contain : glycosides, proteins, saponins, tannins, various phenolic compounds alkaloids , flavonoids, steroids and vitamine C . The results also showed that there were high concentrations of B, Fe , Zn respectively and low concentrations of Mn, Cu, pb,Cd respectively ,very low concentrations Ni ,Co , Se . The levels of oxidative enzymes and Inflammatory cytokines in group 3 were significantly lower than those in the group 2.Our results suggest that soursop treatment protects the rat brain against ischemia-reperfusion induced brain injuries.
CONCLUSION:
The present study confirm that the fruit extracts of Soursop (Annona Muricata L.) posses in vivo anti-inflammatory and antioxidant activity because of its content (glycosides , tannins , saponins ,proteins ,various phenolic compounds ,alkaloids , flavonoids, steroids and vitamine C )

Epidemiology of Malignant Extra-Hepatic Biliary Tract Obstruction Detected

Omed H.K Abdulwahab

Iraqi Postgraduate Medical Journal, 2016, Volume 15, Issue 1, Pages 102-106

ABSTRACT:
BACKGROUND:
One of the important causes of obstructive jaundice is malignant tumours.
OBJECTIVE:
The current study was undertaken to describe the epidemiology of malignant extra-hepatic biliary tract obstruction in Sulaimaniyah, Kurdistan Region, Iraq.
Patients & Methods: The study was undertaken at Kurdistan centre for gastroenterology & hepatology in Sulaimaniyah city. Patients attending the centre during the period from 1st January 2008 to 1st January 2013 and diagnosed as having a malignancy using endoscopic retrograde cholangiopancreatography were included in the study. A total of 259 patients were found to have such a malignancy and therefore included.
RESULTS:
The mean age of patients was 63.5 years, the male to female ratio was 1:3 and the most common cause of malignant extra-hepatic biliary tract obstruction was cholangiocarcinoma 47.5%, followed by ampullary and peiampullary carcinoma 26.6%. In males, 37.7% of cancers were cholangiocarcinoma, 30.8% ampullary and periampullary carcinoma, & 26% pancreatic carcinoma, versus 60.2%, 21.2%, & 15% in females respectively (P= 004). Most cancers occurred between 50-79 years of age.
CONCLUSION:
The causes of malignant extra-hepatic biliary obstruction in order of frequency were cholangiocarcinoma, ampullary and periampullary carcinoma, pancreatic carcinoma & carcinoma of the gallbladder.

(( Prevalence of Soluble Fas Protein in Breast Cancer Patients:correlation with the Clinico-Pathological Parameters))

Manar Abed AL-Kreim Abed Oun; Hedef Dhafir El-Yssin; Nada A.Al-Alwan

Iraqi Postgraduate Medical Journal, 2016, Volume 15, Issue 1, Pages 107-117

ABSTRACT
BACKGROUND:
Breast cancer is the most common cancer among the Iraqi population. Alteration in the expression of Fas and Fas ligand (FasL) compared to normal tissues are reported in the literature.
OBJECTIVE:
To investigate whether measuring this tumour marker in serum of breast cancer patients before and after treatment might also be useful markers in the diagnosis, screening and monitoring the malignant tumour progression and response to therapy.
METHODS:
Serum samples were obtained from (28) apparently healthy women (Control Group) with a mean age of 40.9 ± 7.6 years and (60) female patients complaining from primary breast cancer (Patients Group) with a mean age of 48.3 ± 8.9 years. They were divided according to their clinical end point into: Pre-Surgical Group, Post-Surgical Group and post- chemotherapy Group. Serum sFas level was measured using ELISA kits.
RESULTS:
The mean serum levels of sFas were significantly elevated (P<0.05) in breast cancer patients than controls. There was no significant influence of the studied personal and pathological characteristics upon biomarkers levels in any of the breast cancer subgroups (P > 0.05). sFas level was found an effective test (P < 0.05) in both pre- surgery and post- chemotherapy groups (accuracy is 87% and 90% respectively). At readings ≥ 300 pg/ml in both groups, sensitivity approached 85%. Fas was not found an effective test in the post surgery group (P > 0.05).
CONCLUSION:
It could be concluded that sFas is useful for monitoring the response of breast cancer patients to surgery and chemotherapy if the effect of systemic inflammatory reactions is excluded.
KEY WORDS: soluble fas,post-chemotherapy.

The Value of Diffusion Weighted MRI in Differentiating Benign from Malignant Solid Focal Liver Lesions

Mohammed abd kadhim; Firas Salah Hameed; Mohssin Abd Ali Hussain

Iraqi Postgraduate Medical Journal, 2016, Volume 15, Issue 1, Pages 92-101

ABSTRACT:
BACKGROUND:
Diffusion-weighted imaging (DWI) is increasingly used for the detection, characterization and diagnosis of various focal liver lesions (7-10).
OBJECTIVE:
to investigate the utility of (DWI) in evaluating solid focal liver lesions, and to measure the ADC values of these lesions trying to differentiate benign from malignant lesions.
PATIENTS AND METHODS:
A prospective study was conducted at MRI units of Al-Imamain Al-Kadhimain medical city and Baghdad teaching hospital between June 2014 to January 2015. Study included of 51 patients with 87 solid focal liver lesions more than 10mm in diameter. They underwent DWI using 1.5 tesla MR units .Mean apparent diffusion coefficient (ADC) values were measured and were correlated with histo-pathological results as well as follow-up imaging results.
RESULTS:
Of the 87 lesions, 50 (57.5%) were malignant and 37 (42.5%) were benign. The highest ADC value was for haemangioma with significant difference from other benign and malignant solid focal liver lesions. Mean ADC values for FNH and HA were close to each other with insignificant P value (0.903), but they were of significantly higher values than those of metastases and HCC. Mean ADC values for HCC and metastases were low and close to each other with insignificant P value (0.629). The mean ADC value of benign lesions was higher than that of malignant lesions with significant P value (0.0001). The mean size was 33.46±23.67mm for benign lesions and 40.04±41.81mm for malignant lesions, and this difference was statistically insignificant (P value 0.392).The mean age for malignant lesions (55.30±7.47 year) was higher than that of benign lesions (43.14±13.70year) and this difference was statistically significant (P value 0.0002).
CONCLUSION:
DWI is a good imaging modality for diagnosis and characterization of solid focal hepatic lesions, particularly in patients with renal impairment. In general ADC value of benign hepatic lesions was higher than the ADC value of malignant lesions.

Risk Factors of Wound Dehiscence After Laparotomy and the Role of Prophylactic Retention Sutures

Haider Abdulhussein Ahmed

Iraqi Postgraduate Medical Journal, 2016, Volume 15, Issue 1, Pages 67-72

ABSTRACT :
BACK GROUND :
(laparatomy wound dehiscence) is a serious postoperative complication which is associated with high morbidity and mortality rates.
OBJECTIVE:
To evaluate abdominal wounds dehiscence in term of risk factors and to assess the role of prophylactic retention suture in prevention of wound dehiscence.
PATIENTS AND METHOD:
Prospective study done in the General Surgical unit of Al–Imamain Alkadhmain medical city on 167 patients with 20 patients underwent prophylactic retention suture, from the 1stof July 2013 to the 1st of July 2015.and to know the effect of different factors on incidence of wound dehiscence.
RESULTS:
The number of wound dehiscence cases was 19 patients out of whole total 167 patients which represent 11.38%. Wound infection was present in 63 patients out of 167 patients (37.2%) and 19 patients out of 63 patients (30.2%) developed wound dehiscence. The other risk factor was chest complication which was present in 76 patients out of 167 patients (45.5%). and 17/76 patients (22.4%) developed wound dehiscence. Smoking was present in 92/167 patients, anemia was present in 80/167 patients and 13/80 patients (16.3%) developed wound dehiscence. Age > 50 years was present in 53/167 patients and 10 /53 patients (18.9%) developed wound dehiscence. steroid usage found in 17/167 patients and 5/17 of them patients (29.4%) developed wound dehiscence, and jaundice was present in 8/167 patients and two/8 patients (25%) developed wound dehiscence. Prophylactic retention sutures were done for 20 patients all of them were male with generalized peritonitis and emergency cases. 19 patients were anemic. 18 patients were smokers and 15 patients were above 50 years of age; from these 20 patients only one patient who had all listed risk factor developed wound dehiscence after prophylactic retention suture wound inspected from 2ndpost-operative day on word
CONCLUSION:
Post-operative wound dehiscence rate in the surgical unit of Al–Amamain Alkadhmain medical city is 11.38% and that wound infection, emergency operations and compromised immunity, are factors which increase the rate of wound dehiscence; and prophylactic retention sutures is a valuable maneuver to reduce it.

Disorders of the Cerebellum In Children , MRI – Clinical Correlation

Ahlam Mohamad Abdulabbas; Muna Abdul Ghani Zghair; Raad Hifdhi Al-Khayat

Iraqi Postgraduate Medical Journal, 2016, Volume 15, Issue 1, Pages 13-18

ABSTRACT:
BACKGROUND:
The recognition of cerebellar anomalies, with the advent of neuro-imaging, has greatly improved, it present a wide variety of clinical and radiological Imaging findings.
OBJECTIVE:
1. To describe the spectrum of cerebellar anomalies by MRI .
2. To correlate with clinical presentation.
MATERIALS AND METHODS:
Sixty six patients(22Females, 44 Males) with the diagnosis of some form of cerebellar malformations, were included in this study, in the Central Teaching Hospital of Pediatrics in Baghdad over 18 months from July 2103 through December 2104. They were arranged for complete clinical and neuro-radiological evaluation. Age ranging from over 1month --- 15 years.
RESULTS:
Twenty nine patients ( 43.9 % ) had vermian hypoplasia, ranging from mild to moderate , cerebellar hypoplasia( 19) patients ( 28.7 % ) ,combined anomalies in 16 patients (24.4%)and 2 patients (3 %) with cystic dilatation of the posterior fossa.The bulk of cases fall in the category of 1-- 5 years age group, with the major clinical presentation being motor and speech deficits, 28 ( 80 % ) and 27 (77.1 % ) patients respectively.
CONCLUSION:
Magnetic resonance imaging is the basic modality of choice, in the setting of cerebellar malformation, especially in the association of extreme variability of clinical presentation, and lack of easy availability of the required cytogenetic analysis

Co-Existence of Anatomical Variants and Rhinosinusitis on Multi-Sliced Computed Tomography

Abdullateef Aliasghar; Meethaq Muhi Abdullah; Muhamed Dheia

Iraqi Postgraduate Medical Journal, 2016, Volume 15, Issue 1, Pages 79-85

ABSTRACT:
BACKGROUND:
Computed tomography (CT) is mandatory and a medicolegal requirement to evaluate rhinosinusitis and provides a road map regarding anatomical variants and endoscopic treatment of rhinosinusitis.
OBJECTIVE:
To identify coexistence between anatomical variants of nasal constituents and rhinosinusitis by using multi-sliced CT and to ascertain the value of CT as a road map prior to functioning endoscopic sinus surgery.
PATIENTS AND METHODS:
This is a cross sectional study was done on 87 patients referred for CT scan of the paranasal sinuses. The patients were clinically suspected to have sinonasal diseases. The sample of this study was consist of 52 males and 35 females. The age of patients ranged from 12 - 60 years. All patients were examined by using 64 multi-slice CT scan of paranasal sinus including axial sections and coronal reformat.
RESULTS:
76 patients were had diseased sinuses, we discovered 5 abnormalities; mucosal thickening, opacification, air fluid level, mucosal polyp and cyst. The most commonly involved sinus was the maxillary (62 patients) followed by anterior ethmoid, and the commonest abnormality was mucosal thickening. Types of variations include; nasal septal deviation(52.4%), concha bullosa(49%), enlarged ethmoidal bullae (15.9%), large Aggar nasi (15.9%), Haller cells(19.1%), bent uncinate process(11.4%), Onodi cells (11.4%), paradoxical middle turbinate(9.1%), maxillary sinus hypoplasia (7.9%), pneumatized crista galli (6.8%), and both pneumatized nasal septum and asymmetrical ethmoid roof were of (3.4%). The total number of patients having anatomical variants but not associated with sinonasal mucosal abnormalities were (17.1%), while (82.9%) of patients were associated with sinonasal abnormalities.
CONCLUSION:
The study reveals correlation between certain anatomical variations and specific sinonasal mucosal abnormalities that may interfere with the drainage of the sinus secretions and subsequent secondary infection. Another group of variants were discovered that may lead to intra-operative complications if surgery indicated.

Wallplasty Versus Non Wallplasty in Arthroscopically Assisted Anterior Cruciate Ligament Reconstruction

Firas Abdalhadi ALObidi; Majed Aswad Alsaad

Iraqi Postgraduate Medical Journal, 2016, Volume 15, Issue 1, Pages 73-78

ABSTRACT:
BACKGROUND:
Anterior cruciate ligament reconstruction (ACLR) is one of the most commonly performed orthopedic procedures. Technical factors especially correct tunnel placement play major role in its success. However its failure rate is still high (10%), and impingement of the graft on the posterior cruciate ligament (PCL) and the medial wall of the lateral femoral condyle is an important cause of failure. Wallplasty is a technique used to prevent graft impingement, but there is no consensus on its routine use.
OBJECTIVE:
Is to compare between the postoperative knee functional outcome and stability of arthroscopic ACLR performed with wallplasty versus those performed without wallplasty.
PATIENTS AND METHODS:
A prospective experimental non randomized study was performed on 32 patients (30 males and 2 females) who necessitated arthroscopic ACLR. The patients were divided into 2 groups, in group A (made of 16 patients) the reconstructions were done without wallplasty and in group B (made of 16 patients) were done with wallplasty. Three months postoperatively the two groups were compared in regard to Lasholm score changes (preoperative and postoperative), Lachman test, and Pivot shift test results.
RESULTS:
There was better improvement in Lasholm score in group B than in group A, and the difference was statistically significant (p value =0.036). Knee stability tests were better in group B than in group A, but the differences were statistically not significant.
CONCLUSION:
Wallplasty has statistically better functional outcome than non wallplasty in ACLR and it is recommended to be done routinely in all cases of ACLR.

Surgical Management of Large Infra Renal Abdominal Aortic Aneurysm

Abdulameer mohsin Hussein; Raid Adel Aziz; Akeel Salman Yosur

Iraqi Postgraduate Medical Journal, 2016, Volume 15, Issue 1, Pages 52-57

ABSTRACT:
BACKGROUND:
Abdominal aortic aneurysm is a common disease of the elderly, with a complex etiology.
OBJECTIVE:
This study aimed to review the management and the outcomes of surgical treatment of the abdominal aortic aneurysm.
PATIENTS AND METHODS:
This is a retrospective study of 20 patients who had been referred to the surgical department at Ibn al-nafees hospital from 1st of January 2007 to 31th of December 2011 as cases of abdominal aortic aneurysm. The clinical features, imaging techniques, surgical operations, morbidity, mortality and follow up were analyzed.
RESULTS:
out of 20 patients with abdominal aortic aneurysm, there were 16 male and 4 female patients in a ratio 4:1.70% were smokers ,20% were diabetics and 65% were hypertensive .History of ischemic heart disease was present in 55% of the patients . 20% of the patients were asymptomatic, 70% of the patients were presented with backache followed by abdominal pain and 10% were presented with lower limb ischemia. Pulsatile abdominal mass was felt in 75% of the cases. 75% had left ventricle dysfunction. The transverse aortic diameter was 6-7cm in 20%, 7-8cm in 50% and more than 8 cm in 30%. All of the patients underwent surgical intervention. The overall mortality was 20%.
CONCLUSION:
Patients who underwent urgent surgery had poor outcome in comparison with those who did the procedure on elective basis.

Laparoscopic Treatment of Hydatid Cyst of Liver: Local Experience

Iraqi Postgraduate Medical Journal, 2015, Volume 14, Issue 4, Pages 468-473

ABSTRACT:
BACKGROUND:
Hydatid cyst disease remains a real health problem in many parts of the world. Surgery remains the mainstay of treatment of liver hydatid disease. Laparoscopic hydatid surgery (LHS) is gaining acceptance all over the world with promising early results.
OBJECTIVE:
To present our experience of laparoscopic management of liver hydatid disease in our locality.
PATIENTS AND METHODS:
All patients presented with liver hydatid disease to our department in Al-Jumhori Teaching Hospital were planned to undergo laparoscopic hydatid surgery (LHS). The diagnosis was made by abdominal ultrasonography and/or computed tomography. Surgical treatment was decided for cysts larger than 4 cm. Exclusions from laparoscopic intervention were for patients with; multiple cysts (>3 cysts), complicated cysts, cysts at risky site, recurrent hydatid, and those who refused the laparoscopic approach.
RESULTS:
From Sep 2001 to Jan 2013, 70 patients with hydatid liver disease were presented for surgical treatment. LHS was performed in 46 patients; 15 were males and 31 were females. Their mean age was 35 years (SD±14). In 31 cases the cysts were in the right lobe, in 5 cases were in the left lobe and in 8 cases were in both lobes of liver. In one patient, there were 2 cysts in liver and one cyst in spleen. In 9 patients (19%) the operation was converted to open surgery. The mean operative time was 75 minutes (range, 40 – 120 minutes). The mean length of hospital stay was 3 days (range, 3-8 days). Pus collection in the residual cavity was occurred in two patients, who were managed by laparotomy and drainage. Recurrence was detected in one patient 10 years after the LHS (2.3%). There was no mortality.
CONCLUSION:
This study highlighted that laparoscopic approach for hepatic hydatid surgery is a safe and effective method in selected patients.
.

Resection and Reconstruction of Cervical Tracheal Stenosis

Adil Khamees Abdul-Hameed; Waleed Mustafa Hussen; Akeel Salman Yuser

Iraqi Postgraduate Medical Journal, 2015, Volume 14, Issue 3, Pages 385-391

ABSTRACT:
BACKGROUND :
Tracheal resection and primary re anastomosis for tracheal stenosis or tracheal tumor is not uncommon operation .
OBJECTIVE:
To assess the aetiology of stenosis of cervical trachea and their surgical reconstruction .
PATIENT AND METHODS:
This is a retrospective study of forty patients with cervical tracheal stenosis ,who were treated at Ibn Al Nafees Hospital during six years period from January -2006 to October -2012 .It illustrates the diagnostic methods and the surgical techniques of reconstruction .
RESULTS:
Most of the patients ,were male (80%) and only (20%) were female .The most common etiological factor was post intubation stenosis (70%),less common cause was traumatic stenosis and the least was neoplastic stenosis . Progressive dyspnea was the most common presenting clinical feature .The mean length of resection was three rings .Seven patients developed complications , and dealt with successfully with one mortality .
CONCLUSION:
Bronchoscopy and radiography remain the main diagnostic tool for evaluating it .Resection and end to end anastamosis is the best method of treatment In special cases .Some cases can be treated by endoscopy and laser therapy .

Haemodynamic and Pulmonary Changes During Laproscopic Versus Open Cholecystectomy

Iraqi Postgraduate Medical Journal, 2015, Volume 14, Issue 4, Pages 474-479

ABSTRACT:
BACKGROUND:
Laproscopy is a minimally invasive procedure allowing endoscopic access the peritoneal cavity after insufflation of a gas (CO2)to create space between the anterior abdominal wall and the viscera for safe manipulation.
OBJECTIVE:
Is to note the haemodynamic and pulmonary changes during laparoscopy in the early postoperative period in comparison with open cholecystectomy.
PATIENTS AND METHODS:
30 adult patients of ASA class I and II studied in each group according to surgical procedure used ,monitoring used pulse oximetry ,non invasive automatic blood pressure measurement ,peak inspiratory pressure and capnography.
RESULTS:
There is slight reduction of mean arterial pressure(MAP) and heart rate(HR) following induction of anesthesiain both groups.Howevere,these effects tended to normalize in open cholecystectomy over time while in laproscopy tend to normalize after desufflation.Postoperatively both groups sustain significant reduction in oxygen saturation(SPO2) but in laproscopy was transient and clinically not significant.
CONCLUSION:
This study show that laproscopy give better recovery and may decrease the need for postoperative oxygen therapy.

Efficacy and Safety of Valsartan As an Antiproteinuric Agent in Children Aged 3 to 18 Years with Minimal Change Nephrotic Syndrome

Iraqi Postgraduate Medical Journal, 2015, Volume 14, Issue 4, Pages 514-521

ABSTRACT:
BACKGROUND:
Nephrotic syndrome is primarily a pediatric disorder which causes heavy proteinuria , hypoalbuminemia , edema, and hyperlipidemia. Most children (90%) with nephrotic syndrome have idiopathic nephrotic syndrome caused in 85% of the patients by minimal change glomerular disease.
Valsartan is an angiotensin II receptor blocker approved in adults for the treatment of hypertension, heart failure and it may also reduce proteinuria in nephritic syndrome.
OBJECTIVE:
The aims of this study are to assess antiproteinuric effect of valsartan in nephrotic syndrome in comparison with propranolol and captopril , and to assess safety of valsartan in pediatric age.
PATIENTS AND METHODS:
A case control study was done for 104 patients who attended three pediatric hospitals ( The Central Pediatric Hospital, Al- Elwyia Pediatric Hospital and Ibn Al-Baladi Hospital) where they were newly diagnosed with minimal change nephrotic syndrome and 38 of them (36.5%) were diagnosed with hypertension from 2006 to 2013 and they were followed up for six
months (course of disease treatment). Data collected in this study included: age, sex, time of diagnosis and blood pressure was measured. Laboratory tests were done which include: measurement of blood urea, serum creatinine, serum potassium , serum cholesterol, serum albumin, hemoglobin level, liver enzymes (serum glutamate pyruvate transaminase, serum glutamic-oxaloacetic transaminase and serum alkaline phosphatase ) and albumin in urine.
RESULT:
Despite comparable reduction in blood pressure among the 3 groups, angiotensin receptor blocker-treated group showed statistically more significant reduction in proteinuria (amount and onset after initiation of therapy) than other groups.
Drug-related adverse events were minor and infrequent, no patient developed dangerous increase in serum potassium, renal function and liver function parameters nor dangerous decrease in mean hemoglobin level.
CONCLUSION:
Valsartan is an effective and safe drug to be used in childhood minimal chang nephrotic syndrom with rapid and consistent antiproteinuric effect even beyond its antihypertensive effect.

Assessment of Dialysis Adequacy Using Urea Reduction Ratio and KT/V in four Pediatric Hemodialysis Centers in Baghdad

Iraqi Postgraduate Medical Journal, 2015, Volume 14, Issue 4, Pages 522-529

ABSTRACT:
BACKGROUND:
The 21st century has been set to enhance dialysis adequacy. Numerous studies have confirmed the association between the delivered dose of hemodialysis and patients outcomes. There is thus some evidence regarding the relationship between dialysis dose and quality of life.
OBJECTIVE:
To assess dialysis adequacy using (Urea Reduction Rate and KT/V), and to determine the association between dialysis dose and different Hemodialysis characteristics in children with End Stage Renal Failure undergoing Hemodialysis.
METHOD:
This was an observational cross-sectional study that was conducted for three months, from (November 2014 till January 2015); we enrolled 50 children with End Stage Renal Failure in four hemodialysis centers in Baghdad. Samples for blood urea (predialysis and postdialysis) were drown to calculate the adequacy dose.
RESULTS:
Thirty two (64%) of patients were male and 18(36%) were females; with male to female ratio was (1.7:1).The mean urea reduction ratio and Kt/V were 59.63 ± 7.345% and 1.29 ± 0.275, respectively, with fair dialysis adequacy .A Kt/V less than 1.2 and a urea reduction ratio less than 65% were found in 42%, and 38% of the hemodialysis patients, respectively. There was a significant correlation between dialysis dose and (Blood flow rate, Dialysis hours, Dialysis frequency /week and Effective surface area), while there was insignificance correlation with (gender, age, volume of ultrafiltration.
CONCLUSION:
Our results were better than neighbor countries with fair dialysis adequacy. It is important to regularly measure the parameters of dialysis adequacy in order to assess whether targets are achieved in accordance with K/DOQI guidelines.

Serum Her-2/Neu a Potential Biomarker in Breast Cancer Patients: Correlation with the Clinico-Pathological Parameters

Iraqi Postgraduate Medical Journal, 2015, Volume 14, Issue 4, Pages 555-563

ABSTRACT:
BACKGROUND:
Breast cancer is the most common malignancy in women, and a major cause of mortality and morbidity despite the advances in diagnosis and treatment. There is evidence that changes in HER2 protein expressions are associated with breast cancer progression.
OBJECTIVE:
To investigate whether measuring this tumour marker in serum of breast cancer patients before and after treatment might also be useful markers in the diagnosis, screening and monitoring the malignant tumour progression and response to therapy.
METHODS:
Serum samples were obtained from (28) apparently healthy women (Control Group) with a mean age of 40.9 ± 7.6 years and (60) female patients complaining from primary breast cancer (Patients Group) with a mean age of 48.3 ± 8.9 years. They were divided according to their clinical end point into: Pre-Surgical Group, Post-Surgical Group and post- chemotherapy Group. Serum Her-2/nue level was measured using ELISA kits.
RESULTS:
Level of Her2/neu (3130.4 pg/ml) was significantly higher in after 6 cycles of chemotherapy group than each of control (1400.8 pg/ml), before surgery (1597 pg/ml) and after surgery (1487.4 pg/ml) (P < 0.05). Her2/neu is effective test only after 6 cycle chemotherapy with an accuracy of 95.2%. The best performance for Her2neu was observed at values ≥ 1464 pg/ml (sensitivity = 95% and specificity = 61%). There were significant influences of the studied personal and the pathological characteristics of the tumour upon the biomarker levels where the levels were significantly higher with the increase of tumour pathological stage and in the presence of positive status for Her2neu receptors (P < 0.05).
CONCLUSION:
In this study there was a statistically significant association between tissue HER-2/neu and serum HER-2 /neu levels in the extracellular domain. It could be concluded that using serum Her-2/neu in patients after six cycles chemotherapy could predict response to therapy.
.

Outcome of the First Trimester Threatened Miscarriage: Study of the Predicting Factors

Abdulrazak H. Alnakash; Nibras A Omar; Faris Anwer Rasheed

Iraqi Postgraduate Medical Journal, 2015, Volume 14, Issue 3, Pages 320-328

ABSTRACT:
BACKGROUND:
Threatened miscarriage is a distressing condition to both pregnant woman and gynecologist. It is important to predict the outcome of threatened miscarriage through maternal history, biochemical tests, and fetal ultrasound for patient counseling and to avoid delay in management.
Study design
A prospective multiple logistic regression analysis study.
OBJECTIVE:
To assess the power of factors which are maternal history (age, vaginal bleeding, parity and hypertension), biochemical tests (β-hCG & serum progesterone level) and fetal ultrasound (crown rump length& fetal heart rate) for predicting the outcome of pregnancy (fetal demise & ongoing pregnancy) complicated by threatened miscarriage between 7-11 wks and to determine the time interval from onset of symptoms to fetal demise development.
PATIENTS AND METHODS:
The study was carried out on 80 pregnant women at their 7-11 weeks of gestation suffering from vaginal bleeding attending Al-Elwiya Maternity Teaching hospital. They were subjected to ultrasound to confirm fetal viability, assay of serum progesterone and β-hCG levels and pain with bleeding scores. All these were repeated on weekly basis for four weeks follow up to monitor the pregnancy and identify the period to fetal demise (if happened). The data is gathered on questionnaire paper and then subjected to statistical study.
RESULTS:
The β-hCG (human chorionic gonadotrophin hormone) level was found to be the main predictor for pregnancy outcome (miscarriage/fetal demise & ongoing pregnancy) and highly statistically significant (P value<0.0012), followed by bleeding (p <0.002) and maternal age (p<0.01) respectively, while other variables (serum progesterone, fetal ultrasound, parity) showed no statistically significant effect (P value=0.47, 0.63, 1.146 respectively) on the risk of miscarriage/fetal demise. Serum progesterone level was highly significant in predicting ongoing pregnancy (P value=0.001)
CONCLUSION:
Measuring of beta hCG levels is found to be a good predictor for the outcome of the first trimester threatened miscarriage whether ends in to fetal demise or continuing pregnancy, while other factors like ultrasound, serum progesterone levels and parity are useful in assessing an ongoing pregnancy but have no power in predicting possibility of fetal demise. Also measuring the interval from the onset of bleeding to fetal demise development can be useful to avoid delaying pregnancy management.

Comparison of Measurement of 24-Hour Urine Protein Excretion Versus Random Urine Protein-Creatinine Ratio in Pregnant Woman with Pre-eclampsia

Miami A. Ali; Manal Madany A. Qader; Manal Jasim

Iraqi Postgraduate Medical Journal, 2015, Volume 14, Issue 3, Pages 313-319

ABSTRACT:
BACK GROUND:
Measurement of protein excretion in a 24-hour urine collection has been the long-standing gold-standard but time consuming test for the quantitative evaluation of proteinuria induced by preeclampsia. An alternative method is the measurement of protein- creatinine ratio in a spot urine sample, which provides a more convenient and rapid method to assess protein excretion.
OBJECTIVE:
To assess the correlation between the spot urine protein- creatinine ratio and 24-hour urine protein excretion in women with preeclampsia and to use the urine protein- creatinine ratio as alternative to time-consuming 24-hour urine protein collection.
Study design: A cross sectional study.
Setting: Department of Obstetrics and Gynecology at Al-Yarmouk Teaching Hospital for a period of one year from Jan. 2013 to Jan. 2014
PATIENTSAND METHODS:
Eighty three singleton pregnant women suffering from pre-eclampsia with gestational age between 28 to 39 weeks were selected to participate in the study. They were divided into two groups: 61pregnant women with mild to moderate pre-eclampsia and 22 with severe pre-eclampsia.These women were prospectively studied for proteinuria. Urine protein- creatinine ratio was determined in a spot mid-stream urine sample, and the amount of protein excretion was measured in 24-hour urine collected on the subsequent day. The correlation between the two tests was assessed.
RESULTS :
Diagnostic value of protein/creatinine ratio was expressed in terms of specificity and sensitivity.There was significant correlation between protein/ creatinine ratio in a single void urine with 24 hr. urine collection for protein as the P value was (0.0001), The ROC curve analysis showed an area under the curve of (0.879), indicating that the urine protein: creatinine ratio can detect severe proteinuria at a cutoff point of 4.2 with a sensitivity of (81.8%) and specificity of (85.2%).
CONCLUSION:
There is a significant correlation between the spot urine protein/ creatinine ratio and 24-hour urine protein excretion in women with preeclampsia.

Acute Accidental Poisoning in Children Admitted to Child’s Central Teaching Hospital in Baghdad

Iraqi Postgraduate Medical Journal, 2015, Volume 14, Issue 4, Pages 506-513

ABSTRACT:
BACKGROUND:
Poisoning defined as any substance causing a harmful effect when administrated accidently. Acute accidental poisoning is important medical emergency in children worldwide.
OBJECTIVE:
To determine the pattern of accidental poisoning in children, the association between accidental poisoning with gender and residence and to determine the clinical presentation and outcome of each poison.
METHODS:
A prospective study was carried out in Childs Central teaching hospital in Baghdad for all children bellow ten years with history of accidental poisoning during six months period Data including: age, gender, residence, type of poisoning, presenting symptoms, and outcome were studied.
RESULTS:
Total number of children admitted were 10280 cases, of these 250 cases were presented with history of accidental poisoning, accounting for (2.43%) of total cases admitted. Most of patients (93.2%) were within age group of 1-5years.Males to females ratio was (1.27:1).Most common poison was hydrocarbons(50.8%) followed by medications(31.2%) .Most of patients were from urban backgrounds(78.0%).Vomiting was the most common clinical presentation(28.8%). (80.0%) Patients discharged from emergency reception within 24 hours .The mortality rates were (0.8%) .
CONCLUSION:
Poisoning in children are well recognized problem and affecting large number of children. The mortality rate was low.

The Value of Focused Assessment Sonography for Trauma the Management of Patients with Blunt Trauma to the Abdomen

Nabil Isam Naiem; yahya Kareem Hammodi; Tharwat Idrees Sulaiman; Mohammed M.Habash

Iraqi Postgraduate Medical Journal, 2015, Volume 14, Issue 3, Pages 379-384

ABSTRACT:
BACKGROUND:
During the last decade focused assessment with sonography for trauma increasingly has become the initial diagnostic modality of choice in trauma patients.
OBJECTIVE:
This study was carried to evaluate the sensitivity, specificity and accuracy of FAST when done by residents in the emergency surgical department, & its effect in determining the type of management.
PATIENTS AND METHOD:
210 patients with blunt abdominal trauma were assessed with FAST within 30 minutes from admission to the emergency room. FAST results were considered positive if it detected intra peritoneal fluid , negative if it did not detect intra peritoneal fluid , and indeterminate (equivocal) if the results were not conclusive.
In cases with negative Fast results and no other injuries were detected the patients were kept in the emergency department for 24 hours for observation and discharged later on.
Those with indeterminate initial FAST or who deteriorated clinically after negative initial FAST were subjected to repeated FAST and / or emergency abdominal and pelvic computed tomography (C.T scan) or explorative laparotomy according to their clinical condition.
Patients with positive ultrasonography results underwent emergency abdominal or pelvic C.T, or surgery according to their clinical picture.
RESULTS:
From the 210 patients included in the study we found that 177 patients (84.2) % had negative FAST results, 22 patients (10.4)% had positive FAST results , 2 patients (0.95)% had false positive results , 8 patients (3.8)% had false negative FAST results and 11 patients (5.2)% had equivocal FAST results.
After exclusion of equivocal cases , FAST had sensitivity of (71.4)% specificity of (98.8)% , accuracy of (89.1)%, positive predictive value of (90.9)% and negative predictive value of(95.4)%.
CONCLUSION:
FAST is useful adjunct to the initial evaluation of blunt trauma patients with reliable accuracy & high negative predictive value.
FAST had a great effect in determining the type of treatment especially in case of mass causality.
And using FAST by general surgeons helps in the determination of the type of treatment for patients with blunt trauma.

Human Papilloma Virus 16 Survey in Breast Epithelium of Women Using In Situ Hybridization Technique

Mahmoud Mishaal Mohamed; Huda Mahdi Al-Khateeb; Khitam Razzak Kadhim Al-Khafaji

Iraqi Postgraduate Medical Journal, 2015, Volume 14, Issue 3, Pages 337-343

ABSTRACT:
BACKGROUND:
There is increasing evidence that high-risk human papilloma virus (HPV) is involved in cancers other than cervical cancer. A number of reports have identified HPV DNA in breast tissue and breast cancer specimens, suggesting that the virus could play a role in the pathogenesis of this tumor.
OBJECTIVE:
The aim was directed towards the use of In situ molecular methods to localize the virus in breast tissue. In addition, this study investigated the prevalence of high-risk HPV infections in Iraqi women with and without ductal carcinoma (DC) of the breast.
PATIENTS AND METHODS:
29 cases of ductal carcinoma and 44 controls obtained from adjacent area to benign breast. Formalin fixed, paraffin embedded specimens were used by In situ hybridization technique for detection of HPV16 subtype. Data analysis was performed by SPSS 20 software using descriptive statistics and Chi-square tests.
RESULTS:
The HPV16 were identified in 69% and 27.3% of the ductal carcinoma and control breast tissue specimens respectively. Statistically, the difference between the normal and ductal carcinoma cases were highly significant (P=0.001).
CONCLUSION:
HPV16 In situ hybridization revealed statistically significant increase in DC (69%) as compared to controls (27.3%) and most of them were localized in the nuclei in integrative form. HPV16 were detected in skin and mammary tissue in both DC an control cases. This may indicates a role of HPV16 in the pathogenesis of DC.

Simultaneous Complete Intracorneal Ring Implantation with Intrapocket Collagen Cross- Linking for Treatment of Keratoconus

Suzan Amana Rattan; Hayder Kadhum Hassoun; Haider Najim Aubaid; Amina Mohammed Abass Zwain; Majeed H.H. Al; Mustafa Raed Muhi; Amiri; Nabil Isam Naiem; yahya Kareem Hammodi; Tharwat Idrees Sulaiman; Mohammed M.Habash; Adil Khamees Abdul-Hameed; Waleed Mustafa Hussen; Akeel Salman Yuser; Raghad Dawood Najem; Ahlam Mohamad Abdulabbas; Esraa Abd-Alhameed Abd-Al-Azeez; Ali K. Mohammed; Mohammed Hannon Al-Sodani; Jawad I Rasheed; Raed Ahmed Dawood; Adil S.Ghafour; Ali Kadim Karim; Nawfal Madhi Sheaheed; Abdulraheem Taha; Zeki Noah Al-Musawi

Iraqi Postgraduate Medical Journal, 2015, Volume 14, Issue 3, Pages 355-361

ABSTRACT:
BACKGROUND:
Keratoconus is a progressive non inflammatory bilateral (usually asymmetric) ectatic corneal disease characterized by paraxial stromal thinning ,weakening that lead to corneal surface distortion ,vision loss primarily from irregular astigmatism and myopia and secondly from corneal scar.
OBJECTIVE:
To evaluate visual and refractive outcomes after intracorneal continuous ring (ICCR) implantation combined with intrapocket corneal collagen cross linking in patient with keratoconus.
Setting: Eye Specialty Private Hospital, Baghdad, Iraq.
METHODS:
This study assessed the results of implantation of Myoring ICCR combined with CXL in 40 eyes with KC. Outcome measures include UDVA,CDVA(spectacle correction),refraction, complications and side effects. Postoperative follow- up was up to 1 year.
RESULTS:
The study evaluated 40 eyes of 34 patients with a mean age of 25.75 years. Preoperatively, the pachymetry at thinnest location range from (367_555ϻm) and the mean keratometry (K) readings 50.51± 3.94D. Post operatively ,there was statistically significant improvement in the UDVA,CDVA,K reading ,manifest spherical and cylindrical refractive errors ,and spherical equivalent (p

Keywords

KEY WORDS:keratoconus
---
intracorneal continuous ring
---
collagen cross-linking and: implantable collamer lens.

The Value of Focused Assessment Sonography for Trauma (FAST) In The Management of Patients with Blunt Trauma to the Abdomen

Iraqi Postgraduate Medical Journal, 2015, Volume 14, Issue 4, Pages 564-569

ABSTRACT:
BACKGROUND:
During the last decade focused assessment with sonography for trauma increasingly has become the initial diagnostic modality of choice in trauma patients.
OBJECTIVE:
This study was carried to evaluate the sensitivity, specificity and accuracy of FAST when done by residents in the emergency surgical department, & its effect in determining the type of management.
PATIENTS AND METHOD:
210 patients with blunt abdominal trauma were assessed with FAST within 30 minutes from admission to the emergency room. FAST results were considered positive if it detected intra peritoneal fluid , negative if it did not detect intra peritoneal fluid , and indeterminate (equivocal) if the results were not conclusive.
In cases with negative Fast results and no other injuries were detected the patients were kept in the emergency department for 24 hours for observation and discharged later on.
Those with indeterminate initial FAST or who deteriorated clinically after negative initial FAST were subjected to repeated FAST and / or emergency abdominal and pelvic computed tomography (C.T scan) or explorative laparotomy according to their clinical condition.
Patients with positive ultrasonography results underwent emergency abdominal or pelvic C.T, or surgery according to their clinical picture.
RESULTS:
From the 210 patients included in the study we found that 177 patients (84.2) % had negative FAST results, 22 patients (10.4)% had positive FAST results , 2 patients (0.95)% had false positive results , 8 patients (3.8)% had false negative FAST results and 11 patients (5.2)% had equivocal FAST results.
After exclusion of equivocal cases , FAST had sensitivity of (71.4)% specificity of (98.8)% , accuracy of (89.1)%, positive predictive value of (90.9)% and negative predictive value of(95.4)%.
CONCLUSION:
FAST is useful adjunct to the initial evaluation of blunt trauma patients with reliable accuracy & high negative predictive value.
FAST had a great effect in determining the type of treatment especially in case of mass causality.
And using FAST by general surgeons helps in the determination of the type of treatment for patients with blunt trauma.

Short Term Effects of Antiepileptic Drugs on the Heart Using Electrocardiograph as an Assessment Tool of Investigation: A Pilot case Finding Study

Iraqi Postgraduate Medical Journal, 2015, Volume 14, Issue 4, Pages 492-498

ABSTRACT:
BACKGROUND:
Antiepileptic drugs can induce changes in the electrocardiograph (ECG) records including prolongation of QT interval but there is no evidence to link this effect with the sudden death that reported in epilepsy. The new generations of antiepileptic drugs showed variable effect on the heart. Lamotrigine did not prolonged the QT interval in healthy subjects while levetiracetam prolonged the QT interval in patients cardiac channelopathy presented with congenital long QT syndrome.
OBJECTIVE:
This study aimed to investigate effects of antiepileptic drugs that prescribed in a therapeutic regimen to new cases of epilepsy as a part of management on the ECG records at the end of the 1st three months of treatment.
PATIENTS AND METHODS:
A total number of 25 patients, presented for the first time with epilepsy, were recruited from Al-Yarmouk Teaching hospital. Each patient was assessed clinically by consultant neurology prior to enrollment in the study. An electrocardiogram (ECG) was obtained at the time of entry into the study prior to the admission of the study and after three months of treatment with antiepileptic drugs. In addition to the measurements of heart rate and different ECG intervals, a QT-nomogram and cardiac restitution were used in analysis.
RESULTS:
At the time of entry, three patients had a significant short corrected QT interval (QTcB); four patients had a borderline QTcB interval; and one patient had prolonged QTcB interval. QT-nomogram revealed that many patients have abnormal interval and antiepileptic drugs significantly reduced the relaxation phase of cardiac cycle and prolonged the ventricular repolarization.
CONCLUSION:
Antiepileptic drugs carried a harmful effect on the heart and their assessment should be not restricted in the measurement of QT interval before and after treatment or to study their effects on the healthy subject as epilepsy is commonly associated with mutation of sodium and/or potassium channels. Case finding of significant prolonged QT interval in respect to gender and age, assessment of QT nomogram and cardiac restitution are useful tools to identify the patients who are at risk of arrhythmias.

Prognostic Indicators in Patients with Relapsing Remitting Multiple Sclerosis

Ali Kadim Karim; Nawfal Madhi Sheaheed; Abdulraheem Taha; Zeki Noah Al-Musawi

Iraqi Postgraduate Medical Journal, 2015, Volume 14, Issue 3, Pages 403-409

ABSTRACT:
BACKGROUND:
Multiple sclerosis is an inflammatory demyelinating disease of the central nervous system affecting nearly 2 million people worldwide. Multiple sclerosis typically begins in early adulthood and has a variable prognosis.
OBJECTIVE:
To determine the factors that affects the prognosis in Iraqi patients with relapsing remitting multiple sclerosis.
PATIENTS AND METHODS:
This study includes fifty patients with relapsing remitting MS and was conducted from March 2007 to July 2008 in Baghdad Teaching Hospital MS clinic. A study protocol sheet was done and filled from the patient’s database in the MS clinic. The prognostic indicator of residual disability depends on the Expanded Disability Status Scale (EDSS).
RESULTS:
The mean age for the study sample was 45.58 years, with 27 male and 23 female. High percentage of patients presented as monosymptomatic (70%), most of the symptoms was spinal (48%). The mean value for relapses was 2.3 with maximum number of 6. The study shows that there is no significant effect of gender as a prognostic indicator on the residual disability of patient with relapsing remitting MS. There is significant correlation between the age at CDMS and the EDSS in the first visit (EDSS1).
CONCLUSION:
We concluded that the older age at onset, pyramidal and sphincteric involvement at the beginning of the illness and more relapses in the first 2 years of the illness all are associated with poor prognosis.

Identification of Some Annona Muricata L.(Soursop) Components and Their Antioxidant Effects in Rats

Iraqi Postgraduate Medical Journal, 2015, Volume 14, Issue 4, Pages 576-580

ABSTRACT:
BACKGROUND:
Oxidative stress defines that, the level of Reactive Oxygen Species (ROS) exists in excess of antioxidant defenses. This imbalance in the redox milieu results in a switch from ROS-stimulated ambient signaling processes to ROS-mediated pathophysiological consequences. Oxidative stress has been implicated in the installation and progression of several degenerative diseases via DNA mutation, protein oxidation and lipid peroxidation. Therefore, possible use of soursop fruit extract to protect brain against the Lipid peroxidation.
OBJECTIVE:
The present study was undertaken to evaluate the potential of Soursop (Annona Muricata L.) against the DPPH Free Radical Scavenging System and Lipid peroxidation.
METHODS:
Phytochemical screening was carried out with fruit extract of A. muricata for the detection of various phytochemicals. The extract was tested for the presence of glycosides, proteins, saponins, tannins, phenolic compounds , alkaloids , flavonoids, steroids and vitamine C using the standard procedures and then DPPH radical was estimated according to the method of Blois and Lipid peroxidation was estimated according to the method of Rajakumar.
RESULTS:
The study showed that the Soursop (Annona Muricata L.) in the fruit extract contain : glycosides , proteins, saponins ,tannins ,phenolic compounds, flavonoids , alkaloids , steroids and vitamine C . Fruit extract were found effective in scavenging DPPH (78,6℅) in concentration (250µl/ml), as well as inhibiting the lipid peroxidation (16.2℅).
CONCLUSION:
The results suggest that Soursop (Annona Muricata L.) treatment protects the rat brain against lipid peroxidation and DPPH free radical scavenging.

Outcome of Endonasal Endoscopic Dacryocystorhinostomy in Nasolacrimal Duct Obstruction

Ali A.Abdalwahid; Ragheed T. Miteab; Hussein J. Mohsin

Iraqi Postgraduate Medical Journal, 2015, Volume 14, Issue 3, Pages 344-354

ABSTRACT:
BACKGROUND:
Dacryocystorhinostomy (dcr) is the standard trcatmert for nasolacrimal duct Obstruction .based on opening the lacrimal sac, which is connected to the nose, by removing the bone and the mucosa between these two structures at the level of the middle meatus.
OBJECTIVE:
To highlight the procedure of endonasal endoscopic dacryocystorhinostomy.
PATIENTS AND METHODS:
This was a prospective study conducted at Ghazy Al- hariri teaching hospital for surgical specialties during the period from 22nd of February 2011to the 4th of March 2013. A total of 22 patients were referred from the ophthalmologist for endoscopic dacryocystorhinostomy after had been diagnosed as distal obstruction of nasolacrimal duct or sac. Data were collected and all patients were investigated with general pre-operative investigation in addition to CT scanning to exclude any associated abnormalities or neoplasm and rigid nasal endoscopy were performed for all patients. Intranasal decongestant and steroids along with oral antibiotic were given pre-operatively in 14 patients. Endoscopic dacryocystorhinostomy was performed; the patients were followed up for 6 months and evaluated regularly for any complication.
RESULTS:
The mean age of the patients was (32.9 ± 12.7) years with range of (12– 69) years. About 59% of the patients aged 21-40 years. Females were predominant with a female to male ratio of 3.4:1. All patients had mucopurulant conjunctival discharge. The median duration of presentation was 5-6 months. The DCR performed eleven in right side and eleven in left side, and 4 associated operation were conducted for management of associated abnormalities. Eight complications developed during different time of follow up and only one patient needed re insertion giving a success rate of 95.5%.
CONCLUSION:
The endoscopic endonasal DCR is a safe procedure for the treatment of nasolacrimal duct obstruction and with high success rate and less serious complications.

Effect of Shock Wave Frequency on Treatment Outcomes in Patients with Renal Stone Treated by Extracorporeal Shock Wave Lithotripsy

Samir Ali Muter; Ziad Hammad Abd; Hasan Ali Rasheed; Noorulhuda Mukhlif Najm Al-Ani

Iraqi Postgraduate Medical Journal, 2015, Volume 14, Issue 2, Pages 197-202

ABSTRACT:
BACKGROUND:
since the introduction of ESWL in treatment of renal stones, it remained the first option for most renal and ureteric stones, with a success rate ranging from 60% to 90%. Multiple variables can affect treatment outcome, including those related to the machine, dose administered, and factors related to the patient; the exact role of most of these factors is still under study.
OBJECTIVE:
We investigated the effect of shock wave frequency on treatment outcomes in terms of success and complication rates.
PATIENTS AND METHOD:
139 patients with radio-opaque renal stones, presented to the Urology consultancy clinic during the period June 2010 through January 2012 and decided to undergo ESWL treatment were randomized into three groups, the first group (46 patients) received shock waves at a frequency of 120 waves per minute, the second (47 patients) at 90 w/m, and the third group (46 patients) at 60 w/m. Patients were followed for treatment outcome and appearance of complications at 1 week, 3 weeks, and 6 weeks. Stone free status or insignificant asymptomatic residual gravels of 5mm or less are considered as success. Durations of hematuria and analgesic requirement were the main complications looked for during follow up, while subcapsular and retroperitoneal hematomas were looked.
RESULTS:
All patients received 3500-4000 shock waves per session at 17-18 KV energy. Success rate was significantly higher in the second and third groups, while the durations of hematuria and analgesic requirement were significantly shorter in groups 2 and 3. There was no significant difference between groups 2 and 3 in all outcome and complication parameters; however, the duration of treatment was significantly longer in groups 2 and 3.
CONCLUSION:
ESWL efficacy in fragmenting renal stones is significantly improved by decreasing frequency from the standard 120 sw/min to slower rates (90 and 60 sw/min), with significantly decreased analgesic requirement and hematuria durations. There were no significant differences between the 60 and 90 sw/min frequencies. Taking in account the longer treatment duration for the 60 sw/min frequency; the 90 sw/min frequency would be optimal in terms of stone disintegration, complications, and duration of treatment.

Study of Pseudomonas Areuginosa Proteases Enzymes in Corneal Ulceration by Using Real - Time PCR

edi; Aida Hussain Al; Saa; Munera Chaloob. Al - Abaadi; Jassim Mohammed Karhoot; Faiz Al- Sakarchi

Iraqi Postgraduate Medical Journal, 2015, Volume 14, Issue 2, Pages 281-287

ABSTRACT:
BACKGROUND:
Pseudomonas aeruginosa (P. aeruginosa) is the most frequently isolated bacteria in clinical cases of ulcerative keratitis. P. aeruginosa produces several proteases and toxins, the best characterized being exotoxin, elastase, alkaline protease and IV. These are all important factors in the establishment of bacterial infection and the amount of damage caused by the infection to the cornea.
OBJECTIVE:
The aim of the present study was to study the role of P. aeruginosa proteases ( elastase ( LasB) , LasA, Alkaline protease, and protease IV ) in corneal ulceration by using Real - time PCR.
METHODS :
One hundred - twenty clinical samples (corneal scraping) were collected from patients suspected with bacterial keratitis presenting to Ibn –Alhaytham Teaching Hospital from May 2013 until November 2013. Methods for isolation and identifying P. aeruginosa based upon culture coupled with biochemical tests and confirmed by new technique called Vitek 2 compact system. The role of proteases enzymes ( elastase ( LasB), LasA, alkaline protease and protease IV ) of P. aeruginosa in the corneal ulceration was studied by Real – time PCR.
RESULTS :
Real time aalysis demonstrated that three bacterial isolates of P. aeruginosa were possessed elastase gene (11.5%), one bacterial isolate was harbored LasA gene (3.8%), twenty bacterial isolates were possessed protease IV gene ( 76.9%) , and all bacterial isolates were possessed alkaline protease gene (100%).
CONCLUSION:
The presence of the alkaline protease and protease IV genes in almost bacterial isolates of P. aeruginosa improved the fact that these enzymes were not only tissue damaging but also very important colonizer agents to cornea.

Laparoscopic Cholecystectomy : Retrieval of the Gallbladder Specimen and Spilled Gallstones, Inside a Sterile Male Condom as an Endobag, Reduces the Septic Complications

Jawad Kadhim S. AL-Dhahiry

Iraqi Postgraduate Medical Journal, 2015, Volume 14, Issue 2, Pages 209-215

ABSTRACT:
BACKGROUND:
During the course of laparoscopic cholecystectomy .the gallbladder specimen and the spilled stones are retieved by the formal endobag , which is not available in Iraq , or directly through the umbilical or the epigastric port .Direct retrieval of the gallbladder specimen and the spilled stones may cause contamination of the port site .
OBJECTIVE :
To evaluate the safety,cost effectiveness and incidence rates of intraperitoneal and port site infections when using a sterile male condom as an endobag for retrieval of gallbladder specimen and spilled gallstones .
METHODS :
This is a prospective study performed in AL-Karama Teaching Hospital, Medical College / Wasit University, Iraq .A total of 306 patients, with symptomatic cholelithiasis underwent Laparoscopic Cholecystectomy (LC), were included in this study performed during the period from April 2011 to June 2014. A sterile male condom was inserted through 10 mm epigastric port. The gallbladder specimen / spilled gallstones of every patient were retrieved inside a sterile male condom. Patients less than 15 years old and those with liver cirrhosis, gallbladder carcinoma and obstructive jaundice, were excluded. The follow-up period ranged from 2 to 42 months.
RESULTS:
Dissected gallbladders / spilled gallstones of the 306 patients; 279 (91.2%) were females and 27(8.8%) were males with a mean age of 39±12.5 SD (range 16-75) years, were safely retrieved through 10 mm epigastric port inside male condoms.
Incidental perforation of gallbladders ,during their dissection from the hepatic bed, was observed11(3.6 %) patients. Perforation of the condom during retrieval of the gallbladder specimens/spilled stones occurred in 12(3.8%) patients.
This study had no intraperitoneal nor port site infections. No mortality occurred during the follow-up period.
CONCLUSION:
Use of a sterile male condom as endobag for retrieval of gallbladder specimen and spilled stones is simple, inexpensive and safe technique. It also reduces the intraperitoneal and port site septic complications .

Can the Automated Pump be an Alternative to Tourniquet in Knee Arthroscopy?

Firas Abdalhadi Naser Alobidi

Iraqi Postgraduate Medical Journal, 2015, Volume 14, Issue 2, Pages 179-184

ABSTRACT:
BACKGROUND:
Arthroscopic knee surgeries are performed in very large numbers worldwide, and in spite of relatively low complication rate, but the total number is significant. Some of these complications are due to tourniquet use and can be serious.
OBJECTIVE:
Is to asses if automated pump (with or without) dilute epinephrine saline irrigation can replace the tourniquet use in soft tissue arthroscopic knee surgeries.
PATIENTS AND METHODS:
36 patients (9 females 25 % and 27 males 75 %) were included in this prospective experimental nonrandomized study, and were necessitated soft tissue arthroscopic knee surgeries. Patients were divided into two groups, in group A (patients) tourniquet and automated pump were used. In group B (18 patients) automated pump with or without epinephrine irrigation fluid were used. For both groups, visibility, time of surgery, amount of irrigation fluid used, pressure of pump, postoperative pain and hemoglobin level before and after surgery were assessed and compared.
RESULTS:
There was no significant statistical difference( p value more than 0.05) in regard to visibility, time of surgery, amount of irrigation fluid used, pressure of pump and postoperative pain between the two groups. There was no significant statistical difference between hemoglobin levels before and after surgery in both groups.
CONCLUSION:
Automated pump (with or without) dilute epinephrine saline irrigation can replace the tourniquet in soft tissue arthroscopic knee surgeries.

Growth Retardation in β-Thalassemia Major

Qais Abdullah Ali Al-Salehe; Mohammed Shaker Al-Awady; Shaima Khidar Abbass

Iraqi Postgraduate Medical Journal, 2015, Volume 14, Issue 2, Pages 267-273

ABSTRACT:
BACKGROUND:
Thalassemia is an inherited autosomal recessive blood disease caused by genetic defects result in reduced rate of synthesis of one of the globin chains that make up hemoglobin. The combination of transfusion and chelating therapy has dramatically extended the life expectancy of thalassemic patients.
OBJECTIVE:
The objective of this study is to determine the factors associated with short stature in thalassemic patients and main endocrine complications.
PATIENTS AND METHODS:
A case-control study was performed prospectively in Ibn-Al Balady hospital in (Al- Sader city-Baghdad- Rasafa) for the period extended from the 1st of January to 31st of May (2013). Data were collected from 181 thalassemic patients, their ages were 10 to 20 years old being attended the hospital for regular follow up and blood transfusion. The control in this research work was one of the patients' relatives with the same age after thalassemia was ruled out in the control. Data collected in this study included: age, sex, height and weight were assessed by the National Center of Health statistics (NCHS) growth curves , history of splenectomy, times of blood transfusion , hepatitis infection, type of chelating agent. Serum ferritin, hormones level, fasting and random blood sugar and serum calcium were estimated.
RESULT:
It was founded that 79% of the β-thalassemic patients had short stature (their height equal or less than5rd percentile) with significant relation with high serum ferritin (P-value=0.006). Delayed puberty was the commonest endocrine complication in thalassemic patients (83.9%).
CONCLUSION:
High serum ferritin is associated with growth retardation and many endocrine complications . Aggressive iron-chelating therapy and regular measurement of hormones concentration are necessary for thalassemic patients mainly during puberty to avoid growth retardation.

Accuracy of Fiberoptic Nasopharyngoscopy in the Diagnosis of Pharyngolaryngeal Diseases

Ragheed Turky Miteab

Iraqi Postgraduate Medical Journal, 2015, Volume 14, Issue 2, Pages 192-196

ABSTRACT:
BACKGROUND:
In recent years, flexible laryngoscope is a major contribution to endoscopic technique and is a standard method in diagnosis of many laryngeal and pharyngeal diseases.
OBJECTIVE:
To show the accuracy of flexible fiberoptic endoscope in the diagnosis of laryngeal and pharyngeal disorders in comparison with direct laryngoscopy
PATIENT AND METHOD:
A prospective study conducted at otolaryngology department, Surgical Specialties Hospital, Medical City, Baghdad between Feb.2008 and Feb. 2009 with fifty patients were included in the study. All patients with laryngeal or pharyngeal symptoms were examined by flexible fiberoptic endoscope and direct laryngoscope under general anesthesia.
RESULTS:
Male to female ratio was 1.8:1; dysphonia was the main chief complains in 66% followed by dysphagia in 16%. The commonest finding of flexible fiberoptic endoscope was laryngeal mass in 58% patients followed by impaired or immobile vocal cords in 18%. The accuracy of flexible fiberoptic endoscope in diagnosis of pharyngolaryngeal disease was 76% while of the direct laryngoscope accuracy was 92%.
CONCLUSION:
Flexible fiberoptic endoscope is vital instrument in outpatient clinic especially when indirect laryngoscope is unsatisfactory, but don’t supplant direct laryngoscopy specially when biopsy is indicated.

Comparison of Plate VS. Nail Fixation for the Treatment of Distal Tibial Shaft Fractures in a Sample of Trauma Patients

Ali A. Ali

Iraqi Postgraduate Medical Journal, 2015, Volume 14, Issue 2, Pages 172-178

ABSTRACT:
BACKGROUND:
Fractures of the distal third of the tibia are the major cause of morbidity in patients with lower extremity injuries. Most fractures are sustained in young adults during high velocity injuries.
PATIENTS AND METHODS:
Forty patients with closed fractures of distal third of the tibia were treated in Al-Yarmouk Teaching hospital between May 2012 and April 2014. 20 patients had been treated with open reduction and internal fixation by heavy-duty plate and screws and were matched to 20 patients treated with closed reduction and intramedullary nailing fixation, with regard to gender, age, and the AO classification of the fracture.
RESULTS:
There were no significant differences in regard to: time of surgical procedures, non-union, hardware failure or deep infections between plate fixation and intramedullary nailing. Open reduction and plate fixation was associated with higher risk of: delayed union, osteopenia, ankle joint stiffness and algodystrophy. Closed reduction with intramedullary nailing was associated with higher rates of rotational malalignment and knee joint pain/stiffness. The limb length difference was of no clinical significance in all patients.
CONCLUSION:
Intramedullary nailing is the preferred method for treating closed distal tibial fractures but open reduction and plate fixation may provide superior results in terms of optimal alignment.

Validity of the Ratio of Serum Concentration of Interleukin 6 to Transforming Growth Factor-Beta1 in a Sample of Patients With Rheumatoid Arthritis

Nizar Abdulateef Jassim

Iraqi Postgraduate Medical Journal, 2015, Volume 14, Issue 2, Pages 296-301

ABSTRACT:
BACKGROUND:
Interleukin 6 (IL-6), a pro-inflammatory cytokine, plays a key role in the development of rheumatoid arthritis (RA). Transforming growth factor-beta1 (TGF-β1) is an anti-inflammatory cytokine which is considered to be an important (down) regulator of inflammation in RA.
OBJECTIVE:
To evaluate serum concentration of IL6 to TGF-β1 ratio in a sample of Iraqi patients with RA.
METHODS:
A case control single center study was conducted for 11 months. A total of 50 patients with RA diagnosed according to the 1987 American College of Rheumatology (ACR) and 30 individuals matched in age and sex as control group were included. Serum concentration of IL-6 to TGF-β1 ratio and serum IL-17 were determined in both RA groups using enzyme-linked immunosorbent assay (ELISA). The cut off value was assessed by receiver operating characteristics (ROC) test and correlation by spearman's Rholinear correlation coefficient.
RESULTS:
Frequency of females was more than males in patients and controls (88% and 76.7% respectively). Ages of patients range between 20-70 years with a median 43.76 years while in controls, ages range between 20-60 years with a median 37.67 years. Serum concentration of IL-6 toTGF-β1 ratio was significantly more in patients than those in controls (p=0.018). Area under the curve (AUC) at value 0.686 was statistically significant (p=0.018) and had intermediate accuracy. Serum IL-6 to TGF- β1 ratio≥ 2.4pg/ml was the optimum cutoff value that can differentiate between RA and healthy controls with accuracy 71.9%. There was a significant positive linear correlation between IL-6 to TGF-β1 ratio and IL-17( r=0.56, p<0.001) and simple linear regression analysis showed that for each 1unit increase in IL6 to TGF-B1 ration there was a significant increase of 0.7 pcg/ml in IL-17(R2=0.467, P < 0.001)
CONCLUSION:
Serum concentration of IL6 to TGF-β1 ratio was significantly higher in Iraqi sample of RA patients compared to controls. This may help in early diagnosis of RA and suggest potentially an early effective treatment.

Lung Cancer in Non- Smoker Patients in Baghdad Teaching Hospital

Hamza Abdullah Al Sabah; Asaad Abdal Hameed; Abdulla Janger Alfarttoosi

Iraqi Postgraduate Medical Journal, 2015, Volume 14, Issue 2, Pages 258-266

ABSTRACT:
BACKGROUND:
Despite the predominance of tobacco smoking as its presumed etiology, lung cancer is also a significant health problem in those with no history of smoking.
OBJECTIVE:
To assess the clinical and epidemiological characteristics of lung cancer in non smokers patients.
PATIENTS AND METHODS:
This was a retrograde across-sectional study conducted at Baghdad teaching hospital during the period from 14th February 2012 to 8th January 2013. Including 100 patients with proved lung cancer all were never smokers.Medical records of those patients were revised, data were collected regarding sociodemographic characteristics of patients and medical history in addition to the clinical characteristics. Data analyzed with SPSS software, and the results were presented in tables and figures accordingly.
RESULTS:
In the current study 100 patients with different types of lung cancer were included, all were never smoker.
Female gender was more common than males .In this study majority of the cases were aged 60 years and more.The prevalence of passive smoking among studied group was (39%),Urban residence was the dominant, 74%. On X-ray examination all the patients had positive findings; (99%) had unilateral findings and only one with bilateral.Adenocarcinoma was the predominant type, (51%) of the cases, which is much higher than the prevalence of other types. Adenocarcinoma was significantly predominant among females than males (64.7%) vs. (35.3%) respectively, P= 0.003.
majority of the cases were of stage IV (78%) and stage III (22%), this reflected the late presentation of the patients.Vast majority of dead cases (96.5%) were died within 2 years, and only 3 patients were survived for three years while none of the cases were survived for more than 3 years.
CONCLUSION:
The prevalence of lung cancer in non smoker women was higher than in men. In this study the prevalence of lung cancer seemed to be increased with the advancing age. Passive smoking was an important risk factor for lung cancer in more than one third of studied group, and women were more likely to be affected.

Serum Progesterone &CA125 Levels as an Aid in the Prediction of Ectopic &Intrauterine Pregnancy

Maha M. Al-Bayati; Manal Madany A. Qader; Jinan Hadi Salma

Iraqi Postgraduate Medical Journal, 2015, Volume 14, Issue 1, Pages 7-13

ABSTRACT:
BACKGROUND :
Prompt diagnosis of ectopic pregnancy is a difficult dilemma, and reliable predictors for diagnosis and differentiation of ectopic pregnancy from early pregnancy miscarriage are needed.
OBJECTIVE:
To evaluate the diagnostic value of serum progesterone and CA-125 levels in ectopic pregnancy and early intra uterine miscarriage.
Study design: A prospective case control study
Setting: The study was carried out in the department of obstetrics and gynecology of AL-Yarmouk teaching hospital (Baghdad – Iraq) from February 2011 to February 2012
PATIENTS AND METHODS:
This study was carried out on sixty pregnant women in their first trimester. Twenty women diagnosed as unruptured ectopic pregnancy; treated by laparotomy ,twenty women diagnosed as inevitable miscarriage; treated by curettage and twenty women with healthy pregnancy of a comparable gestational age as control group; follow up of this group was done to ascertain uneventful pregnancy with no complications.
We compared the serum levels of progesterone and CA-125 in all groups at the time of presentation and 24h after surgical intervention in first and second groups.
RESULTS :
There was a significant decrease in mean post operative progesterone level in women with ectopic pregnancy and miscarriage groups with significant difference (P<0.0001). The study observed that the mean level of progesterone in women with ectopic group (6.76±3.63 ng/ml) was lower than that in miscarriage group (15.17±6.01 ng/ml) and control group (17.58±4.57 ng/ml) with significant difference (P<0.0001). This study also observed that the mean level of CA-125 in women with miscarriage group (117.07±94.30 U/ml) was higher than that in ectopic group (38.11±28.79 U/ml) and control group (30.51±16.10 U/ml) with statistically significant difference (P<0.0001).
There was a significant decrease in mean level of post operative CA-125 in women with ectopic pregnancy and miscarriage groups with significant difference (P<0.0003).
CONCLUSION:
Combined measurement of both serum progesterone and CA-125 can be sensitive predictors in diagnosis and differentiation of ectopic pregnancy from inevitable miscarriage and normal pregnancy.

Biliopancreatic diversion,duodenal switch,and vertical sleeve gastrectomy operation of patients with Body mass index more than sixtyRetrospective study

Haider A. AL Zobaidy; Sabah Mehdi ALFatlawi; Omar Sameer Abd Ulateef

Iraqi Postgraduate Medical Journal, 2015, Volume 14, Issue 1, Pages 96-101

ABSTRACT:
BACKGROUND:
Obesity is a complex metabolic disorder with significant health and economic consequences due to related co- morbid conditions, including diabetes, cardiovascular disease, and certain cancers, and increased mortality. So when body mass index increase mortality increase.
OBJECTIVE:
Asses and study the result of operations of obesity associated with malabsorption operations to measure the body mass index more than sixty and To prove the benefit of this type of bariatric surgery in weight loss within short period and its benefit in decreasing co-morbidity.
PATIENTS AND METHODS :
A retrospective study conducted in Baghdad Teaching Hospital and Dijla Private Hospital from June 2011 to June 2012 where the follow-up of eleven patients admitted to surgical ward and underwent the operation of Biliopancreatic diversion,Doudenal switch and Sleeve gastrectomy were analyzed the enhance people with diseases and postoperative diseases and complication. All patients were given nutritive instructions three months prior to surgery which was rich in vitamines and low fat.
RESULTS:
from the analysis of the results we found a rapid decline in body weight as well as theBody mass index,where in the 1st 3months BMI dropped of about 22%,after 6 months BMI dropped 39% and dropped more than 50% after 12 months. Also this study show clear and significant improvement in treatment of sleep problems,DM,and HPT.
CONCLUSION:
operation of this type is important for weight loss in morbidly obese patients in addition to high and noticeable improvement in association comorbid diseases.
KEY WORDS: body mass index ,malabsorption operartion , obesity ,biliopancreatic bypass.

Mode of Presentations and Management of Presumed Tuberculous Uveitis at a Referral Center

Faiz Al- Shakarchi

Iraqi Postgraduate Medical Journal, 2015, Volume 14, Issue 1, Pages 91-95

ABSTRACT:
BACKGROUND:
The diagnosis of tuberculous uveitis is often presumptive, because of the difficulty in obtaining microbiological evidence. The diagnosis has to rely on characteristic ocular findings, and possibly a therapeutic treatment trial.
OBJECTIVE:
To illustrate the mode of presentations and management of presumed tuberculous uveitis at a referral eye center in Iraq.
METHOD AND SUBJECTS:
This prospective case series study included patients with presumed ocular tuberculosis presented consecutively at uveitis clinic/ Ibn Al-Haetham teaching eye hospital, from January 2007-January 2013. Ocular tuberculosis was presumed when findings were consistent with possible intraocular tuberculosis, intractable to steroid therapy, and no clinical or laboratory evidence for other causes of uveitis. Strongly positive tuberculin skin test result (more than14 mm area of induration/necrosis) supported the diagnosis, but was not a prerequisite for initiating therapy. All patients were treated with anti tuberculosis therapy. Clinical findings and response on treatment were documented in a special follow up cards.
RESULTS:
64 patients with presumed TB uveitis were included in this study. Mean age of the patients was 35.7 years with no significant sex predominance. Majority of patients were from urban places (79.7%).
Bilateral involvement was recorded in 62 patients. Vitritis was a universal finding, while multifocal choroiditis was the most common fundus lesions (104 eyes; 82.5%).
All patients responded well to anti tuberculosis therapy. Systemic corticosteroids were added after few days in 14 patients to decrease inflammatory reaction, retinal vasculitis, macular edema and macular scaring.
CONCLUSION:
According to this study; vitritis with multifocal choroiditis is the most common mode of presentation in patients with presumed TB uveitis. All cases responded well to anti-tuberculosis therapy, systemic corticosteroids can be added to decrease inflammatory reaction, retinal vasculitis, macular edema and macular scaring.

Immunohistochemical Study of Leydig Cells in the Testicular Interstitial Tissue of Rats Treated with Tribulus Terrestris Using P450scc.

Issam T. Abdul-Wahaab; Malak A. Al-Yawer; Fadhil A. Al; Khafaji

Iraqi Postgraduate Medical Journal, 2015, Volume 14, Issue 1, Pages 140-144

ABSTRACT:
BACKGROUND:
Tribulus terrestris has been commonly used in folk medicine to energize, vitalize and improve sexual function and physical performance in men and laboratory rats.
OBJECTIVE:
To study the effect of Tribulus terrestris on the number of Leydig cells.
MATERIALS AND METHODS:
Tribulus terrestris was given to mature male rats as an oral single herbal suspension in a dose of 2.0mg /1000gbody weight for 14 days to stimulate spermatogenesis. Formalin fixed paraffin-embedded tissue sections were performed for histological, immunohistochemical and morphometrical studies.
RESULTS:
Histological study revealed wider seminiferous tubules and increased spermatocytes population with an increased sperm density inside the lumen of the tubules. Morphometrically, the diameters of seminiferous tubules and thickness of the germinal epithelia were significantly increased in Tribulus terrestris treated rats than that of the control group. There was no significant difference between the number of Leydig cells in the control and experimental groups.
CONCLUSION:
The activity of Leydig cells, manifested by the increments in the diameters, thickness of germinal epithelia and the density of the sperms inside seminiferous tubules, was increased but their number remain unaffected in spite of using the aphrodisiac agent, Tribulus terrestris.

Assessment of L.V. Function by Multislice Cardiac Ct As Compared to 2d_Echocardiography

Hayder Ryaid Abdul Satar; Hasan Ali Farhan; Mohammed Hassan AL-Baghdidi

Iraqi Postgraduate Medical Journal, 2015, Volume 14, Issue 1, Pages 114-122

ABSTRACT:
BACKGROUND:
Assessment of left ventricular function and volumes provides valuable information in patients with heart disease. It is also considered a prognostic marker in coronary artery disease. Two- dimensional transthoracic echocardiography is the most widely used method for Left Ventricular function assessment, but this modality is operator dependent and can be impaired by a poor acoustic window.
OBJECTIVE:
To validate a single tertiary center experience in Multi Detector Computed Tomography for the evaluation of cardiac function in patients undergoing coronary CT angiography.
PATIENTS AND METHODS:
A cross sectional study, conducted at Ibn Albitar center from September 2012 till May 2013. Patients included are those who already underwent 64-slice CT coronary angiography to evaluate known or suspected coronary artery disease, CT coronary angiography is performed using a 64- slice Multi Detector CT-scanner. Transthoracic Echocardiography was done by a single operator served as the reference standard.
RESULTS:
Eighty patients (66.3% male) were included in the study, the mean age was 53.19 ± 10.6 years. The mean Left ventricular End Diastolic Volume by Cardiac CT and Echocardiography were 125.31 ± 41.92, 126.75 ± 41.894 ml respectively, with excellent correlation (r =0.912; P< 0.001). Average Left ventricular End Systolic Volume (LVESV) by Cardiac CT and Echocardiography were 58.08 ± 34.18, 53.74 ± 33.15 mL respectively^ With Excellent correlation coefficient (r = 0.971; P0.001), with trends towards CT showing slightly higher values than that of Echocardiography.
Average Left ventricular Ejection Fraction was 55.40 ± 14.57% as determined by Cardiac CT, compared to 59.26 ± 9.8% by Echocardiography, with good correlation between the two methods (r = 0.734; P=0.01), although LVEF was slightly underestimated by Cardiac CT (3.86 ± 9.9%; P0.001).
CONCLUSION:
The current study showed that (our experience in the) assessment of cardiac function by CT is comparable to the commonly used 2D Echocardiography method. And can be used in patients already performing coronary CT angiography, (potentially for those in whom the images from TTE are inadequate. ^w j.

Correlation Between the Stroke Site and Depression

Abdul-Rasoul Al-Yasiri; ShaimaaNaser

Iraqi Postgraduate Medical Journal, 2015, Volume 14, Issue 1, Pages 151-160

ABSTRACT:
BACKGROUND:
Post stroke depression is a common neuropsychiatric consequence of stroke. Some studies show that left hemisphere lesions may be associated with a higher incidence of depression. Others found no significant correlation between lesion location and depressive alterations after stroke.
OBJECTIVE:
To determine whether post stroke depression is correlated with the site of stroke lesion and to evaluate other determinants for the development of depression post stroke.
METHODOLOGY :
A cross sectional study was conducted at Baghdad teaching hospital on 50 patients with single demarcated unilateral lesions was selected according to CT scan of the brain, psychiatric assessment were performed to assess the presence of depression according to DSM-IV criteria. The severity of functional impairment of all patients was performed on the modified Rankin scale (mRS).
RESULTS :
The study showed that 54% of stroke patients were depressed and 46% of them had no depression. Patients with higher functional impairment score were more likely to have depression rather than those with lower score. No significant association had been found between depression with all other variables including site of stroke lesion.
CONCLUSION:
There is no correlation between the sites of stroke lesion and post stroke depression in patients with stroke.

Pregabalin Versus Amitriptyline in the Treatment of Fibromyalgia Patients (A Double Blind Comparative Study)

Luma Eassa Hammody; Samir Yousif Matloub; Sami Salman Shihab

Iraqi Postgraduate Medical Journal, 2015, Volume 14, Issue 1, Pages 38-44

ABSTRACT:
BACK GROUND:
Fibromyalgia is a disorder characterized by widespread musculoskeletal pain, fatigue, sleep and mood disturbances. Its etiology and treatment remain challenging. Oxidative stress may play a role in its pathogenesis.
OBJECTIVE:
The efficacy of pregabalin to that of amitriptyline on FM and the effect of treatment on oxidative status were examined.
METHODS:
123 patients fulfilling the Wolfe 2010 criteria for fibromyalgia diagnosis and assessment were randomized to receive amitriptyline (25 mg) or pregabalin (75 mg) once daily for 12 weeks. The revised fibromyalgia impact questionnaire criteria were also used. Malondialdehide and glutathaion levels were checked at the beginning and at the end of the study.
RESULTS:
Improvement in the pain was better with pregabalin than with amitriptyline (P=0.0001) at 4 weeks of treatment, but achieved comparable improvement at 8 and 12 weeks. The reduction in the somatic symptoms scale was significant for both drugs in favour of pregabalin. Sleep was improved significantly but pregabalin over amitriptyline (P=0.0001). Oxidative status was significantly improved.
CONCLUSION:
Both drugs improved the symptoms. Pregabalin was better than amitriptyline concerning SSS and sleep, but with a comparable effect on pain. Oxidative status was improved. Amitriptyline was better than pregabalin concerning patient compliance and tolerability.

Role of Serum Progesterone in the Diagnosis of Ectopic Pregnancy and Missed Abortion

Abdulrazak H Alnakash; Zeina Abdulsahib

Iraqi Postgraduate Medical Journal, 2015, Volume 14, Issue 1, Pages 22-27

ABSTRACT:
BACKGROUND:
diagnosis of early pregnancy failure (ectopic pregnancy and missed abortion) still challenging even by using of serial B-HCG and ultrasound. Serum progesterone hormone level value is regarded as one of the important diagnostic tools in the diagnosis of many obstetrical and gynecological conditions; one of these is early pregnancy failure.
OBJECTIVE:
To assess the role of serum progesterone level in early diagnosis of ectopic pregnancy and missed abortion.
PATIENTS AND METHODS:
The study is conducted at Al-Elwiyah Maternity Teaching Hospital throughout the period between (April 2010 –July 2011). Ninety women participated in the study, they are at their early weeks of gestation (6-10) weeks. Their ages were between 18-40 years. thirty of them served as a control group (normal intrauterine pregnancy) and sixty pregnant women included in the study group and subcategorized into 2 groups. thirty women with suspected sub-acute or chronic cases of ectopic pregnancy according to ultrasound and β-HCG results and 30 women served as suspected missed abortion. blood samples were taken from the three groups followed by another blood samples after two-day interval to measure of serum progesterone levels. the results were compared among the three groups at first and second readings. p-value, standard deviation and 95% confidence interval calculated and statistically analyzed.
RESULTS:
P-value of the serial measurements of serum progesterone levels in two-day interval in the three groups was statistically insignificant. while serum progesterone levels of both ectopic pregnancy and missed abortion were greatly lower than serum progesterone levels of normal intrauterine pregnancy in both first and second readings, with statistically significant
deference, P-value is
CONCLUSION:
Serum progesterone levels has a useful role in diagnosing ectopic pregnancy and missed abortion.

Aesthetic Results of Superomedial Pedicle Technique in Reduction Mammaplasty

Hamdany; Tariq Abdulqadir AL; Ahmed Khalaf Jasim; Gheiath Sabri Ghani

Iraqi Postgraduate Medical Journal, 2015, Volume 14, Issue 1, Pages 83-90

ABSTRACT:
BACKGROUND:
Breast reduction for mammary hypertrophy is a highly effective procedure with high degree of patient satisfaction. There are many methods of breast reduction which involve removal of excess tissue with reshaping of overlying skin while maintaining a viable nipple areolar complex.
OBJECTIVE:
The purpose of this study is to evaluate the use of the superomedial technique as an effective method for reduction mammoplasty.
PATIENTS AND METHODS:
A total of 30 patients underwent reduction mammoplasty by utilizing superomedial pedicle technique between 2010 and 2013. Those patients were evaluated postoperatively in terms of their aesthetic and functional satisfaction, viability of nipple – areolar complex and nipple sensory preservation.
RESULTS:
The distance from suprasternal notch to nipple ranged 28-32cm on both breasts. The mean breast tissue resection was less than 1000 g on both breasts, the amount of nipple transposition ranged from 8cm – 10cm. All patients were satisfied with postoperative results. All patients had viable nipple, except in one breast who had partial nipple – areolar complex necrosis (1.6%). nipple areolar sensation was preserved in 93.3% in the immediate postoperative period, and after 6 month all patient had preserved nipple areolar sensation.
CONCLUSION:
The superomedial pedicle technique for reduction mammaplasty is simple and safe procedure with good postoperative aesthetic results.

Characteristics of Multidrug Resistance Tuberculosis Cases in Baghdad

Arwa Tahrir Ramadhan; Layth Salihi; Mohammad Yahya Abdulrazaq; Hayder H.Ali Al-Sikafi

Iraqi Postgraduate Medical Journal, 2015, Volume 14, Issue 1, Pages 65-70

ABSTRACT:
BACKGROUND:
Multidrug-resistant tuberculosis (MDR-TB) is caused by strains of Mycobacterium tuberculosis resistant to at least isoniazid and rifampicin, the two most effective bactericidal agents currently available for TB treatment.It has emerged as a global public health emergency . It requires treatment with combination therapy consisting of four to six medications for up to 2 years . Additionally, the treatment is generally more toxic and far more expensive than the standardized treatment regimen used to treat drug-susceptible TB . The latest estimates of the World Health Organization (WHO) arrive at 650 000 prevalent MDR-TB cases among the 12 million tuberculosis cases worldwide.
OBJECTIVE:
To identify the Characteristics of multidrug resistance tuberculosis cases attending the specialized center for chest and respiratory disease in Baghdad during the period 9th of September 2012 – 9th of December 2012.
METHODS :
A cross sectional study was done in the specialized center for chest and respiratory disease in Baghdad during the period 9th of September 2012 – 9th of December 2012.Any patient attending the specialized center for chest and respiratory disease in Baghdad during the study period diagnosed as a case of MDR TB was enrolled in this study.
RESULTS:
The sample is composed of 42 MDR-TB patients (29 male and 13 female ) , with age mean of 38.3±12.8 year . Male sex significantly dominates and exceeds two thirds of the sample (69.0%) (P < 0.05). The study find ages between 25-45 year contribute to about two thirds (62.0%) of patients, and ages between 55-65 years constitute about one fifth (19.0%) of the sample. (P < 0.05). Body habit significantly showed that half the sample (50.0%) were underweight and only 10% were overweight or obese (P < 0.05).Smoking is found in 21.4% of total sample.
The duration of taking first line antituberculosis drugs (FLD) before being labeled as MDR-TB varied from 14 to 72 months, with mean duration of 27.3±15.2 months with no significant difference in mean duration between the two sexes (P > 0.05,). Time required to diagnose these cases as MDR-TB varied from 0 to 24 months with mean time of 9.0±6.5 months. There was no significant difference in mean diagnosis time between males and females (P > 0.05). This study found that around one fifth (19.0%) of the sample have a history of default from treatment with FLD. Only one female was significant to be a case of primary MDR-TB (P > 0.05). Two cases (both were males) significantly had history of reaction to FLD treatment (P < 0.05). None of the sample had positive HIV testing.
CONCLUSION:
Most MDR patients in this study were males aged between 25-45 years .Most cases had acquired MDR TB and primary MDR-TB was rare finding in this study. Around one fifth of the sample have a history of default from treatment with FLD.

Distal left Main Coronany Stem Lesion Managed by Intervententional Crush Technique

Majid Abdul Muhsin; Alaa Abdulhussein Allawi; Ali Hashim Hussein

Iraqi Postgraduate Medical Journal, 2015, Volume 14, Issue 1, Pages 62-64

ABSTRACT:
BACKGROUND:
Intervententional Crush might end high rates of restenosis.
OBJECTIVE:
Studying immediate and late outcome of crush technique in distal left main stem lesion intervention.
PATIENTS AND METHOD:
(40) patient had crush technique intervention method for management of LMS lesions,(15) patients done as primary PCI method, while( 25) patients as elective management.
RESULTS:
A total of 40 patients with distal left main stem lesion included in our study, their age range between 45-75 years with a mean±SD of 59±4.5 years,25 were male,15 female.
One patient died in one year follow up because of noncompliance for medication.
One patient had ISR treated by drug eluted balloon. Two patients lost follow up after 2 months.
25 patients(62.5%)had more than one significant lesion,9 patients (22.5%) had low ejection fraction at time of intervention, functional MR were reported in 5 (12.5%) of patients.
All ischemic chest pain disappeared after interventional procedure.
CONCLUSION:
LMS crush technique is favorable alternative method for the management of LMS especially in patients unable to do CABG.

The Role of Wide Bore Needle Biopsy In Establishing Confidential Diagnosis of Mammary Carcinoma

Nadwa S.Al-azow; Ahmed F. Lazim

Iraqi Postgraduate Medical Journal, 2015, Volume 14, Issue 1, Pages 131-135

ABSTRACT:
BACKGROUND :
Fine-needle aspiration (FNA) is a rapid, safe, minimally invasive, and inexpensive way of
diagnosing malignancy in women with palpable breast tumors.
This study was used the wide bore needle technique to obtain optimal results & can used instead of core needle biopsy .
OBJECTIVE:
Fine-needle aspiration cytology is a rapid, safe, inexpensive and minimally invasive technique for diagnosis of breast malignancy. This study was an attempt to use wide bore needle instead of core needle biopsy to obtain optimal results.
METHOD:
Thirty five females with breast lumps underwent FNA aspiration cytology in the department of Al-jamhuri Teaching Hospital in Mosul city. The study was achieved by using 19 gauged needle, part as routine cytology and other part as tissue block. Immunohistochemical stain for ER, PR and HER2 markers was performed on tissue blocks from 17 malignant cases.
RESULTS:
The cytology findings included 24 malignant cases (22 ductal carcinoma and 2 lobular carcinoma), 7 benign lesions and 4 suspicious cases. On the other hand, in tissue blocks the diagnosis of malignancy was given in 28 cases, 25 ductal carcinomas and 3 lobular carcinomas. Seven benign lesions ,6 were previously diagnosed as such by cytology and one suspicious case turned to be benign on wide bore needle. The four cytologically suspicious cases turned to be malignant in 3 cases and benign fibrocystic changes in the fourth case. Immunohistochemical analysis including ER, PR and HER-2 on seventeen cases of breast carcinomas. Seven out of 17 were shown positivity for ER while 3 cases were PR positive and Her2-neu was positive in 12 cases.
CONCLUSION:
It is preferred to use wide bore needle in the diagnosis of breast lesions to obtain more tissue material and optimal results. As well, to a certain extent the wide bore needle might substitute the core needle biopsy for diagnosis and immunohistochemical assessment because the latter is rather expensive and, at time is not available in our laboratories now.

Relaparotomies in Abdominal Trauma, Systematic Review

Haider Abdulhussein Ahmed; Sajid Hameed Abd Al-Helfy

Iraqi Postgraduate Medical Journal, 2015, Volume 14, Issue 1, Pages 123-130

ABSTRACT:
BACKGROUND:
Treatment of a number of complications that occur after abdominal trauma surgeries may require that Urgent Abdominal Re-explorations, the life-saving and obligatory operations, are performed.
OBJECTIVE:
To evaluate the reasons and incidence of re-operations in abdominal trauma cases and their outcomes in our centre, so that more preventable morbidity can be avoided.
METHODOLOGY:
A retrospective study of all trauma victims who sustained laparatomies and relaparatomies in the Emergency Department of Al-Imamain Al-kadhymain Medical City, Baghdad, over a 2 years period. A review of the case sheets of these victims has been reviewed to identify the various circumstances of trauma cases and the detailed operative findings and definitive causes of relaparatomies were noted.
RESULTS:
The study included 21 relaparatomy cases out of 244 laparatomy for various abdominal trauma reasons ; 180 patients (74%) males and 64 (26%) females, with a male to female ratio of about (3:1). The commonest causative accidents were missile inury 97pt (39%), gunshot injuries 58 (24%), road traffic accidents 43pt (18%), stab wound 32 pt(13%), and. Fall from height 14 pts (6%) . Reoperations were performed in 21 cases Incidence (8.6%), finding in reoperation including second look operation (which constituted 4 patients) were as the followings:
Bleeding 11 pts ( 52%), peritonitis from missed bowel injuries & anastomosis leak 5 pts (24% ), small bowel obstruction one pt (5%), IAC(abscess) 2pt (9.5%) and prolonged ileus & peritonism 2 Pts (9.5%).
Overall mortality in the reexplored patients was 8 patients(38%). Incidence of missed injuries 24% of reoperation and 1.6% of total trauma cases.
CONCLUSION:
many pt can be saved from repeat laparatomy by avoiding missed injuries. The main reason for immediate reoperation is bleeding and lately is peritonitis and sepsis.

Pregnancy Outcome of Primigravida with Threatened Miscarriage and Subchorionic Hematoma

Anwar Noori Al-Bassam; Manar K. Dahash

Iraqi Postgraduate Medical Journal, 2015, Volume 14, Issue 1, Pages 14-21

ABSTRACT:
BACKGROUND: : Threatened Miscarriage is vaginal bleeding occurring any time between implantation and 20 weeks gestation , with or without uterine contraction, without dilatation of cervix , and without expulsion of the products of conception Threatened miscarriage tends to be associated with a high likelihood of adverse subsequent pregnancy outcome.
Subchorionic Hematoma is described as the collections with circular or crescent-shaped ecogenity localised between the chorionic membrane and the uterine wall and it has been reported to occur with a varying incidence of 4- 48 %in pregnancies, which experienced vaginal bleeding in early stage.
OBJECTIVE:
To evaluate the association between threatened miscarriage in the presence of subchorionic hematoma in first and second trimester and adverse pregnancy outcome with regard to maternal and neonatal outcome.
PATIENTS AND METHODS:
prospective case control study(follow –up study) done at the Department of obstetrics and gynecology, Baghdad Teaching Hospital, Medical City complex, Baghdad.
60 primigravida women with threatened miscarriage in their first and second trimester were included in the study . . Thirty women had Subchorionic hematoma (SCH) (study group) were matched with thirty women without Subchorionic hematoma (control group). The demographic feature, course of pregnancy, obstetric outcome and neonatal outcome were analyzed.
RESULTS:
Analysis of data show that there is statistically significant difference between both groups regarding maternal and neonatal outcome. There is increasing rate of miscarriage (50%),(p=0.032) and preterm labour in study group ((93.3%), (p=0.046 ), when compared to control group . Regarding neonatal outcome there is increasing rate of very LBW <1.5 kg(26.7%), and LBW <2.5kg (40.0%) (p=0.029) and poor Apgar score in one minute (86.7%) (p=0.015) and five minutes in study group(53.3%)( p=0.002) when compared with control group. Also the study show that there is no statistically significant difference regarding the gestational age. at presentation as threatened miscarriage ,placental site, volume of hematoma, method of delivery and sex of the fetus.
CONCLUSION:
Women with threatened miscarriage who had Subchorionic hematoma are at increased risk for adverse maternal and neonatal outcome.

A Review of 277 Cases of Patients with Chest Trauma in the Medical city Teaching Complex

Abdulameer Mohsin Hussein

Iraqi Postgraduate Medical Journal, 2014, Volume 13, Issue 4, Pages 599-605

ABSTRACT:
BACKGROUND:
Thoracic trauma is one of the leading causes of morbidity and mortality in developing countries. It represents 50% of all traumas. They are the cause of 25% of trauma deaths.
OBJECTIVE:
Describing the incidence, association with other injuries, understand the mechanism of common fatal injuries in chest trauma, diagnosis and operative morbidity and mortality.
PATIENTS AND METHODS:
A retrospective study of 277 patients, victims of chest trauma between August 2009 and August 2011 in Ghazi Al-hariri teaching surgical specialties hospital – Department of thoracic and vascular surgery/ medical city teaching complex. The records of all patients were reviewed and data were collected retrospectively. Management and follow up of the patients during hospitalization were evaluated. According to management patients were divided into two groups (conservative and surgical).
RESULTS:
Of 277 patients involved in this study 244(88.08%) of them were male and 33(11.91%) were female, with female /male ratio: (1/7.33). The majority of patients were in their third decade of life 100(36.10%) from 21-30 years. Penetrating chest trauma was seen in262 (94.58%) of the total number, 11(3.97%) had blunt chest trauma and 4(1.44%) had blunt and penetrating chest trauma. Bullets or shells in 205(74%), were the commonest penetrating injury, and commonest blunt trauma cause was blunt object in 8(2.88%) patients whereas 3(1.08%) patients due to RTA. The associated traumas were seen in 40.4% and the commonest one was limbs trauma in 57(20.57%) patients. The majority of the patients 219(79.06%) arrived to the hospital within hours of the injury mainly the first 4 hours. 190(68.59%) patients were treated as emergency cases and 87(31.40%) as cold cases. Chest x-ray performed to the all patients and the main radiological findings were haemothorax in 172 (62.1%). Conservative treatment in 37 (13.35%) patients and surgical treatment in 240 (86.64%) patients. The main Indication for thoracotomy was an initial drain more than 1500ml in 17(6.13%) patients, lung injuries were the commonest operative finding 29(10.46%). Hospital stay ranges from 1 day to 1 month and most of the patients 187(67.5%) discharged within the first 5 days of admission. Morbidity was seen in 19(6.85%) patients, wound infection was the commonest seen in 6(2.16%) patients, wound infection in 6(2.16%) patients, atelectasis in 5(1.8%) patients, respiratory distress syndrome in 4(1.44%) patients, CVA in 1(0.36%) patients, stress ulcer in 1(0.36%) patients, postoperative bleeding in 1(0.36%) patients and post intubation tracheal stenosis in 1(0.36%) patient. The overall mortality were 10(3.61%) patients, 2(0.72%) of them died perioperative were both of them they had associated injuries namely cardiac and central vessel injury respectively. All the 10 patients were male and the type of injury was penetrating in all. 8 out of 10 died had associated injuries.
CONCLUSION:
Penetrating chest injuries resulting from violence are the major public health problem in Iraq and bullets or shells are the commonest cause. Chest X-ray is diagnostic in most of cases. Associated injury should be carefully considered in the medical response strategies. The majority of patients with simple chest injuries can be managed by tube thoracostomy. Mortality is common with penetrating chest injuries.

Glucose Tolerance Test in Beta-Thalassemia Major in Al-Sader City

Qais Abdullah Ali Al-Salahe; Mohammed Shaker Al-Awady; Abas Abdalsaheb Al-Gharbawy

Iraqi Postgraduate Medical Journal, 2014, Volume 13, Issue 4, Pages 550-559

ABSTRACT:
BACKGROUND:
β-thalassemia are inherited defects in the synthesis of B-globin portion of hemoglobin. The combination of transfusion and chelating therapy has dramatically extended the life expectancy of thalassemic patients.
OBJECTIVE:
This study is to determine the prevalence of diabetes mellitus and association of some factors with impaired glucose tolerance test in transfusion dependent β- thalassemia major.
PATIENTS AND METHODS:
A case-control study done on patients attending blood disease center in Ibn-Al-Balady hospital from 1st of July to 31st of October 2011. Data collected from 287 thalassemic patients (being attended the hospital for regular follow up and blood transfusion) and their relatives which included age, sex, height, weight, history of splenectomy, family history of DM, hepatitis B or C infection, serum ferritin level and an oral glucose tolerance test.
RESULTS:
It was found that 9.7% of β- thalassemic patients had impaired glucose tolerance test and 1.1% were diagnosed with diabetes, 32.7% were splenectomized, 38.3% had viral hepatitis infection, mean serum ferritin in those older than 20 years was 5923±1033µg/l and 16.8% had family history of diabetes.
CONCLUSION:
Increased serum ferritin concentration, splenectomy and viral hepatitis infection are associated with abnormal glucose tolerance in patients with blood transfused b-thalassemia. Aggressive iron-chelating therapy and prevention and treatment of viral hepatitis infection were warranted.

Types ,Frequency,Clinical Presentation of Congenital Central Nervous System Anomalies in Al- Kadmayhia Teaching Hospital

Lamyaa Abdul Kareem Hamoodi

Iraqi Postgraduate Medical Journal, 2014, Volume 13, Issue 4, Pages 524-531

ABSTRACT:
BACKGROUND:
The central nervous system (CNS)anomalies are the most severe, difficult to detect its etiology, and predict its clinical presentation and course.
OBJECTIVE:
To find out the common types of congenital malformations in central nervous system.,determine the frequency and the clinical features of these malformations.
And to study the risk factors associated with congenital central nervous system malformations.
PATIENTS AND METHODS:
This cross-sectional study was performed at Al-Kadhimiyia Teaching Hospital (Neonatal care unit) from the 1st of January to the 1st of July, 2011.
One hundred newborn infants were proved to have congenital abnormalities by physical examination alone. Fifty five neonates were diagnosed as having CNS congenital anomalies.
neonatal evaluation include: gestational age, sex, body weight, type of CNS congenital anomaly.
Maternal age, parity, antenatal care, any history of abortion, previous baby with CNS congenital abnormality, still births, or drug intake during pregnancy.
the residency of the family and consanguinity .
RESULTS:
The number of neonates delivered alive was 2700 neonates, one hundred of them (3.7% of total deliveries) were delivered with congenital anomalies, and 55 cases from those (2% from total deliveries / 55% from congenitally abnormal deliveries) have had CNS congenital anomalies,the most frequent anomalies aremeningocele 25( 45.5%),the second and third in frequency were hydrocephaly 12 (21.8%), and myelomeningocele 10 (18.2%) respectively.
There were 34(61.8%) male and 21 (38.2%) female. There were 30(54.5%) full term and 25(45.5%) preterm.
Thirty cases out of the total 55 cases (54.5%) with body weight 3-3.5 kg.
Most of the affected neonates to mothers with an age range of 20-40 years where 34 mothers (61.8%) aged between 20-30 years .
Most of the mothers were multipara (45 cases / 81.8%) .The majority of the neonates were the product of a consanguineous marriage 39 (70.9%).
Maternal peri-conceptional folic acid supplementation was not taken in the vast majority of cases (43 cases / 78.2%).
Positive family history of CNS congenital anomalies was reported in 4 cases only (7.3%) .
Familial residence was documented as urban in 30 cases (54.5%), and rural in 25 cases (45.5%).
CONCLUSION:
The most common type of CNS anomalies is meningocele with relatively higher male to female ratio.These anomalies occur in full term multipara mothers. Occur more frequent in infants with larger body weight and to younger multipara mothers. Consanguinity is a major risk. There was a low utilization of maternal peri-conceptional folic acid supplementation

Corneal Specular Microscopy Changes in Type II Diabetes Mellitus

Yousif Farhan Dawood; Najah Kadhum mohammad Al-Quraishi

Iraqi Postgraduate Medical Journal, 2014, Volume 13, Issue 4, Pages 591-598

ABSTRACT:
BACKGROUND:
Corneal endothelial cells count and shape are vital in keeping corneal transparency with normal vision. Diabetes mellitus is associated with significant changes in the corneal endothelium.
OBJECTIVE:
To compare corneal endothelial structure and central corneal thickness (CCT) between type II diabetics and non-diabetic control patients.
METHODS:
Specular microscopy was used to measure central corneal thickness (CCT), average size of endothelial cells, standard deviation of cell size and coefficient of variation in cell area (CV), endothelial cell density, as well as hexagonality of 260 eyes from 260 patients ( 130 eyes from type II diabetic patients and 130 eyes from non diabetic controls).
RESULTS:
The diabetic corneas have a significant increase in average size of endothelial cells (410.4 ± 89.6 µm² vs. 382.3 ± 83.4 µm²)(p <0.05 ), standard deviation of cell size (152.2 ± 38.0 µm² vs. 128.7 ± 19.5 µm²)(p <0.05) and coefficient of variation (CV) (38.3 % ± 5.4 % vs. 33.4 % ± 4.4%)(p<0.05). and a significant decrease of endothelial cell density (2570.7 ± 563.1 cells / mm² vs. 2704.1 ± 572.5 cells / mm²)(p <0.05) and hexagonality (48.3 ± 17.1% vs. 56.5% ±15.6%)(p<0.05). There was no significant difference in central corneal thickness(CCT) (516.3 ± 63.4 µm vs. 512.8 ± 61.7µm )(p >0.05).
CONCLUSION:
Type II diabetes associated with a significant changes in the corneal endothelium including, reduction of endothelial cell density, increased variation of cells shape (pleomorphism) and increased variation of cells area (polymegathism). There was no significant changes of central corneal thickness (CCT).

The Clinical Presentation of Hypertensive Crisis in the Emergency Department of Baghdad Teaching Hospital

Manal Khudder Abdul Razak

Iraqi Postgraduate Medical Journal, 2014, Volume 13, Issue 4, Pages 515-523

ABSTRACT:
BACKGROUND:
Uncontrolled hypertension can progress to a hypertensive crisis defined as a systolic blood pressure ≥180 mm Hg or a diastolic blood pressure ≥120 mm Hg which is potentially fatal. It can manifest as either hypertensive emergency or urgency, depending on end-organ damage including cardiac, renal, retinal and neurologic injury.
OBJECTIVE:
To analyze the clinical presentation, and characteristics of patients presented with hypertensive crisis and to assess the frequency of the target organs involved.
METHODS:
An 8 months cross sectional study in which 306 patients older than 18 years who attended the medical emergency department of Baghdad Teaching Hospital with a hypertensive crisis were selected; excluding cases of preeclampsia and eclampsia. The criteria that were used were based on the 7th Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure which was the latest report at the time of the study. Patients were differentiated into hypertensive emergency or urgency, and were divided according to age into five groups: ≤30y, 30-39y, 40-49y, 50-59y, ≥60y. From each patient, a clinical history, physical examination including fundoscopy, blood analysis, electrocardiogram, and a chest X-ray were obtained. Computarised tomography was done when indicated.
RESULTS:
Hypertensive emergency was found in 60.8% and hypertensive urgency in 39.2% of cases. Of total; 56.2% were males. Mean age of total sample was 48.7 ± 16.2y, but patients with a hypertensive emergency were older with statistically significant difference. Hypertension was unknown to 48% of patients.Twenty-four percent of patients were diabetics. Smoking and dyslipidemia were significant risk factors. Hypertensive emergency presented with dyspnea in (30%), and papilledema was found in (18.63%) with statistically significant difference. Patients with hypertensive urgency presented with epistaxis in (11.90%), and papilledema was found in (9.80%). Most cases of hypertensive emergency corresponded to acute myocardial infarction (25.3%) followed by encephalopathy (21.0%), renal failure (20.4%), heart failure (17.2%), and cerebrovascular accident (11.3%).
CONCLUSION:
Hypertensive emergency was more frequent, males were more frequently affected and were significantly older than those with a hypertensive urgency. Smoking & dyslipidemia were significant risk factors. Hypertension was unknown to about half of patients. The most frequent clinical manifestations were papilledema and dyspnea. Acute myocardial infarction, encephalopathy, and renal failure were the most frequent target organ lesions in hypertensive emergency.

Survey of Human Papilloma Virus 18 in Breast Epithelium of Iraqi women Using In situ Hybridization Technique

Mahmoud Mishaal Mohamed; Huda Mahdi Al-Khateeb; Nawfal K. Yas

Iraqi Postgraduate Medical Journal, 2014, Volume 13, Issue 4, Pages 584-590

ABSTRACT:
BACKGROUND:
There is an increasing evidence suggesting that high-risk human papilloma virus (HPV) was involved in cancers other than cervical cancer. A number of reports have identified HPV DNA in breast tissue and breast cancer specimens, suggesting that the virus could play a role in the pathogenesis of this tumor. Therefore,
OBJECTIVE:
was directed towards the use of In situ molecular methods to localize the virus in mammary gland tissue. In addition, this study investigated the prevalence of high-risk HPV18 infections in Iraqi women with and without ductal carcinoma of the breast.
PATIENTS AND METHODS:
Twenty night cases of ductal carcinoma patients and 44 controls obtained from adjacent area to benign breast lesions. Formalin fixed, paraffin embedded specimens were used by In situ hybridization technique for detection of HPV18 subtype. Data analysis was performed by SPSS 20 software using descriptive statistics and Chi-square tests.
RESULTS:
The HPV18 were identified in 65.5% and 20.5% of the ductal carcinoma and control breast tissue specimens respectively. Statistically, the difference between the normal and ductal carcinoma cases were highly significant (P=0.001
CONCLUSION:
Statistically, In situ hybridization revealed a significant increase of HPV18 in cases of ductal carcinoma (DC) (65.5%) when compared to their controls (20.5%) .
Most HPV were localized in the nuclei of integrative form.
HPV18 were detected in skin and mammary tissue of both ductal carcinoma and control cases. This may indicates that HPV18 has a role in ductal carcinoma pathogenisis.

Frequency of Anti Lactoferrin Antibodies in Patients With Systemic Lupus Erythematosus and Rheumatoid Arthriti

Nahla Ghanim Abdul; Majeed; Mahmood Raheem Al-Rubaye; Najeha Ahmed Ameen; leen Khalooq Mustafa Kamil

Iraqi Postgraduate Medical Journal, 2014, Volume 13, Issue 4, Pages 571-577

ABSTRACT:
BACKGROUND:
Lactoferrin is a multifunctional iron-binding protein present in several mucosal secretions as well as in secondary granules of polymorphonuclear leukocytes.Anti-Lactoferrin antibodies, which belong to antineutrophil cytoplasmic antibodies have been described in several immunomediated diseases, including Systemic Lupus Erythematosus and in patients with Rheumatoid Arthritis and others, with conflicting results regarding either their prevalence or clinical associations.
OBJECTIVE:
Detection of anti-Lactoferrin antibodies in Systemic Lupus Erythematosis and Rheumatoid Arthritis patients and studying its association to disease activity in comparison to healthy controls.
PATIENT& METHODS :
The study involved 74 Systemic Lupus Erythematosis patients, 40 Rheumatoid Arthritis patients who were referred to Immunological Department in Teaching laboratory Medical City during period of (1st of January – 31st of June) 2011 and 30 apparently healthy individual. Antinuclear antibody, complement C1q, rheumatoid factor and lactoferrin antibody were detected by enzyme-linked immunosorbent assay technique While double stranded DNA was detected by indirect immunofluorescent technique and complements (C3, C4) by single radial immune diffusion.
RESULTS:
Anti-lactoferrin Ab was detected in 14(18.9%) SLE patients, 4 (8.9%) Rheumatoid arthritis patients. Both C3&C4 levels were decreased significantly in Systemic lupus with positive anti lactoferrin Ab level in comparison to healthy controls( p value 0.024). In this regard Circulating immune complex was positive in 38(51.3%) systemic lupus patients only 12(31.5%) had positive lactoferrin antibody level, (p value 0.004).double stranded DNA was detected in 41(55.4%) Systemic lupus patients only 7(17.0%) of them had positive lactoferrin Ab level. Anti -Lactoferrin Abs showed neither a significant correlation with Rheumatoid factor IgG& IgM ( P value 0.159 ) nor with rheumatoid factor IgA ( P value 0. 857).
CONCLUSION:
Anti-lactoferrin antibodies could be detected in patients with Rheumatoid Arthritis and more often in patients with Systemic Lupus with significant correlation to decrease complements levels in comparison to healthy control.

Evaluation of Patients with Lymphadenopathy in Hematology Unit in Baghdad Teaching Hospital

Khudhair A AL-Khalissi; Wisam Sabah Budeir; Azher S AL-Zubaidy

Iraqi Postgraduate Medical Journal, 2014, Volume 13, Issue 4, Pages 538-542

ABSTRACT:
BACKGROUND:
Lymphadenopathy is defined as abnormality in the size or character of lymph nodes, is caused by the invasion or propagation of either inflammatory cells or neoplastic cells into the nodes.
OBJECTIVE:
To determine the etiological and clinical characteristics of Lymphadenopathy in adults.
PATIENTS AND METHODS:
Sixty patients with Lymphadenopathy attended Hematology department/Baghdad Teaching Hospital for the period between December 2011 and April 2012. Diagnostic procedures included clinical history and examination, complete blood count, lymph node, bone marrow studies and immunohistochemistry studies.
RESULTS:
Thirty six male and 24 female patients were included, with mean age of 36.2 ±16.3 years. Malignant causes were found in 55(92%), mainly lymphomas 40(66.7%), while benign causes constituted only 8 %( 5 patients). Size, consistency and systemic symptoms were important parameters in differentiation between both, and immunohistochemistry was important in reaching a diagnosis in one patient and in solving the discrepancy between lymph node and bone marrow results in other patient.
CONCLUSION:
Lymph node and bone marrow examination, in addition to immunohistochemistry were important investigation to reach a diagnosis in patients with Lymphadenopathy. High malignant etiology is attributed to being the study done in tertiary hospital.

Safety Profile of Rituximab In 100 Adults Patients With B-Lymphoproliferative Disorders

Salih Khdier Abdullah; Ali Mohammed Jawad

Iraqi Postgraduate Medical Journal, 2014, Volume 13, Issue 4, Pages 543-549

ABSTRACT :
BACKGROUND:
Non-Hodgkin lymphoma (NHL) is the most common hematologic cancer in adults. Rituximab is a chimeric anti-CD20 monoclonal antibody that transformed the outcome of the B- lymphoproliferative disorders . Treatment with rituximab is relatively safe but occasionally serious.
OBJECTIVE:
To evaluate the safety of Rituximab in the treatment of Iraqi adult patients with B- lymphoproliferative disorders.
PATIENTS AND METHODS:
A total of 100 patients with low grade, high grade B-cell non-Hodgkin lymphoma and chronic lymphocytic leukemia (CLL) who were admitted to the Haematology unit of Baghdad Teaching Hospital to receive their scheduled Rituximab containing protocol were included in this cohort prospective study between April 2011 to march 2012 .The patients were divided into two groups according to the presence or absence of infusional side effects of rituximab. Infusional side effects of rituximab were recorded with each dose and correlate them with certain patients’ parameters including age, gender and serum LDH .
RESULTS:
Fever (36%), Rigor (28%) and nausea and vomiting (23%) were the most prevalent infusional side effects of rituximab in both NHL and CLL, with most of these infusional side effects occur in the first infusion. One treatment related mortality occurred. Infusional side effects of rituximab were more prevalent in CLL than other patients with NHL (P=0.0005) and in those with normal serum LDH(P=0.046)
CONCLUSION:
Rituximb-induced infusional side effects in this study are more common in the first infusion, and patients with CLL . Most of infusional side effects are mild of grade one or two although one fatal side effect had occurred.

The Clinical Significance of Interleukin-15 and Interleukin -17 in Patients with Rheumatoid Arthritis

Noora Z Muhammed; Hassan J Hasony; Mubder A Mohamed Saeed

Iraqi Postgraduate Medical Journal, 2014, Volume 13, Issue 4, Pages 560-570

ABSTRACT:
BACKGROUND:
Rheumatoid arthritis (RA) is a chronic, deforming arthritis that can lead to disabilities and poor quality of life. Cytokines produced by inflammatory cells play a pivotal role in synovial inflammation and joint destruction in rheumatoid arthritis; they are the final mediators and/or regulators of inflammatory process.
OBJECTIVE:
This study was designed to assess serum IL-15 and IL-17 levels in a sample of patients with RA and to evaluate the correlation between their levels and various clinical, laboratory parameters of RA disease activity and severity.
SUBJECTS AND METHODS:
A case – control study was carried out from January 2013 till October 2013. It was conducted on 80 RA patients who attended Basra General Hospital outpatient rheumatology clinic. Eighty apparently healthy adults, age and sex matched, were also included as control group. Peripheral blood samples were collected from both patients and controls and used for estimation of serum IL-15, IL-17 and anti-CCP antibodies by ELISA, RF and CRP by slide agglutination test and ESR by Westergren method. RA activity was measured using disease activity score28 (DAS-28).
RESULTS:
RA patients showed significantly higher serum IL-15 and IL-17 levels than controls (P<0.01). In addition, IL-15 and IL-17 were found to be significantly higher in RA patients with active disease compared to those at remission. No significant correlations were noted between IL-15 serum level and RF, CRP, ESR, anti-CCP but it was significantly correlated with DAS-28, TJC and SJC. Significant positive correlations of serum IL-17 level and ESR, CRP, anti-CCP, DAS28, TJC and SJC were found. Also there was a significant direct correlation between IL-15 and IL-17concentration.
CONCLUSION:
The current study demonstrated that serum IL-15 and IL-17 levels were significantly higher in RA patients than the controls confirming their important role in the pathogenesis of RA and possible target for future therapy .Ele¬vated IL-17 levels could be considered as a possible indicator of more severe clinical course, This is underscored by relatively strong correlations between almost validated disease activity and severity markers including CRP, ESR, anti-CCP, DAS28, TJC and SJC.

The Role of Parity on Some Macroscopical and Microscopical Variables in Placentas of Normal and Preeclamptic Women

Lina A. Hussain; Malak A. Al-Yawer; Huda M. Al-Khateeb

Iraqi Postgraduate Medical Journal, 2014, Volume 13, Issue 4, Pages 578-583

ABSTRACT:
BACKGROUND:
The placenta is a dynamic organ, throughout gestation, it continuously undergoes different changes in structure and function to support the prenatal life. The anomalies of the placenta are usually associated with pregnancy complicated diseases which could lead to fetal complications. Hence, a careful examination of placenta in-utero as well as post-partum provides much insight into the prenatal health of the baby and the mother and can give information which could be useful in the management of complications in mother and the newborn, especially in a community like ours, where antenatal mothers still come unbooked to the labour room.
OBJECTIVE:
The aim of the present study was designed to elicit some morphometrical variables of delivered placentas ( both gross and microscopic) in normal and preeclamptic pregnancies with regard to the role of parity (birth order) as a physiological change in women's life that may affect placental morphometrical variables.
PATIENTS AND METHODS:
A total of twenty- four placentas were freshly collected. They were grouped into two major groups (normal and preeclamptic) and each group was further subdivided according to parity into primi and multi subgroups (6 placentas for each subgroup). The placentas were grossly examined for (shape, insertion of umbilical cord,diameter and central thickness). Then tissue samples were fixed, processed , sectioned and stained by heamatoxylin and eosin stain to study the following microscopical variables as number of (villi, syncytial knots and fetal capillaries) .
RESULT:
Studying placentas had circular to oval shape. The percentage of central insertion of umbilical cord was increased in control group, mainly in multi one. While marginal insertion was increased mainly in primi preeclamptic. There was a significant reduction in diameter of placentas of preeclamptic group, mainly at primi. The placental thickness was significantly increased in preeclampsia. Statistical analysis for histomorphometrical variables had got an increased in number of villi, syncytial knots and fetal capillaries with preeclampsia and parity. The number of fetal capillaries was significantly increased with preeclampsia (mainly in primi subgroup).
CONCLUSION:
In our study, the definite changes in macroscopical and microscopical variables in placentas of normal and preeclamptic women could be attributed to placental insufficiency especially in preeclamptic group and this may be a compensatory repair mechanisms to factors like hypoxia in order to provide better fetal growth.

The Treatment of Flexion Contracture of the Knee Joint in Hemophilic Patients Using Gradual Manipulation and Serial Casting

Ali Bakir Al-Hilli

Iraqi Postgraduate Medical Journal, 2014, Volume 13, Issue 3, Pages 407-412

ABSTRACT:
BACKGROUND :
Hemophilia is a bleeding disorder caused by deficiency of clotting factor VIII or IX; it is inherited as sex linked recessive pattern. Musculoskeletal complications in haemophilic patients are disabling. Bleeding in to the large joints and soft tissues are associated with arthritic changes in the joints and contractures in the soft tissues. Deformities of the large joints especially flexion contractures are commonly seen in knee joint. It is important to prevent deformities, treat existing contractures and prevent recurrence to improve the patient's quality of life.
OBJECTIVE:
This is a retrospective study analyzing the effectiveness of gradual manipulation and serial casting for treatment of knee joint flexion contracture in Hemophilic Iraqi patients.
PATIENTS AND METHOD:
We included ten Hemophilic patients type A, treated between 2006-2008, six with unilateral and four with bilateral knee joint flexion contractures, excluding patients with multiple joint contractures other than knees, have severe arthritic changes, have subluxated unstable knees or have acute bleeding. Their age is between 16-22 years, the duration of deformity is 4-9 months, knee flexion contractures between 20-80 degrees and all of them don’t have significant pain but their daily life is severely restricted by the deformity. Under factor cover, general anaesthesia and haematological care, we started serial manipulations and plaster of Paris casting, the number of casts is between 2-6 casts, till we get straight knees. After that splints are prescribed for the patient and followed up for a minimum 6 months, physiotherapy to strengthen the muscles around knee is initiated from the start and gradually increasing after the application of the removable splints.
RESULTS:
We have ten patients with fourteen deformed knees, after manipulations and serial casting 8 knees get full correction, and 6 knees still have less than 10 degrees of flexion which is acceptable for the patients, all the patients have improvement of their quality of life and walk free of pain after 2 months.
CONCLUSION:
Serial manipulation and casting under general anaesthesia is a very good maneuver to correct knee joint flexion contractures in hemophilic patients.

Laparoscopic Deroofing of Symptomatic Renal Cysts in Al-Jumhoori Teaching Hospital Mosul City

Asim T Suhail; Bashar D Hasan; Siddeek B Mar; zzaw; Ahmed MH A

Iraqi Postgraduate Medical Journal, 2014, Volume 13, Issue 3, Pages 348-355

ABSTRACT:
BACKGROUND:
Laparoscopy offers a safe and efficacious means of ablating symptomatic simple renal cysts with the benefits of shorter hospital stay, quicker convalescence, and reduced postoperative pain. We evaluated the safety and efficacy of laparoscopic cyst deroofing during our early experience in laparoscopic urology work.
OBJECTIVE:
To present the outcome of laparoscopic management of symptomatic simple renal cysts in Mosul Urologic Center.
METHODS:
Between April 2010 and September 2013, 16 patients (had 19 cysts), with male to female ratio of 1:1.6, were underwent laparoscopic deroofing of symptomatic simple renal cysts at urologic theatre in Al-Jumhoori Teaching Hospital in Mosul and their data were collected and analyzed. All procedures were carried out by transperit- oneal approach. Patients underwent clinical review and radiological follow up with ultrasonography ± computerized tomography. Success rate was defined as no recurrence of the cyst and ignificant pain relief.
RESULTS:
All 16 procedures were completed laparoscopically, without major complic- ations or conversion to open surgery. Estimated mean blood loss during and after surgery was about 119.6 ml and the mean operating time was 48.8 minutes. Patients were hospitalized for a mean of 1.4 days. Five patients developed postoperative fever, and one had incomplete clearance of all cysts. After a mean radiological and clinical follow up of 12 and 23 months respectively, one patient had symptomatic and one had radiologic failure (6.25% and 5.3% respectively).
Cytological and pathological findings for malignancy or any other abnormalities were negative in all patients.
CONCLUSION:
Laparoscopic transperitoneal deroofing of simple renal cysts represents an effective and safe method of treatment with minimal morbidity.

Evaluation of the ‘Ovarian Crescent Sign’ in the Preoperative Determination of the Nature of Adnexal Masses

Neda Salih Amen; Basma Zaki Jameel; Noora Abdullah Najm

Iraqi Postgraduate Medical Journal, 2014, Volume 13, Issue 3, Pages 328-335

ABSTRACT:
BACKGROUND:
There are no universally accepted criteria for distinguishing between benign and malignant ovarian masses on the basis of ultrasound findings. Risk of malignancy indices have been proposed, but these methods use complex calculations and study multiple parameters to develop a score. The detection of normal ovarian tissue in the adnexal masses, the ovarian crescent sign, is highlighted as a single ultrasound parameter prejudging the nature of adnexal mass as benign or malignant. It has been reported that absence of the “ovarian crescent sign” is a more sensitive indicator of malignant nature than the risk of malignancy indices.
OBJECTIVE:
To evaluate whether the presence of normal ovarian tissue adjacent to adnexal masses (the ‘ovarian crescent sign’) could assist in the preoperative differential diagnosis of these masses, and to compare its accuracy with standard biochemical and sonographic indices.
METHODS:
Sixty four women with adnexal masses were included in this prospective observational study. Serum cancer antigen 125 levels were measured and transvaginal and/or transabdominal ultrasound scans of the adnexae were performed and the tissue adjacent to the mass was examined for the presence of the ‘ovarian crescent sign’. The risk of malignancy index was calculated and all the findings were compared with the final histopathological diagnosis and the accuracy of each test was compared to the others in the form of sensitivity, specificity, positive and negative predictive values.
RESULTS:
Fifty five out of sixty four women were found to have benign masses, one had a borderline tumor and eight had invasive malignant lesions. Normal ovarian tissue ‘ovarian crescent sign’ was seen in fifty three out of fifty five women with benign lesions but it was not seen in any one of the nine women with malignant lesions.
In the absence of the “ovarian crescent sign”, ovarian cancer was diagnosed with a sensitivity of 100% and a specificity of 96.4%. For the cancer antigen 125 test, the sensitivity was found to be 77.7%, specificity 92.7%; for the Risk of Malignancy Index, sensitivity was 55.6% and specificity was 89.1%.
CONCLUSION:
The “ovarian crescent” sign is a reliable sonomorphological feature that can help to exclude ovarian cancer in patients with adnexal masses, while its absence highly indicates malignancy.

Clinical Presentations and Management of Thyroglossal Duct Cyst and Sinuses

Ayad Ahmed Shihab Al-Azzawi; Azzam M. A. Al-Salami; Muayad A. Al-Khafaji

Iraqi Postgraduate Medical Journal, 2014, Volume 13, Issue 3, Pages 370-374

ABSTRACT:
BACKGROUND:
The thyroglossal duct cyst results from a failure in obliterating the embryonic duct produced during thyroid migration and it represents the most common type of developmental cyst encountered in the neck region. Ectopic thyroid tissue neoplasia is rare, and it is even rarer when associated with the thyroglossal duct cyst.
OBJECTIVE:
To study the clinical behavior, distribution and treatment of thyroglossal cyst and fistula.
MATERIALS AND METHODS:
A prospective study carried out during the period 2002-2011, in the otolaryngology departments of Al Diwaniyah Teaching Hospital and Gazi Hariri Hospital, 72 patients suffering from thyroglossal cyst and sinuses were diagnosed and treated (60 cysts and 12 sinuses). The data were collected on the basis of history, physical examination, investigations, management and follow up.
RESULTS:
A seventy two patients complaining from thyroglossal duct cyst and sinuses were diagnosed and treated. 45 male (62.5%) and 27 female (37.5%). The commonest age of presentation is the second decade, 33 patients (46%). The most common clinical presentation of thyroglossal duct cyst is a midline neck mass and a midline anterior neck discharging opening in cases of thyroglossal sinuses. The thyrohyoid region is the most common location of both thyroglossal cysts and sinuses. The histological diagnosis in all the cases was benign (100%). All the patients were managed by Sistrunk s operation. The recurrence was seen in only one patient (1.3%). The incidence of carcinoma in the cysts or sinuses was 0.0%.
CONCLUSION :
Thyroglossal cysts and sinuses are quite prevalent. Thyroglossal cyst usually appears as a midline swelling in the prehyoid region of the neck. The etiology of thyroglossal sinuses in this study is mostly iatrogenic which means more awareness is required about diagnosis and proper management of thyroglossal cyst. The standard surgical approach is Sistrunk operation for both thyroglossal cyst and sinuses with low recurrence rate.

Surgical Management of Dorsal Wrist Ganglions: A Comparative Study Between Two Surgical Modalities

Ali Adwal Ali

Iraqi Postgraduate Medical Journal, 2014, Volume 13, Issue 3, Pages 375-378

ABSTRACT:
BACKGROUND:
Ganglions are the most common benign cystic swellings found around the wrist, they can be treated conservatively or by different surgical techniques. Our surgical modality (excision of ganglion complex with fat graft) has given encouraging results.
OBJECTIVE:
To compare the efficacy of excising dorsal wrist ganglions and fat graft and excision alone .
PATIENTS AND METHODS:
A prospective study was conducted on patients with dorsal wrist ganglions. Surgical procedure in 25 cases was excision of the cysts and its neck , while for the rest 25 cases, excision of the cysts followed by fat graft, then an immobilization for 7-10 days.12-18 months period of follow-up was adopted for detection any recurrence.
RESULTS:
Most of the patients were females. Most of the patients presented mainly because of cosmetic reasons. Recurrence was the most frequent complication encountered and involved 16 % in those of group A and only 4% in those of group B.
CONCLUSION:
The technique of excision of dorsal wrist ganglions and fat graft is simple and effective.

Anatomical Cervical Cage Versus Autologous Bone Graft for Anterior Cervical Discectomy and Interbody Fusion In Patients with Cervical Disc Degeneration

Dawood Sadik Alobidi; Firas Abdalhadi AL Obidi

Iraqi Postgraduate Medical Journal, 2014, Volume 13, Issue 3, Pages 398-406

ABSTRACT:
BACKGROUND:
Anterior cervical discectomy and interbody fusion (ACDF) is a surgical technique used to treat a variety of cervical spine disorders, such as nerve root or spinal cord compression, cervical spondylosis, and cervical spinal stenosis (1,2).
OBJECTIVE:
To evaluate the clinical outcome of ACDF with an autologous iliac crest graft (AICG) versus ACDF with an artificial anatomical cervical cage made of polyethereterketone (PEEK) filled with artificial bone substitute for patients with cervical spondylosis.
METHODS:
This was a nonrandomized prospective study of 68 patients ( 28 females,41.2%), and (40 males,58.8%) with mean age of 59.4 years, who had symptomatic cervical disc degeneration (CCD) and underwent ACDF from 1st February 2010 till 1st of September 2013.
We divided the patients into two groups, group A made of 25 patients underwent ACDF by using AICG and group B made of 43 patients underwent ACDF by using anatomical cervical cage (PEEK) filled with bone substitute.
All patients were evaluated preoperatively and six months postoperatively by using Neck disability index (NDI), and Visual analogue scale (VAS) for radicular pain, neck pain and headache.
RESULTS :
For group A, the postoperative improvement in NDI was statistically significant, and for VAS the postoperative improvement was statistically significant for radicular pain, neck pain and headache.
For group B, the postoperative improvement in NDI was statistically significant, and for VAS the postoperative improvement was statistically significant for radicular pain, neck pain and headache.
The difference in postoperative improvement between group A and B was statistically not significant for NDI, and VAS (radicular pain, neck pain and headache).
CONCLUSION:
Both methods are effective in treating cervical spondylosis in selected patients.
No method is statistically superior to another in 6 months postoperative clinical outcomes by using NDI and VAS for radicular pain, neck pain and headache.

Pre-Emptive Analgesia for Reduction of Postoperative Pain

Ali Abdul Hammed; Khulood Salih Al-Ani

Iraqi Postgraduate Medical Journal, 2014, Volume 13, Issue 3, Pages 418-423

ABSTRACT:
BACKGROUND:
Pre-emptive analgesia is important for reduction of post operating pain in all surgical procedure including inguinal herniorraphy under, general anaesthesia.
OBJECTIVE:
To compare the effectiveness of pre-emptive analgesia for reduction of post-operative pain in inguinal herniorrhaphy under general anaesthesia.
PATIENT AND METHOD:
30 adult ASA1 male patients undergoing inguinal herniorraphy under general anaesthesia were included in randomized prospective clinical study. The patients classified into two groups. Group 1 (n=15) control group receive 20 mg Ketamin Hcl at induction of anesthesia before operation. Group 2(n=15) receive 75 mg diclofenac sodium 30 min.I.M before induction and1 microgram/Kg Fentanyl citrate at induction of anesthesia. Then 20 ml of 0.25% Bupivacaine infiltrated in tissue under abdominal sheath at surgical area after induction of general anesthesia with another 20 ml of 0.25% Bupivacain was deposited in subfascial area after skin incision and. VAS (visual analog scale) score were all recorded.
RESULT:
In control group (group1) showed mark increase in stress response to post-operative pain as evidence by high visual analogue scale and in stress response to pain as increase in heart rate and mean arterial pressure during 1st 24hr post-operative. While group II patient (study group) mark decrease in post-operative pain as evidence by low VAS and insignificant change in heart rate and mean arterial blood pressure. It shows that pre-emptive analgesia reduces severity of post-operative pain and analgesic requirement in post-operative period.
CONCLUSION:
Our result indicates that pre-emptive analgesia is effective in reduction of post-operative period.

Incidence and Causes of Conversion from Laparoscopic to Open Cholecystectomy

Raed Jawad Witwit; Aws Khidir Jassim

Iraqi Postgraduate Medical Journal, 2014, Volume 13, Issue 3, Pages 379-383

ABSTRACT:
BACKGROUND:
Conversion from laparoscopic cholecystectomy to open procedure should not be considered as a failure; in fact it is an option which should be considered under certain circumstances.
OBJECTIVE:
Calculation of the conversion rate from laparoscopic to open cholecystectomy and identify its direct causes and some of its risk factors.
PATIENTS AND METHODS:
Prospective study conducted in Baghdad teaching hospital and nursing home hospital in medical city complex for two years period. Patients with symptomatic gall stones were included in the study and prepared for laparoscopic cholecystectomy all cases were operated upon as elective cases.
RESULTS:
Two hundred and twenty one (221) patients were enrolled in the study, 177 female and 44 males with female to male ratio 4:1. The mean age of the patients was 38 year .six patients required conversion to open cholecystectomy with all over conversion rate 2.7%. In males the conversion rate was 4.5% and in female it was 2.2%.
CONCLUSION:
Conversion rate in our study is within the lower limits and accepted internationally. Dens fibrous adhesion is the main cause of conversion. History of acute cholecystitis is independent risk factor for conversion from laparoscopic to open procedure. Gender, age and history of jaundice or ERCP are not independent risk factor for conversion

Transanal Endorectal Swenson Pullthrough :Single Center Experience

Ahmed Aboud. Khalaf

Iraqi Postgraduate Medical Journal, 2014, Volume 13, Issue 3, Pages 356-364

ABSTRACT:
BACKGROUND:
Hirschsprung’s disease (HD) is a common cause of intestinal obstruction in children. Definitive treatments consist of excision of the aganglionic segment and anastomosing the normal colon to the anal remnant by trans anal swenson approach.
OBJECTIVE:
The purpose of this study was to evaluate the feasibility and safety of TESPT technique for management of HD & its results.
PATIENTS AND METHODS:
It is aprospctive study ,where 33children (30 boys and 3 girls) with proven HD were treated at our pediatric surgical department between April 2009 and November 2013. Their ages ranged from 6 months to 8 years. The case files were evaluated for age at operation, associated congenital anomalies, operative time, intraoperative blood loss and blood transfusion, time to resume oral feeding, hospital stay, postoperative complications, and postoperative continence state. The median follow-up period was 12 months(range 3 to 21 months) . The diagnosis was confirmed by barium enema &/or by partial thickness rectal biopsy for histopathological examination for all cases. Most patients had a well-defined transition zone at or distal to midsigmoid colon on preoperative contrast enema
RESULTS:
Male to female ratio was 10:1. one patient had positive family history for Hirschsprung's disease . The definitive TESPT was done in the patients at a median age of 10 months( range 6 months - 8 years). Seven patients had primary pull-through without colostomy.The median operative time was 120minutes (range 90-150 minutes). The length of the resected bowel varied between 20cm and 42cm. The length of hospital stay was 3 to 5 days. The time to resume oral feeding was ranging from 24-48 hours. There are 4 patients with recurrence of obstructive symptoms (retained piece) . 3 patients(9.09%) required readmission for treatment of enterocolitis. Postoperative adhesive intestinal obstruction occurred in 1patient (3.03%). Soiling occurred in 3 patient out of 33pts.(9.09%). Perianal excoriation occurring in 7 patients(21.21%) ,1 patient(3.03%) was died.
CONCLUSION:
Tespt technique is both feasible and safe technique in properly selected children with rectosigmoid HD in all ages. The technique is easily learned and is associated with excellent clinical results.

Association of Vitamin D Metabolite Levels with Relapse Rate and Disability in Multiple Sclerosis

Akram M. Al-Mahdawi; Gheyath Al Gawwam; Raad A. Al Ethawi

Iraqi Postgraduate Medical Journal, 2014, Volume 13, Issue 3, Pages 298-305

ABSTRACT:
BACKGROUND:
Multiple sclerosis is an inflammatory demyelinating disease of the central system. It estimated to affect more than 2・5 million people worldwide. It is the most common non-traumatic cause of disability in young adults. Although the cause of multiple sclerosis remains undetermined, number of risk factors for MS have been identified and they can loosely be put into one of two categories; genetic or environmental components. Epidemiologic studies have suggested there is an increase in incidence and prevalence of MS with increasing latitude north and south of the equator. Latitude has implicate vitamin D status as a determinant of risk.
OBJECTIVE:
To study the association of vitamin D level with relapse rate and disability in patients with relapsing remitting multiple sclerosis in Iraq.
PATIENTS AND METHODS:
Thirty patients (6 males and 24 females) with relapsing remission multiple sclerosis (RRMS), their age range from 16 to 45 years, recruited from MS clinic of neurology department of Baghdad teaching hospital in the medical city in Baghdad and twenty five completely healthy controls (6 males and 19 females) from general population and their age range from 20 to 40 years were enrolled in this study in the period from April 2011 to the end January 2012.
RESULTS:
The present study shows low vitamin D levels for both patient with RRMS and control group. There is significantly lower 25(OH)D level in patients with relapse compared with patients without relapse in the last 6 weeks. Also we found higher expanded disability status scale (EDSS) in patients with relapse compared with patients without relapse in the last 6 weeks. Lastly, we didn’t find any correlation between vitamin D level and EDSS in patients group study.
CONCLUSION:
We concluded from this study that there is low circulating level of 25(OH)D in RRMS patients, especially during relapses. Also there is no effect of vit D on disability

The Effect of Aspirin on Histology of Placenta

Eman Ghanim Sheet Al-Hylli

Iraqi Postgraduate Medical Journal, 2014, Volume 13, Issue 3, Pages 434-441

ABSTRACT:
BACKGROUND :
Preeclampsia (PE )is a potentially life-threatening hypertensive disorder affecting_ 2-7% of all pregnancies , It is a leading cause of maternal mortality ,and associated with high perinatal mortality and morbidity, including intrauterine growth restriction (IUGR) and prematurity. A daily low dose of aspirin (60-80 mg /day) may use for prevention and treatment of PE and fetal growth retardation in pregnant women at risk.
OBJECTIVE:
To assess the influence of aspirin therapy on the histology of placenta from mothers with PE and to correlate the findings with those from pre -eclamptic mothers but not using aspirin during their pregnancy and with placenta from normal Pregnancies .
METHODS:
This study was carried out on one hundred twenty –pregnant women, thirty five with uncomplicated pregnancy and eighty five mothers with PE , fifty of these hypertensive women on aspirin therapy since first trimester.
RESULT:
It was found that mothers with pre- eclampsia either take aspirin or not had relatively smaller, irregular placentae. Histological features of vascular insufficiency like thrombosis, cytotrophoblastic cellular proliferation, fibrin plaque formation etc. were present in more or less similar amount in both groups of hypertensive placentae. Babies of such mothers were mostly
small for date.
CONCLUSION :
Despite the little improvement in outcomes of the aspirin treated pregnancy, , histologic evidence of placental pathology persisted in the majority of women with PE. so aspirin therapy is not effective in preventing and treatment PE

Comparison between the Clinical Assessment, Peripheral Nerve Stimulation (PNS), and Acceleromyography (AMG) to Reverse Neuromuscular Blockade

Iyad Abbas Salman; Mortada A. Jubara

Iraqi Postgraduate Medical Journal, 2014, Volume 13, Issue 2, Pages 146-152

ABSTRACT:
BACKGROUND:
Traditionally, most of anesthesiologists in Iraq evaluate the degree of neuromuscular blockade during and after anesthesia using clinical criteria alone, which are inaccurate to assess adequate recovery from neuromuscular block (NMB) which is essential for the patient to have full control of pharyngeal and respiratory muscles. Fade cannot be detected reliably with a peripheral nerve stimulator (PNS) at a TOF ratio > 0.4. The time gap between losses of visual fade by using a PNS until objective TOF ratio has returned to > 0.90 can be considered “the potentially unsafe period of recovery.”
OBJECTIVE:
To compare between assessment of subjective clinical, subjective TOF by peripheral nerve stimulation (PNS), and objective TOF by acceleromyography (AMG) before reversal of neuromuscular blockade
PATIENT AND METHOD:
A prospective clinical trial of one hundred females who underwent caesarian section under general anesthesia. Standard anesthesia was conducted for all patients. Giving of neuromuscular reversal was decided by the anesthesia care providers depending on clinical criteria, at that time, TOF measured by 2 ways, 1st: counting the twitches visually (principal of PNS), and 2nd: the device showing the TOF reading objectively (principal of AMG).
RESULT:
Comparisons between subjective criteria and objective AMG T4T1 ratios revealed no statistical significance (P > 0.05) in all comparisons (except that with the moving limb and lift the head). The association and consistency of subjective criteria and visual PNS was insignificant differences in all comparisons. There was wide discrepancy between objective reading and the visual PNS.
CONCLUSION:
The moving limbs and sustained lift head 5 seconds clinical criteria were correlated to TOF. Other criteria (protruding tongue, respiratory effort, and swallowing reflex) were not correlated to TOF. Objective AMG more sensitive to detect the fourth twitch than the subjective PNS.
KEY WORDS: train of four (TOF), peripheral nerve stimulator (PNS).

Acute Renal Failure in Neonates, Single Center Experience: Child's Central Teaching Hospital

Jessar S. Hasan; Basil M. Hanoudi; Mahdi M. Murad

Iraqi Postgraduate Medical Journal, 2014, Volume 13, Issue 2, Pages 257-261

ABSTRACT:
BACKGROUND:
Acute renal failure is an acute deterioration in the ability of the kidneys to maintain homeostasis of body fluids, electrolytes and is associated with acute decrease in the glomerular filtration rate that leads to retention of toxic metabolic end products. It’s incidence in hospitalized neonates is 8-24%. The main causes of acute renal failure in neonates are pre-renal in nature, intrinsic and post-renal mechanisms of failure are much rarer conditions.
OBJECTIVE:
To evaluate; types, associated predisposing factors, and short term outcomes of renal failure in neonates of neonatal unit in Child’s Central Teaching Hospital, and to compare the results with those reported in the literature.
PATIENTS AND METHODS:
A cross sectional study was carried out on 30 neonates with acute renal failure admitted to neonatal unit in Child’s Central Teaching Hospital during the period from 1st of June 2012 to 30th of November 2012.
RESULTS:
There were 43 cases diagnosed as renal failure out of 927 hospitalized neonates (4.63%).Thirteen cases were excluded according to the inclusion criteria, so only 30 cases were enrolled in this study. Male to female ratio was 1.7:1. Most of patients were term (86.7%). The prevalence of pre-renal, renal and post renal causes of acute renal failure were 76.6%, 16.7% and 6.7% respectively. The most common predisposing factors for acute renal failure in this study were sepsis (80%), perinatal asphyxia (10%), heart failure (3, 4%). Most patients had more than one predisposing factor. Among admitted neonates with renal failure, mortality rate was 16.7% and it was significantly higher in patients with sepsis (P<0.05).
CONCLUSION:
Early recognition of risk factors such as sepsis, perinatal asphyxia or, heart failure, and rapid effective treatment of contributing conditions will decrease acute renal failure in the neonatal period.

Bacteriological, Serological and Histopathological Study on Tonsillectomy Specimens

Haitham Abdul-Malik Alnori; Kawkab Adris Mahmod; Ali A. Muttalib Mohammed

Iraqi Postgraduate Medical Journal, 2014, Volume 13, Issue 2, Pages 219-225

ABSTRACT:
BACKGROUND:
Tonsillitis is one of the commonest infectious disease occurring in the young age group. Tonsillectomy is generally indicated when there are frequent attacks of acute tonsillitis, usually six attacks or more per year for two successive years. Other indications of tonsillectomy include obstructive sleep apnea, quinsy ( usually after the second attack of quinsy) and suspicion of malignancy
OBJECTIVE:
The aim of the present study is to: i) identify the types of bacteria in the tonsil core and to study the sensitivity of bacterial isolates to some antibiotics. ii) estimate serum concentration of Antistreptolysin O (ASO), C-Reactive Protein (CRP) and Epstein Barr Virus (EBV) serology in patients subjected to tonsillectomy compared to control group. iii) study the histopathological changes of routine tonsillectomy specimens.
METHODS:
This case series included hundred patients who underwent tonsillectomy at Al-jamhori Teaching Hospital from January 2010 to July 2012. The main indication for surgery was recurrent attacks of tonsillitis for two or more successive years. Core of the tonsil was studied regarding bacteriology and sensitivity of the cultured bacteria to some antibiotics. At the same time blood sample was obtained and analyzed for ASO, EBV and CRP. Finally the removed tonsils were sent for histological examination.
RESULTS:
The mean age of our patients was 10.32 years with a range of 3-35 years. The study included 60 males (60%) and 40 females (40%) with a ratio of 1.5 :1. Group A beta hemolytic Streptococcus pyogenes was the commonest isolate from tonsil core (21.4%) and was most sensitive to azithromycin. Serological tests for ASO, CRP and EBV were positive in 24%, 22% and 20% compared to 22%, 8% and 10% in control group respectively. CRP was significantly higher among patients than control group. Histological examination revealed chronic non-specific tonsillitis with reactive lymphoid hyperplasia.
CONCLUSION:
The resistance of many bacteria to penicillin and amoxicillin, and the high percentage of beta-lactamase secreting microbes in recurrent tonsillitis mandate the need to consider a combination of amoxicillin and clavulanic acid or second generation cephalosporin. ASO titer is not an accepted indication for tonsillectomy.

Epistaxis Etiology and Management

Ayad Ahmed Shihab Al-Azzaawi; Ragheed Turky Miteab; Muayad A. Al-Khafaji

Iraqi Postgraduate Medical Journal, 2014, Volume 13, Issue 2, Pages 230-234

ABSTRACT :
BACKGROUND:
Epistaxis is one of the commonest medical emergencies. It affects all age groups and both sexes. The causes may be local or systemic. Trauma is considered to be a major etiological factor. Various treatment protocols are utilized to control epistaxis depending upon the type, severity and cause of bleeding.
OBJECTIVE:
To show most etiological factures that causes epistaxis and who we manage each case by different method.
MATERIALS AND METHODS :
This descriptive study was designed to evaluate the etiology and efficacy of management of epistaxis.210 patient underwent prospective evaluation in the otolaryngology department of Al Diwaniyah Teaching Hospital . Standard principles where followed in the management.
RESULTS:
This study demonstrated a bimodal distribution with incidence peaks below25 years and above50 years of age. Males affected more than females (1:1.16) . Anterior nasal bleeding was noted in the majority of patients. Anterior nasal packing was the most effective method of controlling anterior epistaxis followed by chemical cautery. While posterior bleeding was controlled by posterior nasal packing and anterior nasal packing. The most common cause was found to be trauma followed by hypertension.
CONCLUSION:
Epistaxis affects all age groups and it has a bimodal age presentation, it affects both sexes equally. Anterior nasal bleeding is more common than posterior bleeding .Epistaxis may be controlled with chemical or electrical cautery if the bleeding point is visible. In case of failure to localize or access a bleeding point or profuse bleeding, anterior nasal packing can effectively control majority of epistaxis cases. Foley s catheter is a good option that can be used for posterior nasal packing. Gelfoam may be used for controlling epistaxis in cases of bleeding disorders, when there is mucosal ooze.

Trace Elements Levels and Oral Manifestations in Type 2 Diabetic Patients

Huda Shakir Ahmed

Iraqi Postgraduate Medical Journal, 2014, Volume 13, Issue 2, Pages 161-164

ABSTRACT:
BACKGROUND:
Diabetes mellitus (DM) has been shown to be associated with oral manifestations and abnormalities in the metabolism of micronutrients, especially copper, zinc, and magnesium.
OBJECTIVE:
To study the oral manifestations in type 2 diabetic patients and to estimate trace elements levels such as copper (Cu), zinc (Zn), and magnesium (Mg) in those patients comparing to control group.
PATIENTS AND METHODS:
A total of 30 diabetic patients were studied for their oral manifestations and trace elements levels including serum copper, zinc, and magnesium; their age range was (40-55) years and compared with 30 healthy controls.
RESULTS:
There was a significant decrease in serum Cu, Zn, and Mg in DM patients as compared with their controls, (P < 0.05). Also, several oral complications are seen among diabetics.
CONCLUSION:
It can be concluded that several oral complications are seen in diabetic patients. The deficiency of some essential trace metals such as Cu, Zn, and Mg may play a role in the development of diabetes.

Evaluation of Certain Acute Phase Reactants in Patients with Acute Myocardial Infarction

Noaman Abdullateef Abdulrazzaq; Abdulbasit Insief Jassim; Ali Ibrahim Kadhum

Iraqi Postgraduate Medical Journal, 2014, Volume 13, Issue 2, Pages 176-180

ABSTRACT:
BACKGROUND :
Acute myocardial infarction ( AMI ) is an important clinical condition which is associated with a significant inflammatory changes that result in acute-phase responses. Significantly elevated concentrations of cytokines and other acute phase reactants are the major events that accompanied such condition. Our aim was to evaluate certain acute phase reactants : Interleukin-6 ( IL-6 ) , C-Reactive Protein ( CRP ) and plasma fibrinogen in patients with AMI.
OBJECTIVE:
This study was focused on the evaluation of certain acute phase reactants : Interleukin-6 ( IL-6 ) , C-Reactive Protein ( CRP ) and plasma fibrinogen in patients with AMI.
PATIENTS AND METHODS:
Thirty patients from Baghdad city with AMI were included between July 2011 and January 2012 : 21 males and 9 females, their ages range between 40 – 73 years. Thirty healthy subjects ( 16 males, 14 females ), age matched with patients as a comparative group were included. Both groups were investigated for IL-6 , CRP , and plasma fibrinogen levels.
RESULTS :
IL-6 concentrations were found to be significantly higher with ( P value : 0.0001 ) –table 1- in patients with AMI) than in control subjects. CRP concentrations were also found to be significantly higher with ( P value : 0.0001 ) in patients with AMI than in control subjects. plasma fibrinogen level was significantly higher with ( P value : 0.0001 ) in patients with AMI than in control subjects.
CONCLUSION :
The study revealed a significant elevation in IL-6 , CRP concentrations and plasma fibrinogen level in patients with AMI.

The Pattern of Drug Resistance in Iraqi Pulmonary Tuberculosis Patients Referred to the Specialized Center for Chest and Respiratory Disease

Arwa Tahrir Ramadhan; Ahmed Asmer Mankhi

Iraqi Postgraduate Medical Journal, 2014, Volume 13, Issue 2, Pages 181-186

ABSTRACT:
BACKGROUND:
Tuberculosis control in the world today must face the challenge posed by the global spread of Mycobacterium tuberculosis strains that are resistant to standard anti-TB drugs.
OBJECTIVE:
This study was done to identify the drug resistance to the first line antituberculosis drugs in Iraqi Patients.
METHODS:
This prospective study conducted in National Center for Tuberculosis and Chest Diseases in Baghdad from January 2012 to August 2012.For study the demographic characters and drug sensitivity test (DST) in a total number of 155 case of sputum smear positive pulmonary tuberculosis (97 old and58 New) For each patient 3 consecutive sputum samples were taken for direct smear microscopy and cultured to test drug resistance for First Line anti-TB drugs (INH, Rifampicin ,Ethambutol and pyrazinamide).
RESULTS:
In this study we found ethambutol resistant in 20(34.5%)of samples in the new group and in 49(50.5%) of samples in old group. On the other hand,our study showed that resistance to rifampicin in the new group was 58.6% while in the old group was 75.3%. In regard to the INH drug resistance it seen in 72.4% of samples in new group and in 83.5% of samples in old group.This study showed that reistance to streptomycin present in 44.8% of new group samples and in 55.7% of old group samples .The pattern of drug resistance according to patient group show high frequency of polyresistance 82 cases in both patient group(new and old) and low frequency in other group of resistance 14 cases,and MDR type of resistance in total of 17 cases .
CONCLUSION:
The study showed 11%(17/155) of patients with pulmonary tuberculosis in this sample of patients had multidrug resistance MDR tuberculosis .
.

Food Poisoning Outbreak in Tikrit City, Iraq, 2013: Staphylococcus aureus and Salmonella Typhimurium were the Incriminated Pathogens

Asaad Mehdi Asaad; Faris Al Lami; Bashar Abdullatif; Ayad Kareem; Abbas Mahdi; Shaker Mahmood

Iraqi Postgraduate Medical Journal, 2014, Volume 13, Issue 2, Pages 169-175

ABSTRACT:
BACKGROUND:
On June, 22nd, 2013, Communicable Disease Control Center (CDCC) in Baghdad notified on an outbreak of Food Poisoning (FP) involving more than 100 persons attending a restaurant in Tikrit City, Salah Al Din province on21st, June.
OBJECTIVE:
to identify source, and causative agents of the outbreak.
PATIENTS AND METHODS:
A case seeries study conducted on accessed cases in Tikrit and Sala Al Din hospitals. Information on basic, clinical and food item consumed were collected using a questionnaire. Environmental assessment of the restaurant using a standardized checklist and bacteriology testing of food samples, patients’ stool specimens and different specimens from food handlers were conducted.
RESULTS:
A total of 214 persons who attended the restaurant sought medical care for acute gastroenteritis; 82 (38.3%) were admitted. Only 175 patients (including 11 affected food handlers) were accessed. Main symptoms were diarrhea (92.5%), nausea (87.5%), and vomiting (84.5%). Apart of one death, all other patients recovered completely. 32% of patients’ stool samples were positive for Salmonella typhimurium, and 30% of food specimens were positive for Staphylococcus aureus, and 10% for coliform bacteria; 13 food handlers were examined and specimens of blood, urine; and stool, and under the finger nail swabs, were negative. Health inspection of the restaurant revealed unhygienic food processing and poor personal hygiene of food handlers.
CONCLUSION:
Staphylococcus aureus and Salmonella typhimurium were the responsible pathogens. Contaminated food stuff and unhygenic foodhandlers practices were the source. Strengthening the role of health inspection, and upgrading local laboratory capacity were recommended.

Human Papilloma Virus in a Sample of Iraqi Women with Normal and Abnormal Pap Smear

Nada Salih Ameen; Dalia Thamer Ahmmad

Iraqi Postgraduate Medical Journal, 2014, Volume 13, Issue 2, Pages 211-218

ABSTRACT:
BACKGROUND:
World wide, cervical cancer is one of the most common cause of death from cancer in women, HPV testing have a key role in primary cervical screening and the currently accepted view is that HPV is an essential factor in the causation of the disease.
OBJECTIVE:
The objective of the study is to outline the presence of HPV infection in our community through sample of Iraqi's women who attended Central Health Laboratories with normal and abnormal Pap smear during the period from August 2006 to December 2008.
METHODS:
The data were collected from records of the laboratory which includes the information about patients who were referred to the central health laboratories to do HPV test , these data includes: age of the patients , marital state, years after marriage which represents the age of first sexual acts , also the records includes the smoking state, Pap smear results and lastly the HPV test results. HPV testing was done by PCR method , which initially required DNA extraction by MICROGENO DNA from AB Analitica , then DNA Amplificaion by PCR , and finally Electrophoresis for reading the UV light and translating it into certain molecular weight by Molecular Weight Markers.
RESULTS:
The percentage of HPV infection was 15.65 % , the percentage of positive test was 20% among those aged between 20-30 years old , no viruses had been detected above 50 years old . All the cases that have been examined were married and had 15% infection rate among them . The maximum infection rate 20% was among those who had sexual activity for 5-9 years. 91.6% of the infected women were smokers. 5.5% of the women with negative cytological results was infected, 26.3 % of those with ASCUS, 43.3% of those women with CIN I, 45.5% of those with CIN II , and 57% of those with CIN III ; the highest infection rates were 100% among patients with micro-invasive cancer.
CONCLUSION:
-High rate of HPV infection is associated with age , smoking and multiple sexual partners(married more than once).
- High frequency of detection of oncogenic HPV infection are associated with increasing grade of cervical lesion.

Epidermal Skin Cancers: Anatomical and Pathological Distribution

Rana Aasim Abdul-Kareem Azooz

Iraqi Postgraduate Medical Journal, 2014, Volume 13, Issue 2, Pages 273-278

ABSTRACT:
BACKGROUND :
There are three major types of skin cancer; basal cell carcinoma (BCC), squamous cell carcinoma (SCC) and malignant melanoma.The distribution of these tumors on the face follows particular anatomical regions which may be related to histological subtypes of the tumor.
OBJECTIVE:
To describe and compare the clinicopathological characteristics of epidermal skin cancers regarding facial distribution of these tumors and their histological correlations.
METHODS:
Data sources for this retrospective case-series study included all pathological reports of patients with epidermal skin cancers diagnosed at histopathology laboratory of Al-Jamhuri Teaching Hospital in Mosul city between the years 2008 and 2010.
RESULTS:
There were 117 patients with different facial epidermal skin cancers. BCC represented the highest frequency (68.3%) among all facial epidermal skin cancers (and the most frequent eyelid malignancy), followed by SCC (28.5%) while malignant melanoma was the least frequent skin cancer (3.2%). There was no difference in the frequency of distribution of both BCC and SCC between nose and cheek (p=1, p=1, respectively) but the nose was the most frequent region of involvement of the nodular variant of BCC. Preexisting mole, xeroderma pigmentosa, actinic keratoses and scar of previous burns were found to be associated with different epidermal skin cancer.
CONCLUSION:
BCC was the most frequent epidermal skin cancer of the face followed by SCC. Histological variant of BCCs followed variable facial distribution , while no difference in facial involvement was found regarding BCCs and SCCs.

The Role of anti –DNA Abs. in Chronic Renal Failure in Diabetes Mellitus Type I and Type II

Suha A.AL-Fakhar; Manal Kamal Rasheed; Mohammed Kamal Rasheed

Iraqi Postgraduate Medical Journal, 2014, Volume 13, Issue 2, Pages 165-168

ABSTRACT:
BACKGROUND:
Diabetic nephropathy (DN) is the leading cause of CKD and end-stage renal disease (ESRD). CKD is characterized by a progressive loss of renal function, chronic inflammation
OBJECTIVE:
To compare the relationship between the anti –DNA Abs in diabetic patients type 1 and type 2 and their relation with chronic renal failure.
METHODE:
The ELISA methods was used to detect the presence of anti-DNA –Abs in sera of diabetic patients with type 1 and type 2 D.M. with CRF.
RESULT:
The concentration of anti-DNA Abs. were more in type II D.M. patients with CRF than those with type I D.M. without CRF and control group.
CONCLUSION:
The anti-DNA Abs. play an important role in the CRF in patients with long duration of D.M. type II ,while in patients with short duration of D.M. type I , anti-DNA Abs. do not play a role.

Delayed Anastomotic Posterior Urethroplasty : Longterm Results

Hayder M. AL-Aridy

Iraqi Postgraduate Medical Journal, 2014, Volume 13, Issue 2, Pages 248-256

ABSTRACT:
BACKGROUND:
There is still controversy regarding the treatment of post-traumatic posterior urethral distraction injuries. Initial suprapubic cystostomy and delayed perineal urethral reconstruction has been considered the reference standard.
OBJECTIVE:
We review our experience with delayed perineal urethral reconstruction,with a focus on the long-term outcome and complications.
PATIENTS AND METHODS:
Between March 2007 and April 2012, 56 patients with posterior urethral distraction injury due to pelvic trauma underwent reconstruction with delayed perineal approach. Motor car accident were the main mode of trauma ocuring in 34 patients(60.71%)followed by blunt pelvic trauma in 15 patients(26.78%)and fall from height in 5 patients(8.92%).Bullet injury in 2 patients(3.57%).The definitive repair was delayed after a time interval ranging from 2 to 9 months (mean 2.83±1.14) after initial management . Mean patient age was 30.16±15.31 (range 6 to 65) years. In all cases, the area of fibrosis was aggressively excised, the corpus spongiosum was mobilized, and a tension-free, spatulated end-to-end anastomosis was achieved by splitting the corporeal bodies. The preoperative evaluation consisted of combined antegrade and retrograde cystourethrograms . A detailed sexual history was obtained in all patients .
RESULTS:
After a mean follow-up of 29.78±15.79 months (range 9 to 60 months ), 50 patients(89.28%) had a successful outcome (with or without additional urethrotomy).6 patients (10.71%)was considered a surgical failure ,endoscopy was unsuccessful .The patients is scheduled for another trial of surgical repair.
CONCLUSION:
Our results support the belief that delayed perineal reconstruction with extensive excision of fibrosis and a tension-free, spatulated end-to-end anastomosis is a successful treatment for posterior urethral distraction defects, with acceptable morbidity.
KEY WORDS:urethral stricture,posterior urethral injuries,urethroplasty.

Prevelance of Helicobacter Pylori in Patients with Hepatic Hydatid Cyst

Safa M. Al-Obaidi; Mohammed Abdzaid Akool; Husham Fadhil Hussein; Ahmed R. Hizam

Iraqi Postgraduate Medical Journal, 2014, Volume 13, Issue 2, Pages 243-247

ABSTRACT:
BACKGROUND:
Echinococcosis (hydatid disease or hydatidosis) is endemic in some parts of the world. It is a zoonotic disease and human is an accidental intermediate host.Helicobacter pylori (H. pylori) is a spiral-shaped bacterium that is found in the gastric mucous layer or adherent to the epithelial lining of the stomach. H. pylori causes more than 90% of duodenal ulcers and up to 80% of gastric ulcers.
OBJECTIVE:
To detect the prevalence of H. pylori in patients with liver hydatid disease.
PATIENT AND METHOD:
The study was carried out from the 1st of July / 2009 to the 1st of October / 2010 & included two groups: Group A, which included sixty patients who presented to the surgical units of Baghdad teaching hospital & Al – Fairoos general hospital in Al – kut governorate with liver hydatid cyst for elective surgery, they were investigated for H pylori(by ELISA test for anti H-pylori IgG Ab). Group B, which included 72 of the patients first degree relatives who live in the same house also investigated for H pylori.
RESULTS :
The study found that in group A : patients with hydatid cyst and positive H pylori represents 48 cases ( 80% ) , while in group B: first degree relatives with positive H pylori 43( 59.7%).
CONCLUSION:
The prevalence of H-pylori is increase in the patients with hepatic Hydatid cysts, as There is a significant positive relationship between the presence of H pylori and liver Hydatid disease.

Evaluation of Amniotic Fluid volume with Ultrasound at Term Pregnancy and its Correlation to Perinatal outcome

Abdulrazak H. Alnakash; Areej Sabah Abdul Ridha

Iraqi Postgraduate Medical Journal, 2014, Volume 13, Issue 2, Pages 202-210

ABSTRACT:
BACKGROUND:
recognition of abnormal amniotic fluid volume before delivery may alert the clinician to situations of potentially high prenatal risk. pregnancies complicated by extremes of amniotic fluid volume also experiences increase maternal & neonatal morbidity.
OBJECTIVE:
To identify the incidence of fetal morbidity & mortality associated with abnormal liquor volume compared with those having normal liquor volume at term pregnancy.
Study design: A prospective cohort study.
Setting: The study was conducted at Al-Elwiya Maternity Teaching Hospital, during the period from Mar. 2011 to Apr. 2012.
PATIENTS AND METHODS:
Three hundred fifty one pregnant women at their term were collected for the study. The participants were classified according to the amniotic fluid volume into 3 groups: Group 1: (244) those with normal liquor volume (maximum vertical pocket 3-8 cm), Group 2: (63) those with oligohydramnios ( maximum vertical pocket <3cm), Group 3: (44) pregnants having polyhydramnios ( maximum vertical pocket > 8 cm). Multiple pregnancy, preterm, postterm pregnancy or those with ruptured fetal membranes had been excluded. The fetal outcome of the groups were analysed & data arranged in tables & subjected to statistical study.
RESULTS:
In oligohydramnios group, hypertensive disorders & IUGR were 17.4% & 9.52% respectively, while in polyhydramnios women with diabetes diseases were 22.7% versus1.64% in the control group. In oligohydramnios group, low birth weight , intrapartum complications & admission to NICU were more significant with incidence of 9.59%, 39.6%, 46% respectively versus 0.04%, 5.33%, 11.07% for control respectively. Fetal congenital anomalies, early neonatal complications , macrosomia, low Apgar score& early neonatal death were more in polyhydramnios group as follow: 18.18%, 29.25%, 15.9% , 18.18% & 9.09% respectively compared with the control which were 0.41%, 8.6%, 5.74% respectively & there were no recorded cases of low Apgar score or early neonatal complications in the control group.
CONCLUSION:
Largest vertical pocket less than 3cm at term is associated significantly with higher incidence of hypertensive disorders & IUGR. It was highly significant in predicting neonatal admission (NICU ) & intrapartum complications. While when the largest vertical pocket is more than 8cm, diabetes disease, fetal macrosomia, congenital anomalies, low Apgar score, early neonatal complications & neonatal death are more frequently seen.

Seroprevalance of Hepatitis B&C In Pediatric Malignancies

Nada Ali Ahmed AL-Ali; Thalfaa Nathim Al-Kayatt

Iraqi Postgraduate Medical Journal, 2014, Volume 13, Issue 2, Pages 262-267

ABSTRACT:
BACKGROUND:
Children with cancer who are on intensive chemotherapy require multiple blood and its products transfusion which increases the risk of blood transmissible infection
OBJECTIVE:
To know the prevalence of HBV and HCV infection in pediatric malignancy after starting anti cancer therapy and To identify the risk factor, that increased the possibility of infection
Design a Prospective interventional study
Participants The present study was conducted on 85 children with malignancies who were attending the department of pediatric oncology in Mosul,(Ibn-Alather hospital) the age of the patients were between 1-15 years with male: female ratio of 1.5: 1
Main outcome measure. All our patients were tested for HBsAg and HCV antibodies at diagnosis of malignancy and before starting chemotherapy then after six and twelve months
RESULTS:
Two patients (2.3%) had HBV infection, and no patient had HCV infection initially, while after 6 month of receiving chemotherapy we have 8/70 (11.4) had HBV and also no patient with HCV, and after 12 months of receiving chemotherapy the percentage of patients with HBV and HCV were increase to 13/63 (20.6%) and 2/63 (3.2%) respectively .
CONCLUSION:
Its important to ensure on accurate screening of blood and its products before transfusion to these patients, and also ensure on the receiving HB vaccine before starting chemotherapy. Before this study, the prevalence of HBV and HCV infection in pediatric malignancy in Mosul city were unknown, the present study was designed to fill this gap.
.

Accuracy and Safety of the Free Hand Technique for Thoracic Pedicle Screw Placement in Spinal Deformity

Mohanned A. Al-Falahi; Mohammad Saeed; Adnan A. Karim

Iraqi Postgraduate Medical Journal, 2014, Volume 13, Issue 2, Pages 279-290

ABSTRACT:
BACKGROUND:
Pedicle screw construct has become widely accepted method for correction of spinal deformities. Better correction, higher rates of fusion as well as low complication rates have been reported. Free hand technique for placement of pedicle screw has been shown to be associated with low complication rate when performed by experienced surgeon. Low dose CT scan was used for postoperative assessment of screw placement and shown to be safe and effective method.
OBJECTIVE:
To determine the accuracy and safety of malpositioned screws in the thoracic spinal deformities using the free hand technique and to determine the effectiveness of the low dose CT scan regarding this issue
METHODS:
502 pedicle screws were used in 21 patients with adult idiopathic and congenital scoliosis using the free hand technique, screws positions were estimated one week postoperatively using low dose CT scan.
RESULTS:
Of the 502 screws inserted 262 (52.19%) were well placed inside the pedicle while 110 (21.91%) were medially misplaced and 108 screws (21.51%) were misplaced laterally, 16(3.19%) anterior perforation, 5 (1%) perforated the underlying neural foramen and 1(0.2%) perforated the upper end plate; without any significant neurological or visceral complication.
CONCLUSION:
Placement of the thoracic pedicle screws in the surgical correction of the deformed spine using the free hand technique is a safe, cost effective and non-time consuming and that the low dose CT scan used postoperatively is effective and safe method in detecting malpositioned screws.

Her 2/Neu Overexpression in Gastric Cancer

Nadwa Subhi Al-Azow

Iraqi Postgraduate Medical Journal, 2014, Volume 13, Issue 2, Pages 268-272

ABSTRACT:
BACKGROUND :
Overexpression of Human epidermal growth factor receptor 2(Her2/neu)
Protein has been observed in many human cancers including gastric cancer . Gastric cancer remains the most common cause of cancer –related death worldwide. Her2/neu overexpression
in gastric cancer associated with poor prognosis and shorter survival rate , the assessment of this protein for selection of eligible patients for treatment with trastzumab in addition to conventional chemo therapy.
OBJECTIVE:
To evaluate the Her2/neu over expression in gastric cancer by immunohistochemical
Technique and to find the correlation between the protein exopression and clinicopathological
Parameters as age ,sex, histological types and grade of the tumor.
MATERIALS AND METHODS :
This is a pro-& retrospective study conducted at the pathology department of Al-Jamhuri Teaching hospital and some private laboratories . A total of 30 cases of gastric cancer were collected and diagnosed in the period spanning from April 2010 to April 2012, .An immunohistochemical technique was used for the assessment of Her2 against age,sex, histological types and grade of tumor
RESULTS :
The mean age of the patients was 54.5 years ranging from 30 to 87 years, Her2/neu overexpression was shown in 30% of the cases , in this study there is no relation between Her2 positivity and age or sex, , it was associated with histological types p-value = 0.04,where as 42.6 % of the intestinal type show immunoreactivity and 11.1% of diffuse type,while two cases of mixed types were shown no reactivity(0.0% ). Her2 positivity was associated with moderate differentiated tumor (50%) more than poorly differentiated (20%) but not reaching the statistical significance.
CONCLUSION:
Her2/neu positivity was found in 30% of gastric cancer , there is no relation between the age or sex of the patient & Her2 positivity while intestinal type and moderately differentiated tumor were associated with high percentage of Her2 positivity.

Effect of Hypertension on Aortic Root Size and Prevalence of Aortic Regurgitation

Ghassan Abbod Ahmed; Amal Noori Al; Marayati; Basil Najeeb; Asaad Abdullah Abbas; Talib Hashim Salim; Basil Najeeb Saeed; Riyadh S. Abultiman; Abdulhameed A. Majeed Al-kassir; Namir M. Taher Abdullah; Zainab Abdul Razak AL-SharifiA; Halla Ghazi Mahmood; Amjad Daoud Niazi; Hassan Sarhan Haider; Rafal Rajab Hasan; Alaa Hussein Altaee; Raghad Hannon Shinenalsudani; Iyad Abbas Salman; Saba J. AL-Wardi; Khudir Z. Mayouf; Faiq. I. Gorial; Warda S. Lasso; Mohanned A. Al-Falahi; Mohammad Saeed; Sinan Adnan; Islam Ghanem Mahmood; Ali A. Muttalib Mohammed; Ammar Hadi Khammas; Mohammed Radef Dawood; Yaseen Adeeb Sakran; Azad Mohammed Abdullah; Bassam Musa Sadik Al-Musawi; Waleed Mustafa Hussen; Osama Elhassani; Muhanad Fadhil

Iraqi Postgraduate Medical Journal, 2014, Volume 13, Issue 1, Pages 61-69

ABSTRACT:
BACKGROUND:
Although early reports suggested that hypertension predisposed to aortic root enlargement and consequent aortic regurgitation, more recent pathological and M-mode echocardiographic studies have not found an association between hypertension and aortic root enlargement when age is considered.
OBJECTIVE:
The aim of this study is to asses the effect of hypertension on aortic root size and to estimate the prevalence of aortic regurgitation.
METHODS:
measurement of two-dimensional echocardiographic diameters of the aortic root at four locations and compared findings with resting blood pressures and measures of body BMI in 110 normotensive and 110 hypertensive men and women matched for age and sex.Colour and continuous wave Doppler study are used to diagnose and assess severity of aortic regurgitation.
RESULTS:
Aortic diameters at the anulus (2.40±0.29 versus 2.33±0.24 cm, P=.06) and sinuses (3.45±0.43 versus 3.35±0.35cm, P=.08) were marginally higher, whereas diameters at the supra-aortic ridge (2.93±0.39versus 2.73±0.33cm, P

Keywords

such a difference in this population of
---
asymptomatic hypertensive individuals.

Colonoscopy at the National Center for Early Detection of Cancer: Evaluating Indications and Diagnostic Yield

Maral F.Thabit; Mohammad A. Hashim; Hani M.S.M.Kadhum Al-Ansari

Iraqi Postgraduate Medical Journal, 2014, Volume 13, Issue 1, Pages 1-6

ABSTRACT:
BACKGROUND:
Colonoscopic procedure is an accepted modality for the evaluation of colonic disease and an accurate procedure in the workup and screening of patients with lower gastrointestinal symptoms. The clinical spectrum and diagnostic yield depend upon the indications for the procedure.
OBJECTIVE:
To identify the yield of the major indications for the procedure, and the pattern of colon pathology in study population.
Study design and Setting:
A retrospective study was conducted over a period of 6 months extending From 18th November 2011 to 18th May 2012 at the National Center for Early Detection of Cancer by reviewing the records of 224 colonoscopy examinations which were done in the center between January 2010 and December 2012.
RESULTS:
The patients comprised 66 females (29.4%) and 158 males (70.6%) and their mean ages was (46.6) years. There were 114 patients (50.9%) who were aged less than 50 years. Complete examination to the caecum was possible in 114 cases (50.9%).
Pathological findings were identified in 127patients (56.7%). The diagnostic yield of patients referred for lower abdominal pain and alternation in bowel habit was low, of (29.72%) and (46.66%), respectively. The yield was high for those with lower gastrointestinal bleeding (71.15%), diarrhea (61.9%), category 'others' (65%). The diagnostic pattern showed that non-specific colitis and double colonic lesions were identified in (29.13%), and (16.53%) respectively. Colonic cancer was diagnosed in 19patients (14.96%), ulcerative colitis in 9patients (7.08%), polyps were detected in13patients (10.23%), and internal hemorrhoids in17patients (13.38%).
CONCLUSION:
The highest diagnostic yield of colonoscopy procedure was for lower gastrointestinal bleeding and diarrhea and the main pattern of colonic pathology was nonspecific colitis and double colonic lesions.

Study of Some Miswak (Salvadora persica L) Components and Effect of Their Aqueous Extract on Antioxidant

Mustafa Taha Mohammed

Iraqi Postgraduate Medical Journal, 2014, Volume 13, Issue 1, Pages 55-60

ABSTRACT:
BACKGROUND:
Oxidative stress defines that, the level of Reactive Oxygen Species (ROS) exists in excess of antioxidant defenses. This imbalance in the redox milieu results in a switch from ROS-stimulated ambient signaling processes to ROS-mediated pathophysiological consequences. Oxidative stress has been implicated in the installation and progression of several degenerative diseases via DNA mutation, protein oxidation and/or lipid peroxidation. Therefore, possible use aqueous extracts of Miswak to protect brain against the Lipid peroxidation.
OBJECTIVE:
The present study was undertaken to evaluate the potential of Salvadora persica L. (miswak) against the DPPH Free Radical Scavenging System and Lipid peroxidation.
METHODS:
The chemical components of the prepared aqueous extracts of Miswak were detected as: glycosides, alkaloids, saponins, phenolic compounds, tannins, flavonoids , proteins ,steroids and Vitamine C. and then estimate DPPH Free Radical Scavenging System and Lipid peroxidation
RESULTS:
The study showed that the Miswak ( Salvadora persica L.) in the aqueous extracts contain : glycosides , proteins, saponins ,tannins ,phenolic compounds, flavonoids , alkaloids , steroids and vitamine C . Aqueas extracts were found effective in scavenging DPPH(62.45℅) in concentration (250µl/ml), as well as inhibiting the lipid peroxidation (42.04℅).
CONCLUSION:
Our results suggest that Miswak ( Salvadora persica L.) treatment protects the rat brain against lipid peroxidation and DPPH free radical scavenging.
.

Plague Epidemic in Sumerian Empire, Mesopotamia, 4000 years ago

Amjad Daoud Niazi

Iraqi Postgraduate Medical Journal, 2014, Volume 13, Issue 1, Pages 85-90

ABSTRACT:
This research work concerns the realization and verification that an epidemic of plague had in reality occurred 4000 years ago in Sumer , present day Iraq, that affected the population in a catastrophic way and had lead to the decline and fall of the Sumerian Empire . This important conclusion came after verifying the translations and transliterations of thousands of clay tablets which was made available by scholars and international academic agencies . Of course there was no mention clearly of the disease as we know now but there was a clear description of various aspects of the disease including signs and symptoms, epidemic occurrence and effects on the people and propagation through place over time which may have reached a pandemic proportions . It was concluded that such an epidemic could be the main factor in the declining of the Sumerian Empire. The epidemic itself could be a ring in the chain of plague epidemics propagated through place in history and known nowadays as the black death,

Severe Early– Onset Preeclampsia: Prognostic Role of Uterine Artery Doppler Examination

Eftekhar Shmkhee Abood; Shamam Y. Mohammed; Lilyan W. Sersam

Iraqi Postgraduate Medical Journal, 2014, Volume 13, Issue 1, Pages 37-43

ABSTRACT:
BACKGROUND:
Preeclampsia is essentially an endothelial disease. Early- onset preeclampsia appears to be linked mainly to a failed placental vascular remodeling. Uterine artery Doppler is a validated noninvasive surrogate of trophoblastic invasion and placental perfusion.
OBJECTIVE:
To evaluate the predictive capacity of uterine artery Doppler investigation for maternal and neonatal complications in women with severe early- onset preeclampsia.
METHODS:
This prospective comparative study was carried out on sixty-five Iraqi pregnant women with severe early-onset preeclampsia. Their gestational age ranged from 28-34 weeks of gestation. A uterine artery Doppler examination was performed on admission to the participants. According to the result of Doppler ultrasound, they were arranged into two main groups: group one comprising twenty-nine patients with normal uterine artery Doppler results, and group two comprising thirty-six patients with abnormal uterine artery Doppler results. The maternal and neonatal outcome of women with abnormal uterine Doppler results was compared to those with normal Doppler results, and then results were analyzed accordingly.
RESULTS:
Sixty-five patients were enrolled in this study. In 53% of them, uterine artery Doppler results were abnormal. This group showed statistically significant lower birth weight (p = 0.003), higher caesarean section rate (p= 0.014), abnormal umbilical artery Doppler examinations (p=0.0001) and higher neonatal complications rate (P= 0.006). Regarding the maternal complications (HELLP syndrome, neurological manifestations, acute renal failure and pulmonary oedema), occurred at higher rate in the group with abnormal uterine artery Doppler compared with those having normal Doppler results (58.3% versus 37.9%), but only acute renal failure reached the statistical level of significance (P=0.017).
CONCLUSION:
Women with severe early-onset preeclampsia are at higher risk of maternal and neonatal complications if abnormal uterine blood flow is present. .

Direct Primary Trocar Insertion without Prior Pneumoperitoneum is a Safe, Feasible and Quick Laparoscopic Entry Technique

Jawad Kadhim S. Al-Dhahiry

Iraqi Postgraduate Medical Journal, 2014, Volume 13, Issue 1, Pages 18-24

ABSTRACT:
BACKGROUND :
In laparoscopic surgery, the primary (first) trocar entry is of a great importance because of it’s association with serious complications such as visceral and vascular injuries. There are several techniques for laparoscopic entry, the commonly used ones are Veress Needle (closed) and Hasson’s ( open ) techniqes. Recently, the Direct Primary Trocar Insertion (DPTI ) without prior pneumoperitoneum was reported as safe alternative laparoscopic entry technique .
OBJECTIVE:
This study assesses the safety ,feasibility ,complications and time of DPTI without a prior pneumoperitoneum in laparoscopic surgery.
PATIENTS METHODS:
This is a prospective study included 219 patients ,196 females ( 89.5 %) and 23 males (10.5 %), prepared for different laparoscopic procedures using only DPTI .Open laparoscopic entry ( Hasson’s technique ) was reserved for patients with associated small umbilical hernias or previous mid-line lapararotomy.Veress Needle ( VN ) and other methods of laparoscopic entry were not used.This study was performed in AL-Karama Teaching Hospital/ College of Medicine / Wasit University,IRAQ from April 2011 till July 2013 .Recorded data were : age,sex, indications for laparoscopic surgery,time of DPTI , laparoscopic entry related complications, conversion to laparotomy , length of hospital stay and the mortality.
RESULTS AND DISCUSSION:
DPTI technique was feasible in 208 patients (95%) while open laparoscopy was reserved for the remaining 11(5 %) patients . Conversion to laparotomy was done for 12 patients (5.47 %) . This study has no major complications nor deaths .
Immediate minor complications occurred in 7 patients (3.2%).Late minor complications occurred in 6 patients(2.7 %).Time of DPTI was 1.80 ± 0.64 SD minutes, P-value= 0.01 . The follow-up period ranged from 2- 27 months .
CONCLUSION:
DPTI entry is a safe alternative to the Veress Needle and other techniques of laparoscopic entry and creation of pneumoperitoneum. It has shorter laparoscopic entry time than the other laparoscopic entry techniques.

Identification of Nasal Bone Fracture by Ultrasonography Versus Plain Lateral X-Ray View

Islam Ghanem Mahmood; Ali A. Muttalib Mohammed

Iraqi Postgraduate Medical Journal, 2014, Volume 13, Issue 1, Pages 122-127

ABSTRACT:
BACKGROUND:
Although a physical examination is regarded as the gold standard for diagnosis of nasal bone fracture, adequate imaging of a nasal fracture is often required because of the legal consequences that can result from the injury's cause.
OBJECTIVE:
The aim of the present study is to compare the validity of ultrasonography versus plain lateral X-ray view of nasal bone in diagnosing different classes of nasal bone fracture.
METHODS:
This randomized clinical trial study included 117 patients presented with trauma to nose who consulted Otolaryngology Department at Aljamhory Teaching Hospital, Mosul, Iraq for the period from August 2008 to May 2009.
The results of plain lateral X-ray view and ultrasonography of the nasal bone were compared with the clinical findings after oedema has subsided completely which is the gold standard for evaluating the results.Moreover, accuracy rate, sensitivity, specificity, positive predictive and negative predictive values of both plain lateral X-ray view and ultrasonography were calculated.
RESULTS:
The accuracy rate, sensitivity, specificity, positive predictive and negative predictive values of plain lateral X-ray view in diagnosing nasal bone fracture were 76.6%, 81.8%, 62.5% ,85.7% and 55.5% respectively. Moreover, the accuracy rate, sensitivity, specificity, positive predictive and negative predictive values of utrasonography in diagnosing nasal bone fracture were 96.6%, 97.9%, 90.9% ,97.9% and 90.9% respectively.
CONCLUSION:
The use of ultrasounography in the diagnosis of different classes of nasal bone fracture was found to be superior to plain lateral X-ray view in accuracy rate, sensitivity, specificity, positive predictive and negative predictive values.

A Comparison of Using Ketamine Versus Combination of Ketamine and Thiopentone in Short Painful Procedures in Pediatrics

Iyad Abbas Salman; Saba J. AL-Wardi

Iraqi Postgraduate Medical Journal, 2014, Volume 13, Issue 1, Pages 103-109

ABSTRACT:
BACKGROUND:
Short painful procedures in pediatric age group like bone marrow aspiration (BMA) and biopsy taking are day case operations which demand rapid recovery and minimal incidence of postoperative complications.
OBJECTIVE:
To compare between intra & postoperative complications & the time of stay in the recovery room for pediatrics undergoing short painful procedures under general anesthesia with either "ketamine and thiopental" or "ketamine alone".
PATIENTS AND METHOD:
THIS IS A PROSPECTIVE RANDOMIZED clinical trial done in Children Welfare Hospital in Medical City, Baghdad, Iraq, from August - November 2010 on 89 children patients who were scheduled for short painful procedures. All patients were allocated randomly into 2 groups: the 1st group (KT) received I.V ketamine 1% (1mg/kg) plus I.V thiopental 1% 3-5 mg/kg (anesthetizing dose) on induction and maintained on intermittent I.V doses of thiopental 1% in case of need. While the 2nd group(K) received I.V ketamine 1% (1.5mg/kg) alone on induction and maintained on intermittent I.V doses of ketamine 1%(0.5mg/kg) in case of need. Any intra or postoperative complications & the duration of recovery for all patients were recorded.
RESULTS:
It was found that the intraoperative complications (temporary & mild decrease in arterial O2 saturation and its associated breath holding, & cough) occurred more in the KT group, while the occurrence of (mild involuntary movements and verbal responses) occurred more frequently in the K group. The postoperative complications (nausea, vomiting, verbal hallucinations and dizziness) occurred only in the K group. The duration of recovery is more prolonged in the (KT) group.
CONCLUSION:
The use of combination of thiopentone and ketamine is associated with more mild and temporary intraoperative decreased arterial oxygen saturation, breath holding, and postoperative cough than using ketamine alone, while the use of ketamine alone is associated with more mild involuntary movements and verbal responses, postoperative nausea &/or vomiting, hallucinations, and dizziness. The duration of recovery is prolonged by the use of thiopental.
KEY WORDS: ketamine, thiopental, TIVA, pediatrics, day case.

Comprative Study between LAT and Elisa in Detection of Toxoplasmosis in Groups of Women

Lazim H. Al-Taie; Abed. A. Al-Shaw; Yasser Sh. Mohammed

Iraqi Postgraduate Medical Journal, 2014, Volume 13, Issue 1, Pages 51-54

ABSTRACT:
BACKGROUND:
Toxoplasmosis is a zoonotic disease caused by the parasitic protozoan Toxoplasma gondii . This parasite is an obligate intracellular organism and is found in two forms in humans. widespread throughout the world, approximately half a billion humans have antibody to T. gondii.
OBJECTIVE:
This study aimed to compare the efficiency of two methods in diagnosis of toxoplasmposis in pregnant and non-pregnant women.
METHODS:
Blood samples were collected from 350 (15-46 year-old, 100 pregnant and 250 non-pregnant) females. Two serological methods were used: Latex agglutination test (LAT) and Enzyme linked immune-sorbent assay for IgM detection (ELISA).
RESULTS:
The study showed that 38.86% of women had given positive results for LAT, of which 31 were pregnant and 105 were non-pregnant, while only 14.28% of the total subjects had given positive results for ELISA.
CONCLUSION:
These results indicate that positive sera for LAT should be further investigate by more reliable method in order to confirm the infection with toxoplasmosis.

Remifentanyl Infusion Intraoperatively Decreased the Total Dose of Atracurium Required for Recipient in Renal Transplant Surgery

Alaa Hussein Altaee; Raghad Hannon Shinenalsudani

Iraqi Postgraduate Medical Journal, 2014, Volume 13, Issue 1, Pages 99-102

ABSTRACT:
BACKGROUND:
Renal failure is a disease characterized by loss of renal function and it affects all body systems.
Anasthesia for renal transplant recipient needs skill and care to manage the abnormal systemic presentation of patient.
Anesthetic plan is affected by renal failure and effects appear by anesthetic drugs choices, doses, and combination. This Anasthetic plan also affected by the cause of renal failure, drugs therapy, dialysis, and duration of disease.
OBJECTIVE:
To assess the effect of remifentanyl infusion on total dose of atracurium required during renal transplant surgery.
METHOD:
Between 1stJanuary-2011 to 1st February-2013, in renal transplant center, medical city-Baghdad-Iraq, and hundred patients had renal transplant. All patients had received midazolam (0.05Mcg/kg), fentanyl (1Mcg/kg), propofol sleeping dose (1-1.5mg/kg) and atracurium (0.6mg/kg) then intubated.
Fifty patients were maintained with isoflurane (0.5-1 MAC), boluses of atracurium. Other fifty had same maintenance with addition of remifentanyl infusion using infusion pump in dose of (0.05-0.1Mcg).
RESULT:
Group with remifentanyl needed less dose of atracurium than group without remifentanyl. Mean dose for group with remifentanyl was (1.255mg/kg) while for group without remifentanyl was (1.623mg/kg).
Mean time for surgery in both groups was approximately equal, in group with remifentanyl time was (172.16min), and other group was (174.16min).
CONCLUSION:
Remifentanyl infusion decrease the dose of neuromuscular blocking agents required and may abolish it but blood pressure and pulse rate should monitored carefully.

Uric Acid and Endothelial Dysfunction in Essential Hypertension

Zainab Abdul Razak AL-SharifiA; Halla Ghazi Mahmood

Iraqi Postgraduate Medical Journal, 2014, Volume 13, Issue 1, Pages 81-84

ABSTRACT:
BACKGROUND:
Uric acid can stimulate the synthesis of c-reactive protein, and that might be one of the mechanisms underlying the endothelial dysfunction. Several studies showed an independent link between UA and CRP suggest that chronic exposure to mild hyperuricemia may be a factor that contributes to micro inflammation and raised CRP in individual the essential hypertension.
OBJECTIVE:
To investigate the relationship between the serum uric acid, C-RP , total cholesterol and endothelial dysfunction in patient with essential hypertension.
PATIENTS AND METHODS:
Twenty patients with essential hypertension and fifteen apparently healthy subjects matched for age and weight have been included in this study,uric acid and total cholestrol were determined by enzymatic methods, high sensitivity C-reactive protein (HsCRP) enzyme immunoassyfor the quantitative determination in human serum was used.
RESULTS:
The data obtained showed that the serum levels of uric acid, C-Reactive protein and total cholesterol were significantly higher in patients with Hypertension than in healthy controls.
CONCLUSION:
The conclusion was that hyperuricemia in individuals with essential hypertension is associated with endothelial dysfunction.the hypothesis that uric acid plays a significant role in this alteration in humans.

Penetrating Carotid Artery Injuries

Abdul Salam Y Taha

Iraqi Postgraduate Medical Journal, 2013, Volume 12, Issue 1, Pages 96-103

ABSTRACT:
BACKGROUND:
Penetrating carotid artery injuries (PCAI) in civil time are infrequent, yet they present significant diagnostic and therapeutic challenges and can be associated with significant morbidity and mortality. Proper resuscitation and urgent exploration is necessary for actively bleeding patients.
OBJECTIVE:
The aim of this paper is to present our humble experience in management of such injuries with literature review.
PATIENTS AND METHODS:
Herein, we present 5 cases of penetrating carotid artery injuries managed in Sulaimania and Basrah from January 1996 to 30th of November 2009.
RESULTS:
All patients were young males. Three injuries were located in zone III and 2 in zone II. Four patients presented hours to days after the injury while the fifth presented after few months. Angiography was done in 2 patients with a false aneurysm of internal carotid artery (ICA). All 3 patients with ICA injuries were managed by ligation due to profuse bleeding and poor access. The 2 patients with common carotid artery (CCA) injuries in zone II had an end to end repair. All 5 patients have survived without significant neurological deficits.
CONCLUSION:
Penetrating carotid artery injuries in zone II usually do not require preoperative angiography unlike those in zone I and III. Repair is always desired. It is a straightforward operation for zone II injuries but really challenging for zone III due to poor access. Certain zone III injuries may be just observed or treated by endovascular stenting when facilities permit. Ligation of ICA carries a high risk of stroke; however, young people with well developed circle of Willis may tolerate it well

Genetic Treatment of Urological Diseases; are We Ready? (Review Article)

Ausama Saadi Abdul Muhsin

Iraqi Postgraduate Medical Journal, 2013, Volume 12, Issue 1, Pages 128-136

ABSTRACT:

There is an increasing interest in the role of genetics in many urological diseases and malfunctions. The door was opened for early diagnosis, application of genetically based armamentarium to prevent, treat or modify the clinical course as well as prediction of the prognosis of such abnormalities.
Many urologists share the idea that the use of a genetic tool to diagnose or treat their patients still has a long time before coming into a real clinical and surgical practice.
The purpose of this article is to briefly and simply review gene therapy, epigenetic therapy and stem cell therapy principles and prospects in the management of various urological disorders and to encourage standard urology centers' authorities in the Middle East countries to develop, share and improve their national experience which can serve genetic counseling and possible therapeutic management of their own patients to cope with the international revolution in this field

Extracorporeal Shock Wave Therapy for Chronic Planter Fasciitis Associated with Enthesophytosis

Nizar Abdul Lateef; Sami Salman; Ahmad Fahim

Iraqi Postgraduate Medical Journal, 2013, Volume 12, Issue 0, Pages 745-750

ABSTRACT:
BACKGROUND:
Painful heel is a common syndrome characterized by severe pain in the inferior or posterior aspect of the heel, which is aggravated by weight bearing, becoming progressively worse and often incapacitating, with evidence of a spur in about 50% of cases.
OBJECTIVE:
To evaluate the efficacy of extracorporeal shock wave treatment (ESWT) in calcaneal enthesophytosis (heel spur).
PATIENT AND METHODS:
Ninety four patients (66 women, 28 men) were examined who had heel pain associated with heel spur. A double blind randomised study was performed in which 52 patients underwent a standardized treatment (group 1) and 42 patients had sham treatment (group 2). Variations in symptoms were evaluated by visual analogue scale (VAS). Variations in the dimension of calcaneal spur were evaluated by x ray examination.
RESULTS:
A significant decrease of VAS was seen in group 1. Examination by x ray showed morphological modifications (reduction of the larger diameter >1 mm) of the enthesophytosis in 25 (48.1%) patients.
In the control group no significant decrease of VAS was seen. No modification was observed by x ray examination.
CONCLUSION:
Extracorporeal shockwave therapy is an effective, safe method that improves the signs and symptoms of most patients with a painful heel.
KEY WORDS: extracorporeal shock wave, plantar fasciitis, enthesopathy, heel pain, enthesophytosis.

Non Union of Diaphysial Humeral Fractures

Mohammed Ali F. Al Bayati; Naji Kareem Hasaan; Mahmood; Lauy Assad

Iraqi Postgraduate Medical Journal, 2013, Volume 12, Issue 0, Pages 716-720

ABSTRACT:
BACKGROUND:
Humeral shaft fractures represent 3-5% 0f all fractures mostly heal by conservative methods ,frequently few fractures fail to unite , several fixation modalities have been used with types of bone graft .
OBJECTIVE:
To analyze the local and environmental factors of 44 patients having non union of diaphysial humeral fractures and the result of treatments by open reduction and fixation with plate and screws and autogenous bone graft application .
METHODS:
Retrospective and prospective study of forty four patients had non union of the daiphysis of the humerus, 34 males ,10 females, age ranged from 18-61, 29 had open injuries , 15 had closed injuries . All patients treated by rigid fixation with plate and screws and ample amount of autogenous bone graft. Follow up from 6-24 months .
RESULTS:
40 patients had good results in clinical and radiological union of their humeri , in four patients the bone fail to unite ,graft resorbed with or without plate failure.
CONCLUSION :
Sever injuries with soft tissue damage is a major cause of nonunion and rigid fixation by plate and screws with autogenous bone graft is a good optional method of treatment when other modalities are not available .
.

Complications of Bone Marrow Aspiration and Biopsy: a New Unexpected Ris

Najlaa Badr Alawadi

Iraqi Postgraduate Medical Journal, 2013, Volume 12, Issue 0, Pages 712-715

ABSTRACT:
BACKGROUND:
Bone marrow examination represents an essential tool for diagnosis and monitoring of haematological and non-haematological disorders. Although some hazards are recognized, bone marrow aspiration and trephine biopsy are generally thought to be safe procedures.
OBJECTIVE:
The aim of this study is to identify the possible complications associated with the bone marrow aspiration and biopsy procedures.
METHODS:
In this study, 2156 cases of bone marrow aspiration with or without trephine biopsy were done in Merjan Teaching Hospital, Babil governorate, Iraq during a five year period from 1st Feb 2006 to 1st Feb 2011. These procedures were done under local anesthesia. The complications associated with these procedures were reported.
RESULTS:
A new previously unreported complication was seen in 2 patients as they developed sudden apnea and loss of consciousness.
The final diagnosis in both patients was acute lymphoblastic leukemia with huge mediastinal widening and they were lying in prone position during the procedure.
Bleeding was seen in 2/2156 (0.09%) cases. Prolonged pain was documented in one case. No infection was reported.
CONCLUSION:
Bone marrow examination is generally safe, however apnea and loss of consciousness can occur in patients with a huge mediastinal mass compressing trachea and/or major chest vessels when the procedure is done in prone position.
KEY WORDS: Bone marrow aspiration.

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

Molecular Analysis of Class II HLA-DRB Polymorphism

Haider Hashim Zalzala

Iraqi Postgraduate Medical Journal, 2013, Volume 12, Issue 0, Pages 760-764

ABSTRACT:
BACKGROUND:
Major Histocompatibility Complex (MHC) system is a polymorphic system and the extensive polymorphism of MHC gene in human and the allelic distribution in different ethnic population become a key component in investigating the genetic relations between populations. Geographical variety is one of the factors that affect HLA polymorphism.
OBJECTIVE:
This study is designed to study class II HLA-DRB polymorphism in Iraqi populations by molecular method.
METHODS:
Seventy four healthy Arab Iraqi populations were enrolled in this study
during the period between November 2012 till April 2013. Direct interview was done with the populations and HLA typing was done by molecular method using Sequence Specific Primer (PCR-SSP) method using One Lambda Kit-USA.
RESULTS:
The most frequent alleles are DRB1*03,*11,*07 with a frequency of (0.47, 0.41, and 0.26) respectively. There are no significant difference between male and female regarding non-DRB1 alleles.
CONCLUSION:
1- The most frequent alleles in Arabic Iraqis populations are DRB1*03,*11, and *07.
2- Gender is not a significant factors affecting the frequencies and hetro- or homozygosity for the nonDRB1 alleles in adults.
KEY WORDS: HLA-DRB1, HLA polymorphism .

Clinical and Sequential Histopathological Study of Scabietic and Postscabietic Nodules

Khalifa E. Sharquie; Sabeeh A. Al-Mashhadani; Adil A. Noaimi; Wissam M. Katof

Iraqi Postgraduate Medical Journal, 2013, Volume 12, Issue 0, Pages 693-699

ABSTRACT:
BACKGROUND:
Scabietic nodules are common problem seen before and after effective therapy of scabies that might persist for months.
OBJECTIVE:
To evaluates the clinical and histopathological features of these nodules during their sequential course.
PATIENTS AND METHODS:
Patients with scabietic nodules were enrolled in this study. Five (14.7%) patients had active scabies at the time of consultation. All recruited patients had personal and family history of treated scabies with persistent itchy nodules. Patients were fully examined for: sites, numbers and sizes of the persistent scabietic nodules. Histopathological evaluation was done from nodules in patients with active scabies before therapy and at different times during the course of the post-scabietic nodules .
RESULTS:
Thirty four male patients were studied with mean age (34.41±16.72) years. The lesions were more prevalent in young adult age group 20-29 (24.5±2.9) years. The nodules had persisted for a period ranged from 1-52(13.47±14.29) weeks. Intolerable itching was evident in all these nodules but without the nocturnal accentuation. The number of nodules ranged from 1-35(8.5±6.8) lesions. These nodules were more heavily involving: scrotum in 20(28.57%) patients and penile shaft 19 (27.14%), and less commonly involving the upper thigh, lower abdomen, axilla and penile corona. Differential white blood cells count revealed normal eosinophilic count in all patients with post scabeitic nodules, while high values were observed in 4out of 5 patients with active scabies.The histopathology of scabietic and post-scabietic nodules revealed: acanthotic epidermis with mild spongiosis, pseudoepithelial hyperplasia present in 2(5.8%) nodules. The infiltrate was mainly diffuse (papillary and reticular dermis) dense lymphocytic in 29 (85.2%) nodules and even in early stages, the density of the infiltrate decline when the nodules persisted more than 6 months. Scattered eosinophils were present in the dermis of all nodules regardless the age of nodule. Mild lymphocytic vasculitis recognized in 3 (8.8%) nodules in patients with short duration (3-9 weeks). Granulomatous reaction with Langhans giant and epitheliod cells was another important finding in4 (11.7%) nodules.
CONCLUSION:
Scabietic nodules tend to affect male adult with a predilection to the scrotum and penile shaft. The histopathological pictures consisted mainly of acanthotic epidermis and diffuse dense dermal lymphocytic infiltrate in 85% of scabietic nodules. No mites or mite parts could be detected. Lymphocytic vasculitis and granulomatous reactions present in few nodules.

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.

Factors Affecting Intra-Cytoplasm Sperm Injection (ICSI) and Pregnancy Outcome in the Fertility Center of Al – Najaf City

Basima Shamkhi Al; Ghazali; Dalal Mahdi Al-Jarrah

Iraqi Postgraduate Medical Journal, 2013, Volume 12, Issue 0, Pages 706-711

ABSTRACT:
BACKGROUND:
Knowing predictors of pregnancy in IVF is helpful for clinicians to individualize the treatment plans and improve patient counseling and for patients to decide whether to undergo infertility treatment.
OBJECTIVE:
A prospective and retrospective study to determine the factors affecting results and outcome of Intra-Cytoplasm Sperm Injection (ICSI) ICSI in the treatment of sub-fertile patients and the pregnancy outcome.
PATIENTS AND METHODS:
140 couples underwent IVF cycle in the form of intra-cytoplasm sperm injection ICSI enrolled in the study, pregnancy rate was analyzed according to the age, type, cause and duration of sub-fertility, hormonal assay, endometrial thickness, type of treatment protocol, number of retrieved oocytes, number of embryos transferred and sperm parameter.
RESULTS:
From the total of 140 women, 23 (16.43%) were cancelled, among 117 cycle, the pregnancy rate was 25.27%, fertilization rate was 39.87%. Factors which significantly affect the outcome of ICSI included the age of the women as fertility decline with advanced age, type and causes of sub-fertility. Sperm quality was more important than sperm number, and the number of embryos transferred also affect pregnancy outcome.
CONCLUSION:
Multiple factors affecting ICSI outcome, the most important one is female age, The cause and type of sub-fertility also affect the outcome.
KEY WORDS: intracytoplasm-sperm injection (ICSI)

A Prospective Randomized Controlled Study of Phototherapy Using Blue LED and Conventional Phototherapy in Neonatal Hyperbilirubinemia

Nada Ail Ahmed AL-Ali; Ghaith Wadah Hamdoon

Iraqi Postgraduate Medical Journal, 2013, Volume 12, Issue 0, Pages 668-674

ABSTRACT:
BACKGROUND:
High intensity light emitting diodes (LEDs) are being studied as possible light sources for the phototherapy of neonatal jaundice, as they can emit high intensity light of narrow wavelength band in the blue region of the visible light spectrum corresponding to the spectrum of maximal bilirubin absorption. We used a new blue gallium nitride LED phototherapy unit with high intensity, and compared its efficacy to commercially used halogen quartz phototherapy device. The prototype device with two focused arrays, each with 20blue LEDs, generated greater irradiance than the conventional device tested.
OBJECTIVE:
To determine the efficacy of blue LED light versus conventional phototherapy lamp in treatment of neonatal jaundice.
PATIENTS AND METHODS:
A total of 101 jaundiced otherwise healthy, term and preterm neonate who had hyperbilirubinemia were prospectively randomized to either LED (n=57) or conventional phototherapy (n=44). Entry criteria to phototherapy followed the American Academy of Pediatrics’ Practice Parameter.
RESULTS:
One hundred and one neonate were included in this study , the mean rate of TSB lowering increase with increase age was significant in LED group (p value =0.000), according to the maturity the mean rate of TSB lowering increase with increase age also was significant in LED group (p- value= 0.000), no significant correlation was found in regarding birth weight and rate of lowering of TSB (P=0.263),there where a significant correlation between mean rate of TSB lowering and initial TSB level in LED group(P-value= 0.000 )and lastly there was a significant higher rate of lowering of TSB in LED group than those with conventional one.
CONCLUSION:
A blue LED phototherapy unit showed higher efficacy in bilirubin photodegradation compared to that of commercially used halogen quartz phototherapy device. And a significant correlation between the rate of lowering of TSB and each of (age, maturity , weight and initial TSB level) in the two groups. Additional studies will be necessary to prove its clinical efficacy.
.