Keywords : KEYWORDS


Value of Magnetic Resonance Cholangiopancreatography Signs in the Detection of Choledocholithiasis

Farah Saad Ahmed; Alaa Saud Sali; Mohammed Abd Kadhim

Iraqi Postgraduate Medical Journal, 2018, Volume 17, Issue 2, Pages 157-163

ABSTRACT:
BACKGROUND:
Common bile duct stones may be small or large, single or multiple, the incidence increases with age. Biliary stones present almost always as low signal intensity on MR images. Therefore, the stone is identified as a round or oval- shaped "signal void" within the common bile duct (CBD), surrounded by the high signal intensity bile, CBD stone can present as sharp cutoff of a CBD at the ampulla, often with a well-marginated “meniscus” configuration, CBD stone may be associated with CBD dilatation and/or dilated intrahepatic biliary tree.
OBJECTIVE:
To evaluate MRCP signs in detecting CBD stones in patients with obstructive jaundice.
PATIENTS AND METHODS:
The study included 50 patients with jaundice suspecting to have CBD stones as a cause of their complaint ,MRCP parameters include: CBD diameter, meniscus sign ,Status of intrahepatic and extrahepatic ducts, Gall bladder status, Pancreatic duct status Statistical analyses for the results were done.
RESULTS:
MRCP diagnose choledocholithiasis in 49(98%) out of 50 patients with a sensitivity of 98%, Accuracy =98%, the specificity of MRCP in diagnosing choledocholithiasis in our study was 95%, P value= 0.001. MRCP show filling defect in 31 patients (3 of them show multiple filling defects) giving Accuracy =62%, sensitivity rate 62%, specificity rate 90%, P value= 0.0001. MRCP show meniscus sign in 18 patients giving Accuracy =36%, sensitivity rate 36%, specificity rate 95%, P value= 0.0001. MRCP show CBD dilatation in 48 patients giving Accuracy =96%, sensitivity rate 96%, specificity rate 95%, P value= 0.001.
CONCLUSION:
MRCP is a non–invasive investigation with high sensitivity, specificity, positive and negative predictive values in detection of CBD stones. Gathering well-defined radiological signs of CBD stones in MRCP allows good diagnostic accuracy. CBD dilatation is the more sensitive sign of detecting CBD stone while meniscus sign is more specific sign for detecting CBD stone in MRCP.
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Role of Lymph Node Biopsy in the Diagnosis of Children with Lymphadenopathy (Single Surgeon Experience)

Kawthar Fakhri Khalaf

Iraqi Postgraduate Medical Journal, 2018, Volume 17, Issue 2, Pages 199-203

ABSTRACT:
BACKGROUND:
Assessment of lymphadenopathy in children represents a diagnostic challenge because of the extensive differential diagnoses, including reactive and malignant conditions.
OBJECTIVE:
To determine the role of lymph node biopsy in the diagnosis of lymphadenopathy in paediatrics age group
PATIENTS AND METHODS:
A cross sectional study was carried out on 92 patients (males 56 and 36 females) with lymphadenopathy admitted to paediatric surgery unit at Children Welfare Teaching Hospital – Medical City Complex – Baghdad in the period between January 1st. 2010 to December 31st. 2016; for biopsy to reach final diagnosis.
Patients were referred from general wards, paediatrics outpatient clinic and oncology unit.
Data regarding patient name, age, gender, signs and symptoms, site of lymph nodes, size of lymph node, duration of enlargement, investigation, types of biopsy, and mode of treatment were collected and reviewed form patients files.
All patients underwent excisional biopsy and the diagnosis was confirmed by histology and through various specific investigations.
RESULTS:
Among the total 92 lymph node biopsies, the most common pathology encountered was reactive hyperplasia in 68 child (74 %) followed by malignant lymphoma (Non- Hodgkin and Hodgkin) in 15 children (16.3%), followed by tuberculosis in 3 (3.3%).The rest of the lesions include: 1 case of granulomatous lymphadenitis (1%), 2 of histiocytosis X (2%), 2 (2%) of rhabdomyosarcoma, and 1 of germ cell tumour (1%).
Common site of lymph node enlargement was cervical in (97%) of patients.
CONCLUSION:
Cervical lymphadenopathy is a common condition in the paediatric age group. In spite that most common cause of lymphadenopathy was reactive hyperplasia. Lymph node biopsy remains an important diagnostic tool in persistent lymph node enlargement and if malignancy is suspected.
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Focused Abdominal Sonography for Trauma (Fast) At the Emergency Department of Kirkuk General Hospital

Mohammed A. Younus; Saad M. Attash; Khalid A. Al-Dabbagh

Iraqi Postgraduate Medical Journal, 2018, Volume 17, Issue 2, Pages 188-192

ABSTRACT:
BACKGROUND :
Blunt abdominal trauma (BAT) is a diagnostic challenge. The introduction of bedside ultrasound provides another diagnostic tool for the emergency physician (EP) to detect intra-abdominal injuries.
OBJECTIVE:
To assess the benefits of FAST in the evaluation of patients with blunt abdominal trauma in the emergency department of Kirkuk General Hospital in Kirkuk.
PATIENTS AND METHODS:
This was a prospective study including100 consecutive cases of blunt abdominal trauma in the emergency department of Kirkuk General Hospital in Kirkuk. The results of FAST scans were analyzed and compared with operative findings, diagnostic laparoscopy and CT scanning when the FAST was positive or followed by a period of clinical observation when the FAST was negative. Descriptive statistics, sensitivity, specificity, and predictive values were calculated.
RESULTS :
There was a 100 consecutive blunt abdominal trauma cases during 9 months period, and FAST scans were performed in these cases. The sensitivity and specificity were 92% and 93.3%, respectively. The negative predictive value was 0.97, while the overall accuracy was 93%.
CONCLUSION:
The high specificity of FAST (93.3%) makes it a good ‘rule in’ tool for BAT patients. The high negative predictive value also makes the FAST scan a useful screening tool. However, ultrasound examination is operator dependent, and FAST scan has its own limitations.
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Assessment of Interleukin-8 in Patients with Chronic Lymphocytic Leukemia in Correlation with the Prognostic Factors: β2-microglobulin, LDH and Binet Stage

Haithem Ahmed AL-Rubaie; Safaa Jasim Mohammed

Iraqi Postgraduate Medical Journal, 2018, Volume 17, Issue 2, Pages 131-136

ABSTRACT:
BACKGROUND:
Chronic lymphocytic leukemia is a malignancy of mature B cells characterized by progressive lymphocytosis, lymphadenopathy, splenomegaly, and cytopenia. The progressive accumulation of leukemic cells is a consequence of defective apoptosis and survival signals derived from the microenvironment.
OBJECTIVE:
Is to assess the levels of interleukin-8, 2-microglobulin and lactate dehydrogenase in chronic lymphocytic leukemia patients and evaluate the prognostic value of interleukin-8 in correlation with 2-microglobulin, lactate dehydrogenase and Binet stage.
PATIENTS AND METHODS:
A case-control study enrolled 40 newly diagnosed chronic lymphocytic leukemia patients attended at Oncology Teaching Hospital, Medical City with 40 adult healthy volunteers as a control group. Interleukin-8, 2-microglobulin and lactate dehydrogenase were investigated.
RESULTS:
There were statistically significant relationships between Binet staging and each of following: plasma level of interleukin-8, serum level of 2-microglobulin and lactate dehydrogenase and (P= 0.005, 0.005 and 0.023, respectively). There were significant correlations between 2-microglobulin and both interleukin-8 and lactate dehydrogenase level (P= 0.005, both) but correlation between interleukin-8 and lactate dehydrogenase was insignificant.
CONCLUSION:
Interleukin-8 level was positively correlated with 2-microglobulin, and higher plasma levels were associated with advancing Binet stage which makes it a reliable marker for patients at late clinical stage.

Pleural Fluid C-Reactive Protein in the Differential Diagnosis of Infectious and Malignant Pleural Effusion at Baghdad Teaching Hospital (Single Center Study).

Iraqi Postgraduate Medical Journal, 2018, Volume 17, Issue 1, Pages 22-29

ABSTRACT:
BACKGROUND:
C-reactive protein (CRP) is an acute phase reactant produced primarily by hepatocytes; its production is stimulated by systemic inflammation of either infectious or noninfectious origin. The cytokines that are released during the inflammation are the main stimulants of the acute phase reactants. Interleukin-6 is the main stimulant cytokine of the synthesis of most acute-phase reactants.
OBJECTIVE:
To differentiate between infectious and malignant pleural effusions by measuring pleural fluid CRP titer.
MATERIALS AND METHODS:
This was a hospital-based cross-sectional study at Baghdad teaching hospital medical wards conducted from the 1st of November 2014 up to the 31th of august 2015.
Fifty patients with pleural effusion proved by the history, examination,
Chest imaging and pleural tapping included in this study, all proved to have
An exudative pleural effusion by the light criteria.
RESULTS:
Showing statistically significant differences in CRP titer between:-
1-Parapneumonic pleural effusion (PPE) and malignant pleural effusion (MPE)
2-TB pleural effusion (TBPE) and malignant pleural effusion (MPE).
CONCLUSION:
Pleural fluid C-reactive protein titer can be used as an aid in the differentiation between some infectious causes of pleural effusion and malignant pleural effusion as there is a statistically significant difference between the Pleural fluid C-reactive protein titer of the infectious pleural effusion and the malignant pleural effusion.
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Evaluation of the Role of Epley's Manoeuver in the Treatment of Benign Paroxysmal Positional Vertigo Without Nystagmus

Qutaiba Kamal Ali; Ali Jabar Falih; Firas Baheej Abdul Aema

Iraqi Postgraduate Medical Journal, 2018, Volume 17, Issue 1, Pages 12-16

ABSTRACT:
BACKGROUND:
Epley's manoeuver can give satisfactory and long lasting relief of symptoms in patients with typical history of benign paroxysmal positional vertigo without nystagmus in Dix-Hallpike positional test.
OBJECTIVE:
To evaluate the effectiveness of Epley's manoeuver in those patients with typical history of benign paroxysmal positional vertigo without nystagmus in Dix-Hallpike positional test.
MATERIAL AND METHOD:
Ninety six patients with benign paroxysmal positional vertigo(37 of them males and 59 females).With Dix-Hallpike positional test 58 patients had nystagmus(objective benign paroxysmal positional vertigo) and 38 patients had no nystagmus (subjective benign paroxysmal positional vertigo), was carried out comparism of Epley s manoeuver in both groups.
RESULTS:
There was significant improvement of symptoms (87%) by Epley's manoeuver in patients who had benign paroxysmal positional vertigo without nystagmus.
CONCLUSION:
Epley's manoeuver can give good result in relieving of vertigo in patients with typical history of benign paroxysmal positional vertigo even if no nystagmus can be detected in Dix-Hallpike test.
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MRI Assessment of Liver and Cardiac Iron Concentrations in Some Patients with Beta Thalassemia Major

Ammar Mosa Jawad; Mohammed Abd kadhim; Mohssin Abd Ali Hussain; Zainab Kassim Al-Jobouri

Iraqi Postgraduate Medical Journal, 2018, Volume 17, Issue 1, Pages 82-90

ABSCTRACT:
BACKGROUND:
Iron overload is a major concern in blood transfusion dependent beta-thalassemic patient and it is a major cause of cardiac dysfunction. Magnetic resonance imaging T2* has a vital role in liver and cardiac iron deposition and assessment of its severity
OBJECTIVE:
To highlight the role of MRI T2* in assessment of liver and cardiac iron deposition and assessment of other methods of liver and cardiac iron concentration estimation.
PATIENTS AND METHODS:
This cross sectional prospective study had been conducted at the MRI unit of Al-Imamain AL-Khadimain medical city, Baghdad/ Iraq, from December 2015 to December 2016. One hundred, blood transfusion dependent beta-thalassemia major patients had been examined by MRI using T2* images to assess its value which had been changed to liver iron concentration and cardiac iron concentration by using a MEDIS software program.
RESULTS:
One hundred patients (56 male and 44 female) of transfusion dependent beta-thalassemia major had been evaluated for their liver and cardiac T2*, 17 of them shows a mild LIC (liver iron concentration) and normal MIC (myocardial iron concentration), 49 patients show mild increase in both LIC and MIC, 9 show moderate LIC and mild MIC, 16 show moderate both LIC and MIC, 2 show severe LIC with mild MIC, only one shows severe LIC with moderate MIC and 6 of them show severe both LIC and MIC. There is a positive significant correlation between liver T2* and cardiac T2* (P values of 0.017), between liver T2* and LIC (P value of > 0.001), between liver T2* and MIC (P value of 0.031) and that between cardiac T2* and MIC (P value is >0.001). There is non- significant correlation between the age and frequency of blood transfusion with LIC and MIC (P value <0.05). There is also a significant negative correlation between S.ferritin and liver T2*and cardiac T2* (correlation coefficient of -0.251 and -0.397 respectively), with a (P value of 0.014 and 0.00015 respectively). There is non significant correlation between S. ferritin and the severity of LIC and MIC (P value of 0.129 and 0.792).
CONCLUSION:
Magnetic resonance imaging has a vital role as a non-invasive and reliable method in the assessment of liver and cardiac iron deposition in patients with blood transfusion dependent beta-thalassemia major. There is no correlation between S.ferritin level and the severity of LIC and MIC. Patients using Exjade show a lower LIC and MIC than those using Desferal. No correlation between age and frequency of blood transfusion with LIC and MIC in patients on regular chelation.
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The Value of Assessment of Intraepithelial Lymphocytes Count in Surface Epithelium of Duodenal Biopsies for the Diagnosis of Celiac Disease with the use of CD3 T-Cell Marker

Hanan Hussein Mohammad; Mustafa Ali Abd-AL Hussein; Nihad Salih Rahmatalla

Iraqi Postgraduate Medical Journal, 2018, Volume 17, Issue 1, Pages 100-108

ABSTRACT:
BACKGROUND:
Coeliac disease (CD) is a chronic reversible enteropathy . Increased intraepithelial infiltrate, crypt hyperplasia, and villous atrophy are the three basic features of coeliac enteropathy.
OBJECTIVE:
The aim of this study was to evaluate the cutoff value number of intraepithelial lymphocyte count needed for the diagnosis of CD , this is supported by the use of CD3 T-cell immunohistochemical staining.
PATIENT AND METHODS:
This is a retrospective study including 25 duodenal biopsies , the cases were divided into three groups, 11 patients their biopsies show only early celiac changes supported by 9 biopsies show histological features of advanced CD, and 5 duodenal biopsies diagnosed as duodenitis.
All paraffin embedded sections were stained with H&E stain and with immunohistochemicalmarker(CD3).
RESULTS:
Mean age of all subjects was 19.5 years. Mean age of control group was 11.8 years. Mean age of patients with early changes was 21.8 years. Mean age of patients with celiac disease was 21.5years. There was no significant difference in mean age and sex among the three groups.
Mean IEL in celiac disease was 63.1, while it was 38.7 in patients with early changes. Mean IEL in control group was 11.6.
The least cutoff count of IEL/100enterocyte to segregate our sample into those with definite celiac disease and those who are free of disease was 20 IEL/100 enterocytes with 100 % specificity and 100% sensitivity.
CONCLUSION:
Mean IEL was significantly higher in celiac disease than in patients with duodenitis and those with early changes of celiac disease
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Assessment of the Motives for Voluntary Blood Donation in the Donors of Iraqi National Blood Bank in Baghdad

Hanin Jomaa Kalefa; Waleed A. Omar; Assal Raad; Samar Ahmed Abdelsahib

Iraqi Postgraduate Medical Journal, 2018, Volume 17, Issue 1, Pages 45-48

ABSTRACT:
BACKGROUND:
Understanding the factors that motivate donors to donate blood will facilitate improvement in recruitment programs. Highlighting aspects of blood donation that are particularly motivating or attractive is important to both induct first-time donors and enable repeat donors to continue their donation behavior.
OBJECTIVE:
Assessment the motives for voluntary blood donation in the donors of Iraqi National Blood Bank through the study of sample of these donors.
DONORS AND METHODS:
This study conducted in the Iraqi National Blood Bank-Baghdad, in the period from November 2015 to February 2016. The persons who included in the study were voluntary donors, conveniently included in the study. A special form was prepared for each donor and a questionnaire is performed to fill the form.
RESULTS:
The study included 208 blood donors; the mean of age was 35.4 years with range of 18 to 60 years. One hundred and ninety eight (95%) donors were males while 10 (5%) females and Males: Female was 19.8:1. Forty donor (19%) donated the blood for the first time (first time donor) while 168 donors (81%) donated blood for more than one time.
The most common motive for blood donation as general, was humanity which was the motive in 89 donors (42.8%), followed by polycythemia (increased blood) which was the motive in 67 donors (32.2%), while patriotic motive was in 31 donors (14.9 %), followed by emergency motive in 14 donors (6.7%) while high blood pressure was the drive in 7 donors (3.4%).
CONCLUSION:
Most of the donors were in the forth decade of life and the majority were males. The most common motives for voluntary donation were humanity, increased blood, patriotic, emergency and high blood pressure
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A Descriptive Study of Erythrocytosis Post Kidney Transplant, A Single Center Experience

Mohammed Hannon Al-Sodani

Iraqi Postgraduate Medical Journal, 2018, Volume 17, Issue 1, Pages 72-81

ABSTRACT:
BACKGROUND :
Post Transplant Erythrocytosis (PTE) is relatively a common complication following renal transplantation, occurs in 8 to 15 percent of renal transplant recipients ,it is mainly due to adequate production of erythropoietin by the transplanted graft and elimination of bone marrow inhibitors attending the uremic symptoms.
OBJECTIVE:
This study was conducted to know the prevalence, manifestation , and risk factors of Post Transplant Erythrocytosis (PTE).
PATIENTS AND METHODS:
This is an observational retrospective study enrolled 290 patients who underwent kidney transplantation and followed up at The Nephrology and kidney transplantation Center, Medical City Baghdad , The data used in this study were collected from the patients, their medical records and from the laboratory. The follow up period was from the third months post transplant to the end of first year. These data include ( name, age, sex ,weight, etiology of chronic renal failure, duration of hemodialysis before transplantation, the use of erythropoietin stimulating agent, living kidney donor (related or unrelated), The use of basilixmab or Anti Thymocyt Globulin) at induction, the calcineurine inhibitor ( cyclosporine or tacrolimus), the occurrence of acute rejection, the type of antihypertensive used post transplant .Laboratory data include ,hemoglobin level, red blood cells packed volume, serum creatinine .
RESULT :
Twenty three patients (7.9%) had erythrocytosis post kidney tranplantation with Hemoglobin level of 17.5 g/dl (17 -17.9) and PCV of 54 % (52.1 – 54.4). Only two patients (8.7 % ) had cerebrovascular accident. From the non transplant related parameters, hypertension was significantly associated with PTE ( P Value of 0.026 ). While the others ( age , gender, weight , etiology of the ESRD and the duration of dialysis) showed no significant association. From the transplant related parameters, low serum creatinine (0.8-1.2mg/dl) showed significant association with PTE (P value <0.0001). Also both hypertension and the use of Beta blocker shows significant association (P value <0.05)
CONCLUSION:
Post transplant erythrocytosis occurs in about eight percent of kidney transplant recipient, it may be asymptomatic or complicated by thrombotic event, and it is associated with lower serum creatinine and hypertension.

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The Early Detection of Subclinical Left Ventricular Diastolic Dysfunction in Iraqi Women with Polycystic Ovarian Syndrome

Ismail Ibrahim Hussain; Suaad Muhssen Ghazi; Henan Dh. Skheel

Iraqi Postgraduate Medical Journal, 2018, Volume 17, Issue 1, Pages 49-57

ABSTRACT:
BACKGROUND:
The left ventricular diastolic dysfunction (LVDD) in asymptomatic patients with polycystic ovarian syndrome (PCOS) has been documented by both pulsed wave Doppler and tissue Doppler echocardiography.
OBJECTIVE:
The aim of this study was to identify the earliest asymptomatic impairment of the left ventricular diastolic dysfunction in polycystic ovarian syndrome women.
PATIENTS AND METHODS:
This study is conducted by the Department of Physiology, College of Medicine, Al-Mustansiriya University in cooperation with the unit of Infertility and unit of Echocardiography at Al-Yarmook teaching hospital in Baghdad during the period from December 2015 to April 2017. A total number of 150 subjects were included in this study, 50 healthy subjects (control group) and 100 patients with polycystic ovarian syndrome with (mean age and standard deviation of 28.27 ± 7.27 years). Pulsed wave blood flow Doppler and tissue Doppler imaging were used for estimating left ventricular diastolic dysfunction.
RESULTS:
11% of the 100 PCOS women showed evidence of left ventricular diastolic dysfunction through impairment of mitral valve annular velocities and in the filling velocities of the left ventricle by pulsed wave Doppler, the ratio of peak early (E) filling velocity to the late (A) filling velocity (E/A ratio) was significantly lower in polycystic ovarian syndrome women with left ventricular diastolic dysfunction (0.780.17). By TDI the ratio of early (e՛) mitral annular velocity to the late (a՛) mitral annular velocity (e՛/a՛ ratio) was significantly reduced in polycystic ovarian syndrome women with the left ventricular diastolic dysfunction. Body mass index, waist circumference, waist-to-hip ratio, fasting blood sugar, fasting insulin, serum cholesterol, serum triglycerides, low density lipoprotein, very low density lipoprotein and homeostasis model assessment of insulin resistance were higher in polycystic ovarian syndrome group with left ventricular diastolic dysfunction.
CONCLUSION:
Diastolic dysfunction can develop early in patient with PCOS, and might be an early signal for cardiac involvement in this patient population.
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Hepatitis Screen in Children with Malignancy at Al-Emamain Al-Kadimain Medical City

Sawsan Sati Abbas; Ali Saadi Salih

Iraqi Postgraduate Medical Journal, 2018, Volume 17, Issue 1, Pages 64-71

ABSTRACT:
BACKGROUND:
Transfusion-transmitted infections continue to be a threat to the safety of the blood supply, in particular the risk is high for parent rally transmitted viral hepatitis in pediatric malignancy.
OBJECTIVE:
The aim is to estimate the prevalence of hepatitis in children with malignancy, identify some variables that could affect the prevalence of hepatitis in these patients, and to have an idea about the effect of vaccination in controlling hepatitis infection.
PATIENTS AND METHODS:
A cross sectional study was done over ten months period between December 1st, 2013 to September 30th, 2014 at the Pediatric Oncology Unit in Al- Emamain Al -Kadimain Medical City, A total of (54) children between the age of [1-15] years with malignancy who were diagnosed and treated at the pediatric oncology department before 6 months and more were studied. Information regarding age, gender ,residence, hepatitis vaccine received ,number of blood transfusion ,any surgical intervention for solid tumors and lymphoma was done, history of hepatitis screen at diagnosis were taken from hospital record and pediatric oncology consultation clinic files ,re- evaluation of hepatitis screen were done through with screen for HBs Ag , Anti HCV. Among those children with malignancy, testing for HBV and HCV were done through blood samples taken from the patients and sent to lab. of the hospital.
RESULTS:
From (54) patients with malignancy, 46 patients were with hematological malignancy(85%) and 8 cases(15%) with solid malignancy, from them 8 (14.8%) cases were HBV positive and 4 (7.4%) cases with HCV positive. Most of the patient were from Baghdad 37 cases (68.5%), male to female ration(1.7:1) and also most dominant age group was from (4-9 year).The number of blood transfusion had significant positive impact on prevalence of hepatitis virus infection , and also the vaccine status had significant positive influence.
CONCLUSION: There is a low frequency of HBV &HCV infection in patients with malignancy treated in Al-Emamain Al- Kadimain Medical City with lower incidence of HCV infections than HBV.
Blood transfusions (more than 3 times) is significantly increasing the incidence of HBV infection and HBV vaccine is significantly reducing the incidence of HBV infection.

A Comparison of Bupivacaine Instillation and Ultrasound Guided Field Block for Post-Operative Pain Relief in Inguinal Hernia Repair

Ali Moayed Jwad; Iyad Abbas Salman

Iraqi Postgraduate Medical Journal, 2017, Volume 16, Issue 3, Pages 248-251

ABSTRACT:
BACKGROUND:
Postoperative pain is a common problem after inguinal hernia repair. Postoperative pain may delay the return to normal activity and delay hospital discharge. Various techniques have been employed to provide postoperative analgesia, by the use of regional anesthetic technique, local anesthesia or traditional analgesic technique: opiates, non-steroidal anti-inflammatory drugs (NSAIDs) or combinations.
OBJECTIVE:
To compare the postoperative pain relief provided by simple bupivacaine wound instillation and ultrasound guided inguinal hernia field block.
PATIENT AND METHOD:
A single blind, prospective, randomized controlled clinical trial for 72 male patients who were undergoing elective unilateral inguinal hernia repair. In 37 of them 10 ml of 0.5% plain bupivacaine was instilled (irrigated) into the wound by the surgeon for 1 minute. In another 35 patients, ultrasound guided field block performed using 20 ml of 0.25% plain bupivacaine at the end of surgery. Vital signs, numerical pain score and analgesia requirement were recorded at recovery (zero hour), 1st, 2nd, 4th& 8th hours postoperatively.
RESULT:
By applying null hypothesis, using the t-student test of two independent samples, pain score and request for analgesia show significant difference only at the first two hours with p-value <0.05, otherwise there was no significant differences in the following hours. For vital signs there was no significant difference for both groups
CONCLUSION:
Bupivacaine instillation is as effective as ultrasound guided field block for inguinal hernia repair pain. We recommend this technique in places where ultrasound machine is not available especially in many developing countries.

Angiographic Findings in Comparison with of Ankle Arm Pressure Index Among Patients with Coronary Heart Disease Referred for Coronary Angiography

Edmon Khammo Benjamin; Asaad Abdullah Abbas; Ali Hussein Mttanish

Iraqi Postgraduate Medical Journal, 2017, Volume 16, Issue 3, Pages 261-265

ABSTRACT:
BACKGROUND:
Epidemiological studies had been demonstrated that subclinical cardiovascular disease in one vascular bed is associated with the presence of clinical disease in another bed; as well as subsequer cardiovascular and total mortalities. Degree of peripheral vascular disease(PVD) in the legs as measured non invasively are common in old adults without overt signs and symptoms of PVD .an ankle —arm index has been shown to be a strong predictor of total cardiovascular morbidity and mortality in those without prior history of clinical cardiovascular disease at the baseline examination.
PATIENTS AND METHODS:
A cross sectional study done in IBN AL NAFEES teaching hospital for cardiology and cardiac Surgery. from 1st of June 2015 to 30th of Feb. 2016, for different age groups and multiple different risk factors (smoking, D.M, hypertension, family history of Ischemic heart disease, previous Ischemic heart disease,, hyperlipidemia) have their ankle-arm index measured by Doppler study and reported as abnormal (<0.9)and normal (>9). Then ‘ their coronary angiographic findings were obtained and correlated to the level of Ankle Brachial Index .
RESULT:
Study showed that 18 patients with low ABI value have abnormal angiographic findings (100%) i.e. High specificity; while 28 patients with normal ABl value proved to have coronary artery disease by (39.1%) i.e. Low sensitivity; but on the other hand low ABI significant relation for both multiplicity and severity of coronary disease diagnosed by angiography (p value 0.0001) for both.
CONCLUSION:
Ankle-brachial index (ABI) index despite it is easy, quick and inexpensive bed side test for cardiovascular diseases it is of low sensitivity ;but its high specificity.

3-Tesla vs. 1.5-Tesla Magnetic Resonance Imaging in the Detection of Ischemic Deep White Matter Lesions

Mustafa Saleh Mutar Al-Sukainy; MayadaFathel Hameed; Mohammed abd kadhim

Iraqi Postgraduate Medical Journal, 2017, Volume 16, Issue 3, Pages 235-241

ABSTRACT:
BACKGROUND:
Deep white matter ischemia (DWMI) is bilateral patchy or diffuse pattern of ischemia and demyelination in the deep white matter region of the brain. WM lesions (WMLs) increase in frequency with age and are associated with lower cognitive performance. Reported prevalence ranges from 5% to 90%, depending on study design, study population, and rating scales. Although the main pathophysiology is still under investigation, they are attributed to degenerative changes of long penetrating arteries and it has been postulated that chronic vascular diseases of the arteries and arterioles supplying these regions can play a role in the process. Deep white matter ischemia is imaged by using T2 weighted (T2W) sequences in addition to FLAIR sequences. Coronal section is used to enable precise sampling of WMLs
OBJECTIVE:
To assess 3T MRI vs. 1.5 MRI in evaluating the extent of DWMI.
PATIENTS AND METHODS:
A cross sectional study was conducted at the MRI unit of the Department of Radiology in Al-Imamain Al-Kadhimain Medical City in Baghdad. Data collection was obtained during the period starting on October 2015– June 2016. The study included 87 patients with the diagnosis of DWMI based on previous MRI data. Patients with initial MRI findings that show no evidence of DWMI as well as patients presented with trauma, migraine, epilepsy, tumor, TB and cerebral venous thrombosis were excluded. Each patient was examined by using 3T MRI, followed by a 1.5 T MRI two days later. The patient images were evaluated for 1.number of lesions, 2.size, 3.volume and 4.intensity of a selected prominent lesion.
RESULTS:
Of the 87 patients, 51 were male and 36 female. Their mean age was 59.48 ± 10.83 years. In all lobes there is a statistical significance (P < 0.0001) between 3T and 1.5T i.e. 3T platform was able to show a greater number of lesions in comparison with the 1.5T platform. It was seen with high statistic significance (P <0.0001) that one the 3T images, mean intensities, sizes, and volumes were higher across the board. The average additional number of lesions shown by 3T over 1.5T was 9.52 lesions with a standard deviation of 6.50.
CONCLUSION:
Three tesla MRI is significantly superior than1.5 tesla MRI in the number of detected lesions, determining size of a lesion, detecting lesion volume and intensity
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Plasma Folate and Vitamin B12 in Patients with Cervical Squamous Intraepithelial Neoplasia

Duja Hasan; Anwar Noori Al-Basam

Iraqi Postgraduate Medical Journal, 2017, Volume 16, Issue 3, Pages 242-247

ABSTRACT:
BACKGROUND:
Cervical squamous intraepithelial neoplasia is a premalignant condition of cervix. Human papilloma virus (HPV) infection has been associated in the development of premalignant and malignant changes in the cervix. Folate and vitamin B12 can potentially influence carcinogenesis through its effect on DNA synthesis or methylation.
OBJECTIVE:
To determine the influence of plasma folate and vitamin B12 concentrations in cervical squamous intraepithelial lesions.
PATIENTS AND METHODS:
A case-control study conducted in Baghdad Teaching Hospital from the 1stof Dec 2014 to the 31st of Dec 2015 whereas 60 patients participated in the current study and divided in two groups: cases whose pap smears showed cervical squamous intraepithelial neoplasia and controls whose pap smear was normal).
RESULTS:
Mean age of cases was 33.6±4.9 years; prevalent age group was 30-40 years (76.7%). No significant difference was observed between cases and controls regarding age (P=0.5), educational level (P =0.6) and oral contraceptive pills (P=0.4), but a significant association was found between cases and controls regarding parity and smoking (0.01 and 0.003) respectively. Moreover significant association was found between both groups of the study regarding to the folic acid deficiency (P <0.001)and vitamin B12 deficiency (P=0.01). Human Papilloma virus was higher among cases than controls but it is still not significant (p=0.2).
CONCLUSION:
There is significant association between folate and vitamin B12 deficiency, smoking and parity with the cervical squamous intraepithelial neoplasia.

Pulmonary Resections Types, Indications, and Complications

Assad Abdullah Abbas; Looiy Mohammed AL-Hallaq; Hussein Aboob Alkabi

Iraqi Postgraduate Medical Journal, 2017, Volume 16, Issue 3, Pages 311-315

ABSTRACT:
BACKGROUND:
A variety of pulmonary resection techniques are currently available, including pneumonectomy (intrapleural, extrapleural, intrapericardial,and sleeve pneumonectomy), lobectomy and sleeve lobectomy , segmentectomy, wedge resection and non-anatomic parenchymal sparing resection.
OBJECTIVE:
To evaluate the experience with pulmonary resections at our hospital.
METHODS:
This is a retrospective study utilized medical records of 110 patients from 1st of January 2013 to the 31st December 2014. After doing the routine laboratory work and chest x-ray for all patients, they were operated under general anesthesia with double lumen endotracheal tube, for whom different types of pulmonary resections were performed for different reasons.
RESULT:
A total of 110 patients, 65 males (59.1%) and 45 females (40.9%). Lobectomy is the most common type of pulmonary resection used 62.7%.Malignant tumor is a common indication for pulmonary resection 36.3%. Trauma and hydatid cyst are a significant cause of pulmonary resection in our country. Mortality rate for pulmonary resection is 9.09%.
CONCLUSION:
Pulmonary resections are the most used surgical modalities for treatment of many pulmonary diseases. It is a safe procedure providing the proper selection of the patient and assessment regarding pulmonary function status.

Pleural Fluid C-reactive Protein in the Differential Diagnosis of Infectious and Malignant Pleural Effusion at Baghdad Teaching Hospital (Single Center Study).

Kareem Abass Kareem; Mohammed Waheeb Salman AL.Obaidy; Kassim .M. Sultan

Iraqi Postgraduate Medical Journal, 2017, Volume 16, Issue 3, Pages 304-310

ABSTRACT:
BACKGROUND:
C-reactive protein (CRP) is an acute phase reactant produced primarily by hepatocytes; its production is stimulated by systemic inflammation of either infectious or noninfectious origin. The cytokines that are released during the inflammation are the main stimulants of the acute phase reactants. Interleukin-6 is the main stimulant cytokine of the synthesis of most acute-phase reactants.
OBJECTIVE:
To differentiate between infectious and malignant pleural effusions by measuring pleural fluid CRP titer.
MATERIALS AND METHODS:
This was a hospital-based cross-sectional study at Baghdad teaching hospital medical wards conducted from the 1st of November 2014 up to the 31th of august 2015.
Fifty patients with pleural effusion proved by the history, examination,
Chest imaging and pleural tapping included in this study, all proved to have
An exudative pleural effusion by the light criteria.
RESULTS:
Showing statistically significant differences in CRP titer between:-
1-Parapneumonic pleural effusion (PPE) and malignant pleural effusion (MPE)
2-TB pleural effusion (TBPE) and malignant pleural effusion (MPE).
CONCLUSION:
Pleural fluid C-reactive protein titer can be used as an aid in the differentiation between some infectious causes of pleural effusion and malignant pleural effusion as there is a statistically significant difference between the Pleural fluid C-reactive protein titer of the infectious pleural effusion and the malignant pleural effusion.

A Novel Study of Predictive Utility of Serum Melatonin in Diagnosis of Systemic Sclerosis: A Case-Control Study

Faiq I. Gorial

Iraqi Postgraduate Medical Journal, 2017, Volume 16, Issue 3, Pages 224-228

ABSTRACT:
BACKGROUND:
Melatonin is a pineal gland hormone with complex roles in the pathogenesis of autoimmune disorders. Immune abnormalities and disturbed endocrine secretion have been reported in patients with systemic sclerosis (SSc). A possible role of melatonin in pathogenesis of SSc patients might be present
OBJECTIVE:
To assess the predictive utility of serum melatonin in diagnosis of SSc patients.
METHODS:
A case-control study conducted at Rheumatology Unit of Baghdad Teaching Hospital-Medical City from November 2015 to April 2016 on 40 SSc patients diagnosed according to the 1980 criteria for classification of systemic sclerosis or 2013 American College of Rheumatology/European League Against Rheumatism for the classification of systemic sclerosis criteria and compared with 40 healthy controls matched in age, sex, and body mass index. Patients with overlapping other inflammatory arthritis or connective tissue disease or autoimmune diseases were excluded. Serum melatonin was measured in both groups by enzyme-linked immunosorbent assay (ELISA).
RESULTS:
Mean level of serum melatonin concentration was significantly lower in patients compared with controls (Mean ± SEM of patients was 602.9 ± 30.69 vs 782.1 ± 43.66 pg/ml for controls, p=0.001). The optimum cut-off value of serum melatonin that differentiate between patients and controls was ≤ 810.8 pg/ml (AUC=0.72, p=0.0005). Validity of serum melatonin at the optimum cutoff value showed highest level of accuracy (75%) with sensitivity 87.5% and specificity 62.5% and if the test was positive and the clinical suspicion of prestest probability was 50% then we have 70% confidence that the patient has systemic sclerosis [ Positive predictive value (PPV) at pretest 50%=70%]. However, this confidence will increase to 95.5% if the clinical suspicion of pretest probability was 90% (PPV at pretest probability 90%=95.5%). Also, if the test was negative then we can exclude the disease with 97.8% with confidence [Negative predictive value (NPV) =97.8%].
CONCLUSION:
Serum melatonin was a valid measure to diagnose SSc.

Association of Helicobacter Pylori Infection with Diabetes Mellitus in Baquba-Diyala Province

A.SH; Shiama; Zainab H. AL-Azawi; Hasan; a R. AL-Salihy

Iraqi Postgraduate Medical Journal, 2017, Volume 16, Issue 3, Pages 285-289

ABSTRACT:
BACKGROUND:
Infection with H. pylori has been recognized as a public health problem worldwide. Studies to address the association of H. pylori infection with diabetes mellitus (DM) had yielded controversial results.
OBJECTIVE:
To figure out the association between H. pylori infection and DMtype 1 and 2 in Baquba city, Iraq .
PATIENTS AND METHODS:
This cross-sectional case control study was conducted in Baquba-Diyala province for the period from August 2015- March 2016. 82diabetic patients (67 with type 2 and 15 with type 1) and 23 healthy non-diabetic individuals were enrolled. The DM patients include 45 (54.9%) females and 37(45.1%) males. The mean age ±SD of type 2 DM patients was51.37± 10.84 years,while the mean age ±SD of patient with type 1 DMwas 23.66 ± 6.99 years. The patients were collected from the outpatient clinic of Baquba General Teaching Hospital according to the WHO definition criteria of the DM. Blood samples were collected, sera were separated and tested for the presence of anti-H. pyloriIgG antibody using the commercially available Enzyme- linked immunosorbant assay kit.Statistical analyses were done using the Statistical Package for Social Science (SPSS) Version 18, and P value < 0.05 was considered significant.
RESULTS:
The results showed that the anti- H. pylori positivity rate among patients with diabetes mellitus and controls was 35.2% and 9.5% respectively, with statistically insignificant difference (p= 0.54). The anti- H. pyloripositivity rate was slightly higher in type 2 DM than in type 1 DM (29.5 % vs 5.7 %, p=0.9).Diabetic male had insignificantly higher positivity rate compared to female ((29.5% vs26.8, p= 0.096%). Furthermore, higher positivity rate was found in the age group 30-50 years.
CONCLUSION:
The anti-H. pyloripositivity rate is insignificantly higher among diabetes mellitus patients; particularly type 2 diabetes mellitus than non-diabetic individuals in Baquba cit, Iraq .

A Comparative Study Between Single Session Versus Six Sessions Mitomycin C instillation in Patients With Low Risk Non-Muscle Invasive Bladder Cancer

Zaidan khalaf; Saad Dakhil F. Daraji

Iraqi Postgraduate Medical Journal, 2017, Volume 16, Issue 2, Pages 158-163

ABSTRACT:
BACKGROUND:
Intra vesicle instillation following trans uretheral resection of low grade and low stage bladder cancer proved its efficacy in reducing recurrence and progression of bladder cancer.
OBJECTIVE:
To compare the efficacy of a single session of mitomycine C versus six sessions mitomycine C following TURBT on recurrence and progression rates in patients with low risk non-muscle invasive bladder cancer.
PATIENTS AND METHODS:
A total of 50 patients with low risk non-invasive bladder cancer were included in a prospective randomized controlled trial. Inclusion criteria include all patients who had a 3cm or less, single, papillary tumor. The tumor was completely resected before were randomized patients into 2 arms; Group one; those who receiving one session mitomycin C instillation of 40 mg (usually within 6 hours) into the urinary bladder. And Group B; Receiving six sessions mitomycin C instillation into the urinary bladder, Median follow up was 24 months. The events studied where the recurrence free rate, the recurrence rate/ year, the number of new tumors developing/year, and progression.
RESULTS:
At 24 months follow up, the recurrence free rate in a single session of mitomycin C instillation (group A) was (70.2%) while in six sessions mitomycin C instillation group was (84.7%) (Group B).
Recurrence rate was ; Group A VS Group B : (10% VS 4 %) and recurrence per year rate (5% VS 2%), were decreased in the six sessions mitomycin C instillation (Group B) compared to the single session mitomycin C instillation (Group A). The number of new tumors per year rate (18% VS 11%), were decreased in the six sessions mitomycin C instillation (Group B) compared to the one session mitomycin C instillation, (Group A). A shorter hospital stay, catheterization period, and low level of local symptoms were noted in one session mitomycin C instillation (Group A) compared to six sessions mitomycin C instillation, (Group B).
CONCLUSION:
Single session mitomycin C given immediately after surgery or within 6 hours after resection may be as effective as six session protocol. This regimen may be cost effective and avoid prolonged hospitalization and catheterization with sex sessions regimen.

Efficacy of Intranasal Beclomethasone in the Treatment of Children with Otitis Media with Effusion and/or Adenoid Hypertrophy

Hassan Mohammed Abbas Al-Timim; Firas Baheej Abdul Aema

Iraqi Postgraduate Medical Journal, 2017, Volume 16, Issue 2, Pages 176-183

ABSTRACT:
BACKGROUND:
Adenoid hypertrophy and otitis media with effusion are very frequent indications for surgery in children. Otitis media with effusion is the commonest cause of their hearing difficulty.
A potential role of corticosteroids in the treatment of both diseases has emerged "6". Short-term use of systemic steroids provides a temporary improvement but long-term use of systemic steroids is not appropriate in children due to severe side-effects. On the other hand, topical nasal steroids without systemic side-effects might be used"7" .
OBJECTIVE:
To prove that intranasal steroid treatment can be a useful alternative to surgery in the treatment of children with otitis media with effusion and/or adenoid hypertrophy
PATIENTS AND METHODS:
A total of 68 children (4–14-year-old) on the waiting list for an adenoidectomy and/or myringotomy with or without ventilation tube placement were enrolled into the study and control groups. The study group (38 patients with adenoid hypertrophy, 19 of them with otitis media with effusion) received intranasal beclomethasone dipropionate (aqueous suspension) 168 mcg daily, and the control group (30 patients with adenoid hypertrophy, 16 of them with otitis media with effusion) was followed up without any treatment. All patients were evaluated at 0 and 8 weeks. The assessment of each patient included history, a symptom questionnaire, a tympanogram, a pure tone audiogram, and otoscopic examination and a plain radiograph (lateral soft tissue X-ray of postnasal space). The size of adenoid tissue was graded as a percentage according to obliteration of the airway of the postnasal space. The adenoid/postnasal (A/P) airway ratio was recorded for each patient. Symptoms were scored as 0 (absent), 1 (intermittent/periodic), or 2 (continuous). The data were analyzed with the “Statistical Package for the Social Sciences” (SPSS 9.0).
RESULTS:
Resolution of otitis media with effusion in the study group (41.6%) was significantly higher than that in the control group (13.3%) (p < 0.001). Twenty -six patients (68.4%) with adenoid hypertrophy in the study group showed a significant decrease in adenoid size according to the plain radiograph evaluation compared to the control group (p < 0.001). A significant improvement in obstructive symptoms was seen in the study group (p < 0.001). The radiographically measured adenoid/postnasal airway ratio and degree of obstructive symptoms showed a significant correlation (r = 0.838 p < 0.001, r = 0.879 p < 0.001, r = 0.838 p < 0.001, r = 0.879 p < 0.001).
CONCLUSION:
Nasal beclomethasone dipropionate treatment can significantly reduce adenoid hypertrophy and eliminate obstructive symptoms. It is a useful alternative to surgery (in good percentage of cases), at least in the short term (8weeks ), for otitis media with effusion.

Clinical Profiles and Outcome of Children Admitted with Measles During 2009 Outbreak

Hadeel Ali Aziz; Muhi Kadhem Al-Janabi; Abbas Oweid Oleiwe; Nadia Aziz Nasir

Iraqi Postgraduate Medical Journal, 2017, Volume 16, Issue 2, Pages 191-197

ABSTRACT:
BACKGROUND:
Measles is a highly contagious acute viral infection. It is a common cause of morbidity and mortality constituting half of vaccine preventable diseases.
OBJECTIVE:
The study was designed to describe the demographic, vaccination status, clinical profiles, and outcome of children admitted with measles during outbreak.
PATIENTS AND METHODS:
A cross sectional hospital based study was conducted on 137 children admitted with measles in Children Welfare Teaching Hospital/Medical City /Baghdad during the outbreak of measles in the period from 1st January- 31st May 2009. Patients below the age of 14 years who were clinically diagnosed as cases of measles were treated and followed.
RESULTS:
The median age was 17 months with a range of 3 months-14 years. Male /female ratio of 1.14:1. 86.86 % patients were admitted in March. Sixty eight (49.63%) children were not vaccinated. Twenty four (55.81%) children of vaccinated group had one dose of measles vaccine only and 19(44.19%) children had two doses. Complications of measles were detected in 120(87.59%) of patients. The most frequent complication of measles was pneumonia which was encountered in 72(52.55%) cases. Gastroenteritis was recorded in 44(32.12%) of patients. Six patients (4.38%) died after developing complications in the form of pneumonia in five and encephalitis in one. Forty four (32.12%) cases were malnourished and majority of them 26 (59 %) cases were in the >15 months age group. Two thirds of deaths were among malnourished children. The case fatality was 4.38%.
CONCLUSION:
One third of measles infections occurred before the age of 9 months. Half of measles cases were not vaccinated. The majority of the complicated cases had occurred in the unvaccinated children. Pneumonia was found to be the most frequent complication of measles that necessitated admission. Young age, pneumonia, malnutrition, immune deficiency and non-vaccination status were significant factors related to mortality.
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Subdural Hematoma and Effusion in Children

Haider Faris Alwash; Ahmed Aman Al-Khalili

Iraqi Postgraduate Medical Journal, 2017, Volume 16, Issue 2, Pages 117-121

ABSTRACT:
BACKGROUND:
Blood gathers between the inner layer of the dura mater and the arachnoid mater. Usually resulting from tears in bridging veins which cross the subdural space, subdural hemorrhages may cause an increase in intracranial pressure (ICP), which can cause compression of and damage to delicate brain tissue. A subdural effusion is a collection of cerebrospinal fluid
OBJECTIVE:
To gate an opinion about the types of surgical procedures which had been done for the collected cases into 2 centers in Baghdad
METHODS:
This is a prospective study conducted at 2 Neurosurgical Hospitals in Baghdad, between September 2012 to December 2013, on 21 children and infants of subdural collection of fluid excluding abscess ages ranging from 40 days to 13 years . Clinical data was collected including symptoms and signs, in addition to assessment of radiological picture and subdural tab and diagnostic burr hole proved the diagnosis .treatment ranged from conservative to surgical interference included burr hole ,subdural peritoneal shunt and craniotomy. condition of the patients during discharge from the hospital was evaluated
RESULTS:
In this study , the higher percentage of patient were under the age of one year. no great difference in the sex of patients , disturbance of consciousness was the more type of presentation , unilateral subdural collections were more than bilateral collections. only 12 patients had surgical interference , of these 12 the majority had subdural peritoneal shunt , which seemed to be the most convenient procedure in chronic cases but in acute cases burr holes were the most convenient procedure. craniotomy was also used in treating chronic cases.
CONCLUSION :
Most of the patient were under one year old , brain ct scan was the diagnostic procedure , brain ultrasound was also useful in diagnosis of subdural collection. the most convenient surgical treatment in acute cases was the burr holes and in chronic cases was the subdural -peritoneal shunt , and to arrange for surgical interference when decided as early as possible to gate better outcome

Study of Thirty Two Patients with Infantile Spasms Admitted to Baghdad Medical City

Raed Jabbar Hussain; Mahjoop N. AL-naddawi; Kefah Essa Nader; Maher Mahdi Salih

Iraqi Postgraduate Medical Journal, 2017, Volume 16, Issue 2, Pages 144-150

ABSTRACT:
BACKGROUND:
Infantile spasms is rare epileptic syndrome affect most often infants in first year of life, occur in paroxysmal attacks in clusters especially in periods of sleep transition range in number from few spasms to many up to one hundred, and associated with crying and abnormal behavior .
OBJECTIVES:
Study various aspects of conditioncauses, clinical features, electroencephalograms, radiological imaging, therapeutics choices, identification the variations in our patients and outcome.
PATIENTS AND METHODS:
the study enrolled thirty two infants referred to child welfare hospital and epilepsy clinic of Baghdad teaching hospital in medical city of Baghdad and were followed up in outpatient clinic of these hospitals for a period extend From beginning of January 2015 to end of January 2016. All data are encoded in patient file and discharging card. Study design was hospital based description of data from patients'records.
RESULTS:
Male-female ratio is 1:1 , age of presentation range from four to ten month,lag period between early seizures and diagnosis was range from two weeks to four months . two weeks in two cases four week in 20 cases ( 62 % ) , 10 cases present with more than four weeks delay (31.25%)seizure types were flexor spasms in 14 (43.75%) , extensor in 6 (18.75%) , and mixed in 12 patients (37.5%) , symptomatic cases were 24 (75 %) , idiopathic in 8 (25 %).
Mode of delivery (18 patients delivered by caesarean section 56.25 %, 14 patients 43.75 % delivered by normal vaginal mode). Causes and gender relation, was that Symptomatic was more than idiopathic in both genders.
The relation of gender to etiologic types, Tuberous sclerosis was the most common etiology in female, but neonatal and other disorders was the most common etiology in male. In Response to treatment and outcome ,16 patient (50%) had Complete remission of spasms, and 15 patient (50%) end with Severe developmental delay .
CONCLUSION:
Flexor type is commonest clinical types. Symptomatic group is predominant etiological types, neurocutaneous syndrome is commonest cause in symptomatic group .Hypsarrthmia is documented in majority of patients Brain atrophy is the commonest in radiological films .Steroids is main treatment. Infantile spasms had poor prognosis, in terms of neurobehavioral development.
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The Prevalence of Papillary Thyroid Microcarcinoma in 489 Cases of Thyroidectomy in Iraqi Patients

Sazan Abdulwahab Mirza AL-Atrooshi; Thukaa T. Yahya; Nadia H. Ibraheem

Iraqi Postgraduate Medical Journal, 2017, Volume 16, Issue 2, Pages 151-157

ABSTRACT:
BACKGROUND:
Thyroid cancer (TC) is considered the most common malignancy of the endocrine system. Papillary Thyroid Microcarcinoma (PTMC) is defined as tumors of less than or equal to 10mm in diameter, it could be non-incidental or incidental.
OBJECTIVE:
To evaluate the prevalence rate of thyroid papillary microcarcinoma, and to correlate the prevalence rate with different parameters including: age, gender, clinical diagnosis and type of surgery.
PATIENTS AND METHODS:
The present study, which is a retrospective study, was conducted on 489 cases of thyroidectomy specimens; the study was conducted at the Teaching laboratories of Medical City over a period of one year from February 2015 to Feb. 2016. The incidence of thyroid papillary microcarcinoma was correlated with different parameters including age, sex, clinical presentation, and type of surgery.
RESULTS:
In this study , cases were divided into: 53(10.83%) cases male, and 436 (89.171%) cases females, with age range 15-68 years and age mean 41.5 years ,regarding histopathological diagnosis ,cases were analyzed as followed: Nodular hyperplasia 354(72.41%) cases. Autoimmune thyroiditis 34(7.0%) cases, thyroid adenoma 28(5.7%) cases, follicular tumors 2 (0.4%) cases, papillary microcarcinoma 28(5.7%) cases, papillary carcinoma 16(3.3%) cases, follicular carcinoma 3(0.6%) cases, medullary carcinoma 1(0.2%) cases, hyperplastic nodule 6(1.2%) cases, toxic goiter 10(2.0%) cases, infections thyroiditis 1(0.2%) case, papillary carcinoma with lymph node involvement 4(0.8%) cases, thyroglossal cyst 1(0.2%) case, parathyroid adenoma 1(0.2%) case. Eight cases of PTMC(3.3%) were below 40 years of age. 20(8.1%) cases were above 40 years. There was a statistical correlation between age and prevalence of TPMC.
CONCLUSION:
The possibility of thyroid microcarcinoma should always be kept in mind while diagnosing a benign thyroid disease. There was a significant statistical correlation between age and prevalence of thyroid papillary microcarcinoma.
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Experience Of Gastric Cancer In Al- Sadder City in Baghdad

Maytham Hatam Shahid; Asaad Abdullah Abbas; Saad Ramadan Jawad

Iraqi Postgraduate Medical Journal, 2017, Volume 16, Issue 2, Pages 129-137

ABSTRACT:
BACKGROUND:
The aim of the study is to assess the following points among the patients with gastric cancer admitted to the surgical wards in Imam Ali Hospital- Al- Sadder City- Baghdad.
• Sex and age distribution.
• Mode of presentation.
• Results of endoscopic findings and histopathology.
• Risk factors and tumour staging.
• Treatment options.
PATIENTS AND METHODS:
A prospective study was done in Imam Ali Hospital for a period of six years from (January 2009 to December 2014) where fifty cases with biopsy proved gastric cancer had been assessed. The age and sex distribution, mode of presentation, site of the tumour, macrosopical appearances histopathological findings, risk factors and treatment options were analysed.
RESULTS:
The male to Female ratio was 1.4:1, peak age incidence was 60-70 years, non-specific symptoms such as vague epigastric pain, dyspepsia, anorexia, weight loss were the most common symptoms; esophagogastric junction was the commonest site, polypoid type was the commonest endoscopic finding (44%); upper gastrointestinal endoscopy with biopsy was the most accurate method of diagnosing gastric cancer; Adencarcinoma was the most frequent histopathological type (96%); cigarette smoking is the predominant risk factor (64%) (32, 33, 34, 35); In the majority of those patients the disease was advanced and the curative measures were not possible.
CONCLUSION:
Gastric cancer remains a significant problem in Iraq, it's one of the most popular malignancies (ninth most common in Iraq) (37). No age group of both sexes can be excluded. Late presentation is a stigmata of the disease and the gloomy prognosis can only be improved by early detection based on a more vigorous diagnostic approach following a high risk index of suspicion in individuals at risk.

Association of Serum Levels of 25 Hydroxyvitamin D and Type 2 Diabetes Mellitus: Age and Gender Dependent Study

Abid A Thaker; Basil O Saleh; Thana I Mustafa

Iraqi Postgraduate Medical Journal, 2017, Volume 16, Issue 2, Pages 138-143

ABSTRACT:
BACKGROUND:
Vitamin D deficiency has been found to have an inverse relationship with the occurrence of diabetes mellitus (DM). The aims of this study were to investigate the serum levels of vitamin D in type 2 DM and to correlates the obtained values with their age and gender.
SUBJECTS AND METHODS:
This case-control study was carried out at Al-Ramadi General Teaching Hospital, and the National Diabetes Center for Treatment and Research at Al- Mustansiriya University, Iraq, during the period from December 2014 to November 2015. It involved, 80 patients with type 2 DM, and 60 healthy subjects. Investigations included serum measurement of 25 Hydroxyvitamin D (25OHD), fasting glucose, Insulin, glycated hemoglobin (HbA1c) in all patients and controls using ELISA technique.
RESULT:
The median concentration of serum 25 OHD of patients with type 2 DM (15.70 ng/ ml) were significantly lower than that of healthy controls (20.27 ng/ ml, P= 0.001). The rate of vitamin D deficiency (VDD) was significantly higher in type 2(82.5%) diabetic patients than in healthy controls (48.3%, P=0.001). Type 2 diabetic patients with age of 60 years and above and female had the highest VDD compared to others, type 2 diabetic patients with age of ≥ 60 years increased the risk of having VDD by 9.8 times compared to those with age group <18 years, but still insignificant (P =0.07).
CONCLUSION:
The results revealed significant deficiency of serum vitamin D in diabetic patients type 2. Supplementation of vitamin D may improve the control of this syndrome or even delay its incidence and complication.
.

The Frequency and Spectrum of K-ras Mutations among Iraqi Patients with Sporadic Colorectal Carcinoma (CRC)

Bassam MS Al-Musawi; Shaymaa KS Al-Thahir

Iraqi Postgraduate Medical Journal, 2017, Volume 16, Issue 1, Pages 18-24

ABSTRACT:
BACKGROUND:
CRC is one of the most common cancers in the world. K-ras is proto-oncogene with GTPase activity that is lost when the gene is mutated. Analysis of K-ras mutational status is very important for CRC treatment, being the most important predictors of resistance to targeted therapy.
OBJECTIVE:
This study aims to determine the frequency and spectrum of K-ras mutation among Iraqi patients with sporadic CRC.
PATIENTS, MATERIALS AND METHODS:
This study enrolled 35 cases with sporadic CRC; their clinicopathological parameters were analyzed. The FFPE blocks were used for DNA extraction; PCR amplification of K-ras gene and hybridization of allele-specific oligoprobes were performed. The assay covers 29 mutations in the K-ras gene (codons 12, 13, 59, 60, 61, 117 and 146).
RESULTS:
The majority of cases have left colonic tumours (57%), without LN involvement (57.1%), of non-mucinous adenocarcinoma histology (85.7%), grade II (82.9%) and stage III (37.1%) tumours. Fourteen mutations were detected in 13 (37%) patients with K-ras mutations; 10 (71.4%) mutations were in codon 12 while 4(28.6%) were in codon 13. The most frequent mutation was the G>T transversions [9 (64.4%)] and the most frequent mutation type was GGT>TGT (GLY>CYS) at codon 12.
CONCLUSION:
The incidence of K-ras mutations lies in the middle of the reported figures worldwide; the majority of mutations occurred at codon 12 followed by codon 13; predominantly of G>T transversion and Gly12Cys type that has a poorer prognosis.
.

Early Detection of Bacteremia and Bacteriuria after Extracorporeal Shock Wave Lithotripsy By C-Reactive Protein Measurements

Ehab Jasim Mohammad

Iraqi Postgraduate Medical Journal, 2017, Volume 16, Issue 1, Pages 41-46

ABSTRACT :
BACKGROUND:
Extracorporeal shock wave lithotripsy (ESWL) has long been accepted as the least invasive and reliable method in the treatment of urolithiasis. The success rates have been very high in renal and upper ureteral stones .
OBJECTIVE:
Is early detection of bacteriuria and bacteriemia after extracorporeal shock wave lithotripsy (ESWL) of calcium and infection stones by measurement of plasma C-reactive protein (CRP) levels.
METHODS:
A total of 150 patients who had infection stones (n 54) and calcium stones (n 96) were included in the study. All patients had sterile urine before ESWL. The mean age was 41.6+_ 4.85 and male/female ratio was 2.12. Blood cultures were obtained within 1 hour post-ESWL period. Urine cultures were obtained 3 times just after and on the first and seventh day of ESWL.
RESULTS:
Post-ESWL evaluations showed 6 positive blood cultures with 4(5.32%) patients in infection stone and 2 (2.66%) patient in calcium stone groups, whereas urine cultures revealed 12 (16%) positive results in infection stones and 8(10..66%) in calcium stones. The patients who had positive cultures also had elevated plasma CRP levels when compared to the levels in patients with negative cultures (p 0.000).
CONCLUSION:
Bacteriuria and bacteriemia after ESWL have been well-identified entities and may be responsible from some of the post-ESWL complications. CRP can be useful for early detection of such complications.

Temporomandibular Joint Disorders among Patients with Juvenile Idiopathic Arthritis

Zainab Shalan Khalaf; Nizar AbduLateef Jassim; Nadia Aftan Al-Rawi

Iraqi Postgraduate Medical Journal, 2017, Volume 16, Issue 1, Pages 98-101

ABSTRACT:
BACKGROUND:
Juvenile idiopathic arthritis (JIA) is an immune mediated chronic disease. In its most severe clinical form, JIA may show localized and/or systemic and oral complications. This may result in variable growth and developmental anomalies. As a result, it is not uncommon for JIA patients to present with skeletal Class II and open bite malocclusions.
OBJECTIVE:
This study was conducted to assess temporomandibular joint (TMJ) among patients with JIA.
MATERIALS AND METHODS:
A cross sectional study was conducted among JIA patients attending Baghdad Teaching Hospital from November 2014 to April 2015. All patients underwent a clinical evaluation of their TMJ condition. TMJ disorder was assessed by using Helkimo’s index (1974a), and distribution of TMJ disorders was assessed according to the age, gender, duration of illness and types of medication.
RESULTS:
The mean age of JIA patients was 17.59±9.63 years old and mean Illness duration of 8.45± 9.29 years. High percentage of patients (93.8%) presented with clinical dysfunction of TMJ (CDI). 22 patients with JIA (27.16%) presented with severe clinical dysfunction, 19 patients with JIA (23.46%) presented with moderate clinical dysfunction and 35 patients (43.21%) presented with mild clinical dysfunction of TMJ. No significant difference in mean value of CDI according to age and duration of illness. Females were affected by clinical dysfunctional index of TMJ more than males, but statistically non- significant. The highest mean value of CDI was among patients treated with prednisolone, while patients treated with combination of drugs were the least affected.
CONCLUSION:
This study confirms that patients with JIA have a high incidence of TMJ dysfunction. The systemic effect of disease may impact on development of TMJ and facial growth. Close supervision is required to JIA patients for orthodontic intervention need, regular dental care, and TMJ evaluation.

The Role of Percutaneouse 95.1 Ethanol Injection in the Treatment of Benign, Solitary, Cold, Cystic Nodule of Thyroid Gland

Malik G. AL-Hashimi

Iraqi Postgraduate Medical Journal, 2017, Volume 16, Issue 1, Pages 25-29

ABSTRACT :
BACKGROUND:
A common problem facing the surgeon and the pathologist is evaluation of patient with apparently single thyroid nodule.
PATIENTS AND METHOD:
Over the period from August 1996 to September 1998 , (152 patients) with clinically solitary thyroid nodules were seen in the medical city , only 72 0f them proved to be single ,cold and cystic nodule and included in this study .
RESULT:
F.N.A.C was done for all patients (72),(57) patients of them were benign ,(6)patients were malignant or suspicious and(9) patients with indeterminate aspirit .pure spirit (ethanol injection into thyroid nodule was done in only 60 patients ) ,42 patients (70%) with benign nodule were successfully treated with aspiration and spirit injection , 24 patients (40%) of them had complete disappearance of nodule, 18 patients (30%)had more than 50% reduction in the size of the nodule ,in 18 patients no significant reduction .
CONCLUSION:
All patients with solitary thyroid nodule should undergo F.N.A.C. to role out malignancy. Cold benign cystic thyroid nodules were successfully treated in 70% of cases , only 3% recurrence was observed .complication requiring hospitalization were not reported .

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.

Saving Versus None Saving of Anterior Cruciate Ligament Remnant in Arthroscopically Assisted Anterior Cruciate Ligament Reconstruction(ACLR)

Majed Aswad Jasem Alsaad

Iraqi Postgraduate Medical Journal, 2016, Volume 15, Issue 4, Pages 413-418

ABSTRACT:
BACKGROUND: Anterior Cruciate Ligament injury is one of the most common injuries of the knee and reconstruction is a commonly done surgical procedure. Successful outcome depend on factors that affects the stability like anatomic graft placement and secure fixation and other factors that affects the proprioception and revascularization of the graft like preservation of the ACL remnant which is used to reduce repeated graft rupture.
OBJECTIVE: To compare the effect of saving of ACL remnant versus none saving on functional outcome and stability of the knee joint postoperatively.
PATIENTSANDMETHODS: A prospective comparative non randomized study was used on 30 patients (28 male and 2 female) who underwent arthroscopic ACLR. The patients were divided into 2 groups (A and B), in group A (15 patients), reconstruction was done without saving of ACL remnant and in group B (15 patients), saving of the ACL remnant was performed. In one year follow up the result was compared according to the anterior drawer, Lachman, Pivot shift tests and Lasholm score changes (preoperative and postoperative).
RESULTS: Regarding to Lasholm score the result was better in group B than in group A which was statistically significant (p value = 0.025). The knee stability was better in group B than in group A which was statistically insignificant.
CONCLUSION:
It is recommended to save the ACL remnant if possible with better knee joint functions and less repeated graft rupture.

Relationship between Amniotic Fluid Lactate and Delivery by CS Due to Dystocia

Manal Madany A. Qader

Iraqi Postgraduate Medical Journal, 2016, Volume 15, Issue 4, Pages 499-505

ABSTRACT:
BACKGROUND:
Lactate level in uterine muscles can be visualized by analysis of amniotic fluid lactase which used as bedside test with partogram to acquire good prediction of labour outcome.
OBJECTIVE:
To assess the relationship between amniotic fluid lactase level of full term pregnant women and their mode of delivery.
PATIENTS AND METHODS:
A cross sectional study carried out in Labour room of Al-Yarmouk Teaching Hospital through the period from the 1st of July to the end of December, 2015 on a convenient sample of 100 women of term pregnancy. Each woman participated in the study was in an active phase of labour with cervical dilation > 4 cm and before artificial rupture of membranes .By coscus speculum the cervix was visualized with 2-3 ml of liquor was taken by a syringe while the amniotic fluid still in the uterus to prevent vaginal contamination, then collected liquor in plain tube after centrifuge was stored in refrigerator at -20° for not more than 3 days before it sent to a private laboratory for analysis of lactase.
RESULTS:
Mean maternal age was 26.5±5.4 years and mean gestational age was 38.6±1.1 weeks. Thirty three pregnant women had elevated lactase level and 31 women were delivered with cesarean section. A significant association was observed between elevated amniotic fluid lactate level (≥10nm) among pregnant women and cesarean section delivery mode (p<0.001). Amniotic fluid lactate was a significant predictor of delivery mode (p=0.001) with odds ratio (5.5).
CONCLUSION:
Amniotic fluid lactate could be a significant predictor of labour outcome for term pregnant women.

Effect of Midazolam on Heart Rate in Pediatric Anesthesia

Sanaa Fareed Qassim

Iraqi Postgraduate Medical Journal, 2016, Volume 15, Issue 4, Pages 441-445

ABSTRACT:
BACKGROUND :
Midazolam is one of benzodiazepines. It is most lipid soluble as a result has a rapid onset and short duration of action, used in anesthesia for sedation or intravenous induction according to the dose used.
OBJECTIVE:
Is to notice if there is an effect of midazolam on heart rate in pediatric patients with using ketamine as induction agent under general anesthesia.
PATIENTS AND METHODS:
60 peadiatric patients undergoing surgery randomly allocated in 2 groups(A and B). Aneasthesia was standardized for all patients (except addition of Midazolam in sedative dose (0.03 mg/kg) i.v. preinduction to group( B). Heart rate measured preoperatively as abaseline and 5 and 15 minutes after induction.
RESULTS:
Adding midazolam associated with a reduction in HR by an average of 10 beats/min 5 and 15 minutes after induction of anaesthesia. This effect failed to reach the level of statistical significance although it was clinically significant.
CONCLUSION:
Midazolam have well known sedative effect but have no significant effect on heart rate in paediatric patients.

Angiographic Predictors of Success of Revascularization by Percutaneous Coronary Intervention (PCI) Using the Japanese Chronic Total Occlusion Score

Hilal Bahjet Al Saffar; Zahraa H.Ismaeel AL-Ridhwany; Zaid Abedel-Elah Mustafa Al- Najjar

Iraqi Postgraduate Medical Journal, 2016, Volume 15, Issue 4, Pages 474-480

ABSTRACT:
BACKGROUND:
Chronic total occlusions (CTOs) are considered as the most complex lesions to treat via percutaneous coronary intervention (PCI), due to the indications, costs and technical difficulties related to these procedures. As a consequence, only about 10% of all coronary artery diseased patients (CAD), clinically eligible for revascularization, are currently being treated via percutaneous coronary intervention (PCI). The majority is treated either medically or by coronary artery bypass graft (CABG) surgery.
OBJECTIVE:
This study sought to estimate the value of application of J- CTO score as a model to stratify the complexity and predict success rates at Iraqi Center for Heart Disease.
METHODS:
One hundred patients with chronic total occlusion were enrolled in this study form October 2014 - May 2015 who were attending Iraqi Center for Heart Disease. Data were collected on demographic, clinical and angiographic characteristics and reviewed by experienced Chronic total occlusions(CTO) operators. Descriptive analyses were performed using Statistical Package of Social Sciences (SPSS) to assess the relationship between procedural success and any variable of the demographic, angiographic and/or clinical characteristics. The level of significance was set at 95% or higher.
RESULTS:
Sixty-one patients out of 100 patients (61%) had a successful PCI. Univariate analyses showed significant differences of Electrocardiography and number of diseased arteries with J-CTO score between the group with successful PCI compared with those with failed PCI.
Angiographically, using Japanese chronic occlusion score we found that a “blunt stump” (42 vs. 75%, p=0.001), “calcifications” (37 vs.70%, p=0.003), “tortuosity” (21 vs. 67%, p=0.001), “CTO length” (44 vs. 84%, p=0.000) and a “re-attempt” (33 vs. 65%, p=0.036) all had a significant negative impact on procedural outcome.
CONCLUSION:
The J-CTO score is valuable tool for predicting successful revascularization of chronic total occlusion by Percutaneous coronary intervention (PCI).

Overweight and Obesity in A Sample of Primary School Children in Baghdad

Faris Al Lami; Riyadh Alredainy

Iraqi Postgraduate Medical Journal, 2016, Volume 15, Issue 4, Pages 452-458

ABSTRACT:
BACKGROUND:
Obesity is one of the most serious public health problems of the 21st century, that has many serious long-term consequences for health. The prevalence of childhood obesity has been increasing at worrying rates across the globe.
OBJECTIVE:
To measure the prevalence and identify potential risk factors of overweight and obesity among a sample of primary school children in Baghdad, Iraq.
METHODS:
This cross-sectional study was conducted on a random sample of 10 primary schools from different localities of Baghdad, followed by a systematic random sample of 620 children aged 10 years or more of both sexes. A questionnaire sent to the parents to gather information on socio-demographic characteristics, dietary habits, daily physical activity, steroids use, family history of obesity and parents` education and job. Children's height (cm), weight (Kg), and BMI-for-age were measured and parents` height and weight were obtained through a questionnaire sent to the parents and accordingly BMI (Kg/m2) was calculated. Child's weight status was categorized based on WHO 2007 Growth Reference.
RESULTS:
The prevalence of high BMI was 30.3%, including 16.3% overweight and 14% obesity. Following application of binary analysis, the significant risk factors included in the logistic regression model that revealed the following significant risk factors: not having regular sports (OR: 4.1; P=0.000), child inactivity (OR: 3.1; P=0.001), high meal frequency (OR: 2.6; P=0.006), positive family history of obesity (OR: 2.5; P=0.01) and more sweets and bicarbonate beverages (OR: 2.2, P=0.002).
CONCLUSION:
The prevalence of overweight/obesity was high among primary school children. Children should be considered the priority population for intervention strategies and to combat early childhood obesity.
.

The Value of Diffusion Weighted Magnetic Resonance Imaging in Differentiating Atypical Vertebral Haemangiomas from Metastatic Lesions

Mohammed Abd Kadhim; Thaair A. Kameel Alkhuzaie; Kirmanj Ismaiel Baker

Iraqi Postgraduate Medical Journal, 2016, Volume 15, Issue 3, Pages 272-278

ABSTRACT:
BACKGROUND:
Atypical vertebral hemangioma and metastatic spinal lesions share many MRI signal intensity and
appearance in common ,thats why differentiation between them is crucial. For two decades,
diffusion-weighted imaging (DWI) has been applied to the evaluation of intracranial diseases, but
DWI technical advancement make it possible to apply for assessment of extra cranial sites,
including vertebral column.
OBJECTIVE:
The goal of our study is to assess the value of diffusion weighted MRI imaging in differentiating
vertebral atypical hemangiomas from metastatic lesions.
PATIENTS AND METHODS:
A prospective cross-sectional study was employed at AL-Imammain AL-Khadymain Medical city
in Baghdad health directorate, (43)patients with total (65) vertebral lesions grouped into three
groups Group(A) 10 patients (23.2%)with total (15) lesions of vertebral typical hemangiomas,
Group(B) 13 patients (30.3%) with total ( 13) lesions of vertebral atypical hemangiomas and
Group (C) 20 patients(46.5%) with total ( 37) lesions of spinal vertebral metastases .
MRI was done for all patients (including T1, T2, T1 fat suppression with IV contrast
administration (when needed) and DWI). Complementary non contrast CT was also done.
RESULTS:
Total study sample were (43) patients with total (65) lesions, with (29/43) females and (14/43)
males with male to female ratio of (1:2), their age range from (28-75 years) and their mean age
was (54.2+ 10.1 years). Atypical hemangioma and malignant lesions were generally low signal in
T1 and high or intermediate signal in T2 WI. Restricted diffusion and low ADC values were seen
in atypical hemangioma compared with metastasis with mean ADC value were (1.426+0.231.6x10
-3mm2/s and 0.6182+ 0.137x10-3mm2/s respectively).
Complementary CT confirmed the lytic or sclerotic nature of malignant lesions while in
haemangiomas, it showed their characteristic striated (polka dot) appearance.
CONCLUSION:
Diffusion weighted Magnetic Resonance Imaging is a valuable tool in differentiation of atypical
hemangioma and metastasis of spine with high sensitivity and specificity with the aid of ADC
values calculated from the maps obtained by DWI.
KEYWORDS: diffusion weighted magnetic resonance imaging, atypical haemangiomas,
metastasis.

The Value of Diffusion Weighted Magnetic Resonance Imaging 3 Tesla in Detection and Staging of Bladder Carcinoma

Shameem Ali Hussein; Raad H. Abed Tawfeeq; Thaair A. Kameel Alkhuzaie

Iraqi Postgraduate Medical Journal, 2016, Volume 15, Issue 3, Pages 266-271

ABSTRACT:
BACK GROUND:
To evaluate the value of diffusion weighted magnetic resonance imaging (DWMRI) in
detection and T- staging of bladder carcinoma and correlation with histopathological staging.
PATIENTS AND METHODS:
An analytic prospective study was conducted at the MRI units of Al-yarmook teaching hospital
in the period from January of 2015 to December 2015, 42patients (36male and 6 female)
presented with hematuria (40 patients ) and 2 patients presented with pelvic pain were enrolled
prospectively ,they underwent conventional magnetic imaging(MRI) and diffusion weighted
MRI using 3 tesla MR units (Achieva ; Philips medical systems, the Netherlands).
Diffusion weighted images were obtained using a single shot echo planar imaging sequence EPI
with b value 0,500sec/mm2.ADC value map was reconstructed and mean ADC value were
measured in 42 patients .and histological examination was done to all patients.
RESULTS:
Correlation between standard MR staging of bladder carcinoma and histopathological results
revealed that 17 patients (40%) had the same T -staging while 17 patients(40%) over staged.
DWI and ADC values were able to declare the cause of overstating by discrimination between
tumoral tissue and peritumoral inflammation. Statistically significant difference is found between
ADC value of bladder tumor and those of urine.
CONCLUSION:
Diffusion weighted MR imaging at 3 tesla is new and good imaging modalities for detection and
staging of bladder carcinoma, , without using contrast media, so can used in patient with renal
impairment or contrast media allergy

Mycoplasma Pneumonia in Hospitalized Patients in Baghdad Teaching Hospital :Clinical, Radiological and Cold Agglutinin Assessment

Salman H. AL-Nuami; Adnan M. AL-Jubouri

Iraqi Postgraduate Medical Journal, 2016, Volume 15, Issue 3, Pages 354-357

ABSTRACT:
BACKGROUND:
Mycoplasmapneumonia is a cause of community-acquired pneumonia. The disease usually is of a gradual onset, with almost equal gender distribution between male & female.
OBJECTIVE:
Assessment of the clinical, radiological & laboratory characteristics of mycoplasma pneumonia in Baghdad teaching hospital.
MATERIALS AND METHODS:
30 patients were collected from Baghdad teaching hospital between 1st of November 2003 till 30th of October 2004 having pneumonia with positive cold agglutinin titer. They were studied regarding their clinical presentation & features including seasonal incidence, radiological assessment, & testing blood for cold agglutinin titer.
RESULTS:
The study showed almost equal gender distribution (14 patients were male & 16 patients were female), with ratio of male: female equal to 1:1.1.
The most common symptoms were dry cough76.7%, headache (6.77%) &fever(70%). Other symptoms are less frequent. Seasonal variation showing more incidence during spring time. Radiological finding showed patchy infiltration in 18 patient (60%), lobar consolidation in 7 patient (23.3%), & pleural effusion in 4patient (13.3%).
CONCLUSION:
There is almost equal gender distribution between male & female.
The most common symptom was dry cough, headache, while fever is more common in old age groups than other age groups.

Prevalence of Latent Tuberculosis in End Stage Renal Disease Patients at Baghdad Teaching Hospital

Muhammed .W.AL.Obaidy; Amer Musa Hasan; Kassim .M. Sultan

Iraqi Postgraduate Medical Journal, 2016, Volume 15, Issue 3, Pages 321-327

ABSTRACT:
BACKGROUND:
Tuberculosis (TB) is one of the oldest diseases known to affect humans, it caused by infection with Mycobacterium Tuberculosis (MTB). MTB is most commonly transmitted from a patient with infectious pulmonary TB to other person by droplet nuclei. End Stage Renal Disease (ESRD) patients are exposed to a variety of infections, including TB. The standard test for detecting Latent TB infection (LTBI) is tuberculin skin test (TST).
OBJECTIVE:
Determination the prevalence of latent tuberculosis among end stage renal disease patients in hemodialysis unit in Baghdad teaching hospital, and assessing its correlations with various conditions.
METHODS:
A stratified random sampling technique was used to select a sample of 71 patients of ESRD in hemodiaylsis unit in Baghdad teaching hospital. The selected patients were interviewed using a structured pretested questionnaire.
Two units of PPD (0.1mL) had been injected intradermally to the volar surface of forearm to be seen within 48-72 hours. The test was considered positive if (>=10mm induration) developed.
RESULTS:
The study showed the rate of tuberculin reactivity among End Stage Renal Disease (ESRD) patients is 28.57%. About 57.14% of patients were male; mean age of patient was 54.34 ± 15.25 years. The major cause of renal impairment were diabetes mellitus (DM) 52.86%, followed by hypertension 15.71%, duration of dialysis more than 6 months was 46.67% .
History of contact with active tuberculosis patient was 62.5%.
CONCLUSION:
Significant relationship between history of contact with active TB patients, duration of dialysis, and age of patients with TST positivity.
.

Acromioclavicular Joint Dislocation Clinical , Radiological and Therapeutic Study

Basim Sabah Abdullah

Iraqi Postgraduate Medical Journal, 2016, Volume 15, Issue 3, Pages 288-295

ABSTRACT:
BACKGROUND:
The ACJ is the most peripheral joint component of the upper extremity appendicular linkage . All significant mechanical forces applied directly to or through the upper extremity are ultimately transmitted across that linkage .
OBJECTIVE:
We try to see the outcome of both conservative and operative treatment on dislocated acromioclavicular joint {ACJ}
METHODS:
From September 2005 – June 2008, 14 patients with ACJ dislocation were seen at AL-Hay hospital wasset , the patient age, sex , occupation, injured side and manner of injury were recorded. The patients were chosen randomly to operative or conservative treatment according to type of injury and will of patients and studied in form of indication tactile approaches to treatment and results were described and discussed in some details.
RESULTS:
Conservatively treated patient regained movement significantly more quickly and fully returned to work earlier and had fewer unsatisfactory results than having early operation. however for severe dislocation with coracolavicullar displacement of 2cm and more, early surgery produced better results.
CONCLUSION:
Conservative management is best for most acute dislocation but younger patients with severe displacement may benefit from early reduction and stabilization.
.

Preliminary Experience of Sleeve Gastrectomy

Israa I.Mohammed; Samir I. Al-Saffar; Yasser F.Zidan; Muthanna A.Al-Sharbaty

Iraqi Postgraduate Medical Journal, 2016, Volume 15, Issue 3, Pages 350-353

ABSTRACT:
BACKGROUND:
Laparoscopic Sleeve gastrectomy (LSG) is the most common restrictive procedure performed worldwide for treatment of morbid obesity.
OBJECTIVE:
To assess the safety, effectiveness and complications of LSG performed for Iraqi patients and shows early experience of LSG.
METHODS:
Prospective clinical case series study conducted in Al-Jumhoori Teaching Hospital and involved 70 patients (57 females and 13 males);their age (19-59 average 37 years) underwent LSG(6 open ,64 laparoscopically with one conversion);51 patients finish 1 year follow up .
RESULTS:
The initial body weight 70-195(122Kg); BMI 31.8-65.9 (50.16Kg/m2); two patients with diabetes mellitus and BMI less than 35Kg/m2 involved.
The average weight loss assessed and found to be (13.85, 32.8, 40.8 and 48.3 Kg) in 1st, 3rd, 6th and 12th month interval; The BMI reduced from 50.16 to 35.43 and 29.52 at 6th and 12th months.
We recorded 1 mortality after 10 days (massive pulmonary embolism), 1 case converted to open and minigastric bypass due to narrowing of the sleeve part.
The associated comorbidities improved after weight loss, and the quality of life improved in 88% of patients depending on bariatric analysis and reporting outcome systems (BAROS).
CONCLUSION:
Sleeve gastrectomy is relatively safe and effective procedure to decrease weight for morbid obesity and it improves the quality of life, but all bariatric procedures needs good health resources and settled countries which were not present in Iraq for the time being.

The Frequency of Autonomic Neuropathy in Type 2 Diabetic Patients

Asaad Abdullah Abbas; Abbas K. Ressan; Ali HAshim Hussein

Iraqi Postgraduate Medical Journal, 2016, Volume 15, Issue 2, Pages 127-131

Abbas K. Ressan, Asaad Abdullah Abbas,Ali HAshim Hussein
INTRODUCTION:
Autonomic nervous system (ANS)
The ANS supplies and influences every organ in
the body and closely integrate vital processes,
such as Blood Pressure (BP), temperature and
adaptation to environmental change (1).
Accordingly, sensory, motor, visceral and
neuroendocrine function can be modulated by
this system (2).
Baghdad Teaching Hospital.
The clinical signs and symptoms that occur in
disturbances of autonomic response which is
influenced by the organ involved. The normal
balance of sympathetic (ST) and parasympathetic
(pst) innervations, the nature of underlying illness
and stage of progression of the disease (3).
To investigate the prevalence of D.A.N. was
defined by simple non- invasive tests in type 2
diabetic Iraqi patients and it is relation to the
duration of the disease.
ABSTACT:
BACKGROUND:
Autonomic Nervous System Innervates vascular and visceral smooth muscle, exocrine and
endocrine glands and parenchymal cells through out the various organ system. Diabetic autonomic
neuropathy is classified as subclinical or clinical upon the presence or absence of symptoms Awide
spectrum of symptoms affecting many different organ system can occur including CVS, GUS,
pupillary, automotor and neuroendocrine systems.
OBJECTIVE:
To investigate the frequency of diabetic A.N.P as defined by simple non – invasive test in type 2
diabetic Iraqi patients and it is relation to the duration of disease.
PATIENTS AND METHODS:
Fifty type 2 diabetic patients , were evaluated with a five bed side tests to detect autonomic
neuropathy and a history of related symptoms was taken there were 30 ( 60%) males and 20 (
40%) females in the age range 30– 70 years .
The five tests were carried out were, heart rate variation during deep breathing, HR response to
valsalva, HR response to standing, BP response to sustained hand grip, BP fall in response to
standing.
Resting ECG (to measure QTc interval) fasting plasma glucose and 2hr., post prandial plasma
glucose were done to each patient.
RESULTS:
Of these 50 patients 34(68%) had evidence of neuropathic abnormality of parasympathetic
involvement 19(38%)patients 13(26%), patients had evidence of combined parasympathatic and
sympathatic involvement and only 2(4%), patients had only sympathetic involvement. Increase
incidence was seen in older age group and poor glycemic control. Autonomic neuropathy more
common in patients who had the disease for more than 5 yrs. There was no correlation with
prolonged QTC intervals.
CONCLUSION:
Diabetic ANP is a common complication and related to poor diabetic control and the duration of
diabetes. While it is not associated with prolonged QTC interval .

Study of Varicose Veins In Sample of Population, Aggrevating Factors and Management

Mohammed J. Jameel

Iraqi Postgraduate Medical Journal, 2016, Volume 15, Issue 1, Pages 61-66

ABSTRACT:
BACKGROUND:
Varicose Veins is a common problem in our population and there are many factors which aggravate its progress.
OBJECTIVE:
In this study the author concern on analysis of risk factors which aggravate varicosities and management of these cases either surgical or conservative.
PATIENTS AND METHODS:
A prospective study is carried on 85 patients with varicose veins from September 2008 to September 2014 at Al-yarmook Teaching Hospital and private sector. History, clinical examination and Color Duplex Imaging were done for all patients and then they were divided into two groups according to the causes of development of varicosity and method of management, group-A include 55 patients (65 Limbs) who were managed surgically while group-B include 30 patients who were managed by conservative methods.
RESULTS:
After a mean follow up period of 30 months (rang from12-42 months). Regarding group-A patients, 46 patients (55 limbs=84.6%) got good results, while six patients (6 limbs=9.2%) developed variable degree of post operative foot and leg edema, in three patients (Four limbs=6.2%) recurrence developed after three years postoperatively. Regarding group-B patients they expressed improvement in their symptoms by conservative measures and life style modification that help to stop the progress of varicosity.
CONCLUSION:
Varicose Veins is a common condition with many causes and aggravating factors, surgery is excellent method to manage extensive varicosities while conservative method is suitable in certain inoperable conditions.

Study of Outcome of Adult Cases Admitted to the Intensive Care Unit (I.C.U) in Baghdad Teaching Hospital

Abudalrasool Noori Nassr; Basil Fawzi Jameel; Qasim Mohammed Sultan

Iraqi Postgraduate Medical Journal, 2016, Volume 15, Issue 1, Pages 86-91

ABSTRACT:
BACKGROUND:
Patients at Intensive care unit (I.C.U) admitted from different hospital departments (Medical, surgical and obstetrics), with different presentations to the I.C.U., some of these cases need sophisticated management and some of them need just monitoring and supportive therapy.
OBJECTIVE:
To evaluate the cases in the I.C.U regarding the gender, age and smoking status, and to assess their clinical status and to predict their prognosis and outcome.
PATIENTS AND METHODS:
A cross-sectional study of 50 case from I.C.U of Baghdad Teaching Hospital. The period of patients' admission from first of January 2013 to 31 of December 2013. Patients 18 year of age and above (adults) were included in the study.
RESULTS:
From 50 case involved in the study, there was 29 (58%) male and 21 (42%) female, among 29 males there was 14 case (48.3%) survived and 15 case (51.7%) Died, while female 11 case (52.4%) survived and 10 cases (47.6%) died. The survival rate lower among smokers; male (25%), while non-smoker male was 64.7%, however the survival rate was higher (100%) for those with hypoxemia without respiratory failure, but patients (especially male cases) who received mechanical ventilation showed very low survival rate (37.5%) compared to those on oxygen therapy with survival rate (72.2%).
CONCLUSION:
Smoker patients showed lower survival than non- smokers. Patients who received mechanical ventilation showed very low survival rate in comparison with those on oxygen mask therapy.

Etiology and Clinical Manifestations of Infectious Bloody Diarrhea in Children Welfare Teaching Hospital

Mohammad Fadhil Ibraheem

Iraqi Postgraduate Medical Journal, 2016, Volume 15, Issue 1, Pages 35-39

ABSTRACT:
BACKGROUND:
Dysentery is an important cause of morbidity and mortality among children less than five years, it is caused by viral, bacterial, or protozoan infections or parasitic infestations. About 10% of all diarrheal episodes in children less than five years are dysenteric, but these causes about 15% of all deaths attributed to diarrhea are dysenteric.
OBJECTIVE:
To highlight the causes and clinical manifestations of bloody diarrhea in children younger than six years of age and to clarify the most important associated factors.
METHODS:
A prospective study was carried out on Children Welfare Teaching Hospital /Medical city/Baghdad, on 92 children who were admitted to the hospital with bloody diarrhea, their ages ranged between two months -6 years. The period of study is from (first of November 2013-30th of April 2014). A thorough history were carried out, general stool examination and stool culture were done by taking fresh stool samples collected from these children and underwent to serial investigations. Any patients who had received antibiotics during their illness were excluded from the study.
RESULT:
Ninety two patients their age ranged from second month of life till 6 years old that admitted to the children welfare teaching hospitals because of bloody diarrhea. The most common microorganism isolated was E .histolytica 59(64.13%) followed by Shigella spp.11 (11.96%).
It was found that male 51(55.43%) and female 41(44.57%), most of them live in urban 39(42.40%) or suburban 31(33.69%) area, most of them consume tap water 47(51.08%),more than half of them with mixed feeding 42(56.75%), the most common age group affected was the first two years 74(80.43%).
Regarding the clinical presentation it was found that in amoebic dysentery the most common finding was tenesmus 52(88.13%),followed by fever 35(59.32%), vomiting 19(32.20%),then convulsion4(6.77%), while in Shigellosis the most common finding was fever 9(81.81%), followed by tenesmus 8(72.72%),vomiting7(63.63%), then convulsion 4(36.36%).
CONCLUSION:
E. histolytica was the most common microorganism isolated in patients with bloody diarrhea and the most common age group affected was the first two years of life.
Mixed feeding in the first two years was associated with higher rate of infection
Consuming of boiled water associated with least incidence of bloody diarrhea and the most common presentation were tenesmus, fever, vomiting, and convulsion.

Tracheostomy in Children Indications, Results and Complications

Raed AbdulSahib Khefi; Firdaws Fadhil Ridha; Samah Abbas Hummadi

Iraqi Postgraduate Medical Journal, 2016, Volume 15, Issue 1, Pages 46-51

ABSTRACT:
BACKGROUND:
To provide an overview of pediatric tracheostomy, focusing on indications, surgical techniques and complications. The indications for pediatric tracheostomy are changing. Today the most common indication is assisted ventilation. Tracheostomy complications are more likely in children than in adult and more common in children under two years particularly preterm infant.
The general indications for tracheostomy are as follows:
• Relieve upper airway obstruction.
• Prevent complications of prolonged intubation
• Reduce anatomical dead space
• Allow suction toilet of the trachea
OBJECTIVE:
To evaluate the indications and complications of tracheostomies performed in children.
PATIENTS AND METHOD:
This is prospective study of 20 patients for whom tracheostomy was done during a period of two years (from October 2011 to October 2013).
Demographic data and details of the surgical work and the follow up notes were collected.
Descriptive, and analytic statistics were applied to the set of data using the Microsoft excel 2010 computer system.
RESULTS:
Total of twenty patients were included in the study. The age range was 2months – 12 years there were 14 males and 6 females.
Fifty percent of the patients were 5 year old or younger.
Sixty five percent of the operations were performed as elective procedures, and 35% as emergency.
The peak incidence of tracheostomy was at 5 years (25%).
The most common indication was the need for assisted ventilation 60%.
The most common underlying cause behind tracheostomy was the neurological impairment whether chronic or traumatic (n=13; 65%), followed by airway trauma.
No intraoperative complications were reported, and the postoperative complication rate was 25%.
Tracheostomy tube (PORTEX blue line) obstruction was the most common encountered complication.
Fourteen patients were decannulated (70%) with mean duration prior to decannulation 19.7± 18.95 days.
There were no tracheostomy related mortalities.
CONCLUSION:
A ssisted ventilation is the most common indication for traceostomy in pediatric age group. Tracheostomy in children is a safe procedure with negligible intraoperative complications.

Post Neonatal Mortality in Children Welfare Teaching Hospital for the Period 2007-2009

Muhi Kadhem Al-Janabi; Nadia Aziz Nasir; Kawes Omer Zangana; Asaad Fakhri Hasan

Iraqi Postgraduate Medical Journal, 2016, Volume 15, Issue 1, Pages 40-45

ABSTRACT:
BACKGROUND:
Post neonatal mortality refers to deaths between 28 days and 1 year of life. It represents about one third of infant death. Post neonatal death rates vary according to causative factors in each area of the world.
OBJECTIVE:
To study the post neonatal mortality and its major causes in Children Welfare Teaching Hospital (CWTH) - Medical City /Baghdad.
METHODS:
The medical records of 782 post neonatal deaths who were admitted to CWTH from 1st jan.2007 - 31st Dec. 2009 were studied, especially for the causes of death as registered in the files.
RESULTS:
The overall post neonatal death rate in the study period was 71.4 per 1000 of post neonatal admissions. Out of 782 total post neonatal deaths, males were 465 (59.5 %) and females were 317(40.5 %). Major causes of death were; pneumonia (24.8 % ), gastro intestinal (22.8 %), infection (18.4 % ) ,cardiovascular (10.3 % ), central nervous system ( 9.8 % ),surgical (4.9 %), renal problems (4.9 % ), malignant causes(2.7 % ),congenital anomalies (0.7 %),inborn error of metabolism(0.7 %) of total post neonatal deaths.
The results of this study indicate that post neonatal death rates are still high in a tertiary referral pediatric teaching hospital in Baghdad.

Vertebrobasilar Dolichoectasia: Clinical Neuroimaging Correlation

Hayder Kadhum Hassoun; Haider Najim Aubaid; Amina Mohammed Abass Zwain

Iraqi Postgraduate Medical Journal, 2015, Volume 14, Issue 3, Pages 362-369

ABSTRACT:
BACKGROUND:
Vertebro-basilar dolichoectasia (VBD) is an uncommon vasculopathy of unclear origin affecting the arterial wall of vertebral artery (VA) and basilar artery (BA). A variety of clinical syndromes and neuroimaging features have been associated with VBD.
OBJECTIVE:
This cross sectional study is conducted to shed a light on the neuroimaging signs of VBD and explore the association between the clinical presentation and imaging parameters of VBD in patients clinically suspected to have VBD with neuroimaging diagnosis.
MATERIAL AND METHODS:
This randomized cross sectional study was performed in Middle Euphrates Neuroscience Centre in Annajaf city between April 2012 to December 2012,A 34 patients with neuroimaging diagnosis of VBD (18 patients by MRI and 16 patients by MDCT) were included, VBD were assessed by studying the basilar artery width (BAW), bending length (BL) and level of basilar artery bifurcation according to Dan Deng et al criteria. The findings were correlated with patient clinical presentation.
RESULTS:
Thirty four patients, (24 males & 10 females) with age range between 25-81 years and mean of 57.9 year were included in this study. Among all presenting symptoms, only headache showed statistically significant association (p value <0.05) with the width of the basilar artery. There was higher prevalence of single cranial nerve involvement (SCNI) in patients with more tortuous basilar artery (55.5% of those with BL more or equal to 10 mm versus 16% of those less than 10 mm) with statistically significant association (p value <0.05), suprasellar extension was seen in 26.4% of cases and showed significant association with headache and visual symptoms.
CONCLUSION:
VBD is an important clinical entity and could be associated with or responsible for many serious clinical presentations, special attention is needed for VBD diagnosis and it's parameter during evaluation of brain imaging especially in patients with un-explained or vague presentation.

Post-Operative Adhesive Intestinal Obstruction, Risk Factors and Complications.

Majeed H.H. Al; Mustafa Raed Muhi; Amiri

Iraqi Postgraduate Medical Journal, 2015, Volume 14, Issue 3, Pages 370-378

ABSTRACT :
BACKGROUND :
Post-operative adhesions form a main lifelong surgical issue, Adhesive intestinal obstruction remains the main complications of adhesions.multiple Risk factors play an important role in the initiation of the disease and its Management.
OBJECTIVE:
To identify the risk factors that increases the incidence of Adhesive intestinal obstruction and the complication of surgical intervention.
PATIENTS AND METHODS :
One hundred and eight patients with adhesive Intestinal obstruction (out of two hundreds and ten patients with acute intestinal Obstruction) were admitted to the surgical wards of Al-Yarmouk Teaching Hospital, studied prospectively for the period between the 1st of January 2013 and the 30th of April 2014 . Data obtained regarding different parameters like Age ,sex, number and types of previous operations,management of those patient Whether conservative or operative.
RESULTS:
Adhesive intestinal obstructions are (51.43%) of the total cases with Acute intestinal obstruction. The highest incidence was among age group between 30-39Year, (32.4%). Explorative laparotomy are the main risk factors for postoperative adhesions with an incidence of 29.6%. The recurrence rate after surgery For adhesive intestinal obstruction is 13.8%.
CONCLUSION:
Since the recurrence rate after surgical Intervention in adhesive intestinal obstruction is relatively low, the role for conservative measures may be limited to a short period of time.

Aortic Valve Calcification in Hemodialyzed Patients at the Iraqi Dialysis Center

Mohammed Hannon Al-Sodani; Jawad I Rasheed; Raed Ahmed Dawood; Adil S.Ghafour

Iraqi Postgraduate Medical Journal, 2015, Volume 14, Issue 3, Pages 397-402

ABSTRACT:
BACKGROUND :
Aortic valve calcification in End Stage Renal Disease (ESRD) patients occurs ten to twenty years earlier than general population. It is associated with myocardial, coronary arteries and conduction system calcification and it is associated with rapid development of aortic valve stenosis.
OBJECTIVE:
To study the incidence of aortic valve calcification in hemodialysis patients and to look for risk factors associated with this calcification.
PATIENTS AND METHODS:
Forty six patients with End Stage Renal Disease (ESRD) on regular haemodialysis in Baghdad Teaching Hospital / Dialysis Unit and forty six patients with no renal disease as control group were studied between February 2005 - January 2006. Duration of dialysis, blood flow rate during dialysis, serum Calcium, serum Phosphorous and their products were included in this study. Echocardiography was done for all patients.
RESULT :
The incidence of Aortic Valve Calcification (AVC) in ESRD patients on haemodiaysis was 30 % and it was higher than that of general population ( p value 0.0085) . It occurs 10-15 year earlier than in patients with no renal disease. End Stage Renal Disease patients with AVC were older than those with non calcified valves. Only 7.4 % of those ESRD patients with AVC have hemodynamic AV stenosis ( p value 0.5 ). The mean duration of haemodialysis in ESRD patients with AVC was longer than that of ESRD patients without AVC which was statistically significant. Also there was statistically significant association between blood flow rate during haemodialysis and AVC. There was statistically significant association between Calcium phosphate products and AVC in ESRD patients.
CONCLUSION:
There is ahigher incidence of aortic valve calcification in ESRD patients on haemodialysis . This calcification occurs earlier than that in patients with no renal disease .The duration of haemodialysis is a risk factors for AVC .

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

Lobar Pneumonia in Hospitalized Children and Response to Empirical Antibiotic Treatment

Raghad Dawood Najem; Ahlam Mohamad Abdulabbas; Esraa Abd-Alhameed Abd-Al-Azeez; Ali K. Mohammed

Iraqi Postgraduate Medical Journal, 2015, Volume 14, Issue 3, Pages 392-396

ABSTRACT:
BACKGROUND:
It is an inflammatory disease of lungs with consolidation of one or more lobes caused mostly by Streptocccus pneumoniae bacteria. It is a worldwide disease with high mortality among children less than 5 years old.
OBJECTIVE:
To determine the proper empirical antibiotic treatment for lobar pneumonia in hospitalized children and the correlation between the blood culture result and response to treatment.
METHODS:
A Cross sectional study was performed between January 2013 through December 2013 to 69 patient admitted to Central Teaching Hospital Of Pediatrics in Baghdad, aged more than two months to ten years, all of them met the WHO case definition of pneumonia, data was collected from the mothers for (age, sex, previous health and vaccination status). Blood sample was collected for blood culture and sensitivity for all patients.
RESULTS:
The study showed that of 69 patients hospitalized with lobar pneumonia 69.5% were males, and 30.5% were females, 82.6% of patients were in an age group less than one year. The study found that 69.6% of patients were not vaccinated and they were mostly less than 1 year. The response to treatment range from 88.8%-94% and Blood culture was negative in 95.6% of samples. Mortality rate was 4.3%
CONCLUSION:
Treatment with Ceftriaxone (3rd generation Cephalosporine) alone is effective as an empirical treatment for lobar pneumonia in hospitalized patients, so no need for combination therapy of Ceftriaxone and Vancomycin and the Blood culture was negative for Streptococcus pneumoniae in all cases so the results of Blood Culture had no correlation with response to treatment.

The Role of Autospreader Flap in Primary Rhinoplasty

Sabir Osman Mustafa

Iraqi Postgraduate Medical Journal, 2015, Volume 14, Issue 2, Pages 185-191

ABSTRACT:
BACKGROUND:
A spreader flap, or autospreader flap, is a flap used for dorsal reconstruction in primary rhinoplasty after cartilage dorsum excision. In a primary rhinoplasty that requires a humpectomy, the dorsal aspect of the upper lateral cartilages is commonly discarded. Many of these patients need spreader grafts to reconstruct the middle third of the nose. However, it is possible to reconstruct the upper lateral cartilages into “spreader flaps” that act much like spreader grafts.
OBJECTIVE:
To evaluate the efficacy of autospreader flap for midvault reconstruction after humpectomy in primary rhinoplasty.
PATIENTS AND METHOD:
This prospective study was done on 124 patients in Erbil, from February 2010 to Jan. 2014. All patients who underwent primary rhinoplasty and requiring humpectomy are included in this study. A tunnel is created on the underside of the upper lateral cartilage, which is released from the cartilaginous septum and also from its attachment to the nasal bone. It is then rolled on itself to make a spreader flap, which is secured with sutures. Scoring along the dorsal edge of the upper lateral cartilage may be necessary in thick cartilage. The flap is then secured to the dorsal edge of the reduced dorsal septum. Data were entered and analyzed using the statistical package for social sciences SPSS version (18).
RESULTS:
In 124 patients who underwent an open approach rhinoplasty (44 patients were male and 80 patients were female), the autospreader flap almost always reconstructed the middle third of the nose. It was easy to execute in the open approach. At surgery, seven patients needed spreader grafts because the flaps were too narrow. Postoperatively, twelve patients exhibited inadequate nasal width.
CONCLUSION:
Autospreader flap is a suitable technique for restoration of midvault after humpectomy in primary rhinoplasty. The application of autospreader flap allows the surgeon to reconstruct the internal valve and design an aesthetically pleasing dorsal nasal line.

The Correlations between JAK2V617F Mutational Status and Serum Levels of Folate and B12 in a Group of Patients with Chronic Myeloproliferative Neoplasms

Haithem Ahmed Al-Rubaie

Iraqi Postgraduate Medical Journal, 2015, Volume 14, Issue 2, Pages 274-280

ABSTRACT:
BACKGROUND:
The Philadelphia-negative classical chronic myeloproliferative neoplasms are characterized by proliferation of one or more cell lines in the bone marrow and increased number of mature and immature cells in the peripheral blood. These myeloproliferative neoplasms include; polycythemia vera, essential thrombocythemia and idiopathic myelofibrosis, in which JAK2V617F is by far the most prevalent mutation. Because of the rapid turnover of cells in these neoplasms, derangement in the serum levels of vitamin B12 and folate is expected.
OBJECTIVE:
To assess the possible correlation of serum B12 and folate levels with JAK2V617F mutation in patients with polycythemia vera, essential thrombocythemia and idiopathic myelofibrosis.
PATIENTS AND METHODS:
This case-control study was conducted from December 2012 to December 2013, and enrolled 54 patients, diagnosed as polycythemia vera (36), essential thrombocythemia (6) and idiopathic myelofibrosis (12), attending Medical City, Baghdad Teaching Hospital. Twenty healthy volunteers were included as a control group. JAK2V617F mutation status had been reviewed at time of sampling. The following investigations were done: automated complete blood counts; serum B12 and folate were measured using the electrochemiluminescence immunoassay.
RESULTS:
The mean levels of serum B12 and folate were much higher in myeloproliferative neoplasm patients than control group (p-value of 0.028 and 0.004 respectively).
Serum B12 level showed significant difference between polycythemia vera patients with positive JAK2V617F and negative mutation (p= 0.04), while no significant difference was found for serum folate level (p= 0.630). Insignificant differences were also found for idiopathic myelofibrosis patients (B12, p= 0.140; and serum folate, p= 0.098), and essential thrombocythemia patients (B12, p= 0.133; and serum folate, p= 0.800).
Correlations of serum folate and B12 with hematocrit, white blood cell count, absolute neutrophil count, platelet count, mean cell volume, and mean cell hemoglobin in myeloproliferative neoplasm patients: significant correlations were only found in PV patients between B12 and total white blood cell count, absolute neutrophil count and platelet count (p= 0.009, 0.012 and 0.002 respectively).
CONCLUSION:
There is derangement in the levels of serum B12 in patients with polycythemia vera in relation to JAK2V617F mutation, thus we may propose that this mutation may have a possible impact on polycythemia vera patients, in particular, reflected by higher levels of serum B12 through the associated increase in absolute neutrophil count.

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

Saad Dakhil Farhan Daraji

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

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

Early Clinical Outcome of Urgent Coronary Artery Bypass Grafting at the Iraqi Center for Heart Diseases

Khaldoon Majid Ali; Mohamed S. Ahmed; Emad Al Mashat

Iraqi Postgraduate Medical Journal, 2015, Volume 14, Issue 2, Pages 244-249

ABSTRACT:
BACKGROUND :
Coronary artery bypass grafting (CABG) can be divided according to it's timing into:elective, urgent, emergency and salvage.The purpose of urgent CABG is to reperfuse the coronary artery blood flow rapidly, improves areas of myocardial ischemia, repair ventricular dysfunction and prevent the spread of the infarction area. Urgent CABG has a higher morbidity and mortality than elective CABG.
OBJECTIVE:
The purpose of this study was to identify preoperative and peroperative risk factors associated with this morbidity and mortality, evaluate clinical outcomes and recommend the possible solutions.
MATERIALS AND METHODS:
This is a retrospective study that reviewed the hospital records of 50 patients who underwent urgent CABG at the Iraqi Center for Heart Diseases for three years (2008-2010). The main daignostic tools were coronary angiography and echocardiography. All underwent conventinal CABG on cardio-pulmonary bypass with cardioplegic arrest. Variables that may be related to operative risk were analaysed.
RESULTS :
Forty-three patients underwent isolated CABG, while six patients underwent postinfarction ventricular septal defect repair and one patient underwent mitral valve replacement in addition to CABG, Postoperative mortality was 20%.
CONCLUSION:
The most common cause of mortality was Low Cardiac Output Syndrome followed by Acute Renal Failure.Preoperative risk factors for perioperative mortality were age more than 65 years, preoperative cardiogenic shock and low ejection fraction below 40.
KEYWORDS: urgent CABG, postinfarction VSD, low cardiac output syndrome.

Lipid Profile in Children with Chronic Renal Failure Undergoing Hemodialysis

Nariman F. Ahmed Azat; Qahtan M. Ali

Iraqi Postgraduate Medical Journal, 2015, Volume 14, Issue 2, Pages 222-228

ABSTRACT:
BACKGROUND:
Dyslipidemia is common in Patients with chronic renal failure undergoing intermittent haemodialysis and is considered a risk factor of cardiovascular disease in these patients.
OBJECTIVE:
To highlight the lipid profile abnormalities in children with end stage renal disease undergoing maintenance hemodialysis and know whether the hemodialysis duration and frequency of sessions per week has any impact on lipid profile in these patients.
PATIENTS AND METHOD:
A case-control study which was collected in the dialysis unit of (Al Karama Teaching Hospital, Child's Central Teaching Hospital , Al Kadhumia Teaching Hospital and Ibn Al Balady Hospital) for six months started on 1st June 2013 till the 1st of December 2013. Blood samples were obtained from 40 patients with end stage renal disease undergoing maintenance haemodialysis (2-3 sessions per week) and 40 matched healthy controls and analyzed for serum total cholesterol, low density lipoproteins, high density lipoprotein and serum triglyceride.
RESULTS:
A statistically significant decrease was found in serum high density lipoprotein level (Mean= 46.40mg/dl ,p < 0.025) in Hemodialysis patients when compared with healthy controls. A significant increase in serum triglyceride content of patients (p < 0.000) was also observed. It was found that improvements in lipid profile results were achieved with the use of more frequent (more than 2sessions of haemodialysis per week). There is no any impact of the duration being on HD on the lipid profile in the study.
CONCLUSION:
This study found that normal lipid profile is better maintained in patients undergoing adequate haemodialysis, and the frequency of haemodialysis sessions can affect the atherogenic states of the lipid profile which is probably the responsible for high incidence of atherosclerotic heart diseases among these patients.

Effect of Hand Deformities on Hand Function in a Sample of Patients with Rheumatoid Arthritis

Khudair Z. Al-Bidri; Mohammed S. Al-Omran

Iraqi Postgraduate Medical Journal, 2015, Volume 14, Issue 2, Pages 288-295

ABSTRACT:
BACKGROUND:
Rheumatoid arthritis (RA) is a chronic systemic autoimmune inflammatory disease that commonly affects the small joints of the hands and feet, and results in irreversible joint damage, deformity, and functional impairment.
Hand function is an important domain of the health status of RA patients. Assessment of hand function, therefore, is an essential part in the follow-up of RA patients and in gauging their response to treatment.
Numerous measures were developed to evaluate the hand function. One widely accepted measure includes simple clinical tests: Key grip, ball grasp, pen grasp, pinch grip and grip strength.
OBJECTIVE:
This study aims to determine the effect of hand deformities on hand function in a sample of patients with RA.
PATIENTS AND METHODS:
A cross-sectional study was conducted on 116 randomly selected patients fulfilling the 2010 ACR/EULAR criteria for Classification of RA. Patients with other conditions that can affect the hand function were excluded.
Patients were evaluated for age, hand deformities and Disease Activity Index (DAS28). A novel score was used to combine all hand deformities into one value.
Hand function was assessed by 3 subjective tests (key grip, pen grasp and ball grasp) and 2 objective tests (pinch strength and grip strength, measured by specialized dynamometers).
RESULTS:
Objective hand function tests (mean grip strength and mean pinch strength) had significant moderate negative correlations with the score of hand deformities (p<0.001, r=-0.459 or better), while the mean ranks of impairment of subjective hand function tests (key grip, pen grasp and ball grasp) showed significant weak positive correlations with the score of hand deformities (p=0.002 or less, r=0.283 or more).
CONCLUSION:
The presence and degree of hand deformities are significantly associated with poor hand function in patients with rheumatoid arthritis.

Managements of Patients with Malignant Gastric Outlet Obstruction: Prospective Study

Laith. R. Alhadad; Ali Hussein Jasim; Wail Sabah Al-Saffar

Iraqi Postgraduate Medical Journal, 2015, Volume 14, Issue 1, Pages 45-52

ABSTRACT :
BACKGROUND:
Gastric outlet obstruction is the clinical and pathophysiological consequence of any disease process that produces a mechanical impediment to gastric emptying. It classified into benign and malignant group. Distal gastric cancer form 35% of cases with malignant gastric outlet obstruction.
OBJECTIVE :
To study the causes of malignant gastric obstruction and how to treat them, in addition the application of gastric outlet obstruction score in our patient pre- and post-treatment.
PATIENT AND METHODS:
Between January-2012 to January-2014, a prospective study involves all patients with malignant gastric outlet obstruction in the surgical department in the gastrointestinal and Hepatology teaching hospital.
RESULTS:
A total of 51 cases of malignant gastric outlet obstruction were enrolled in the research, with mean age 53.21 ±14.6 years. There were 30 male patients (58.8%) with male to female ratio = 1.4:1. Non-bilious vomiting was present in (100%) of cases. antropyloric region was found in (47.1%) patients. Regarding GOOS, there were improvement in all patients (p value =0.048). Distal gastrectomy done in 19.6% of patients and gastrojujenostomy performed in 80.3% of patients. Gastric adenocarcinoma found in 15.7%, in 47.05% of patients was found to have metastatic adenocarcinoma.
CONCLUSION:
Gastric outlet obstruction poses diagnostic and therapeutic challenges to general surgeons. In recent years malignant cause become more. Gastric outlet obstruction score has a role in management of patients. Distal gastrectomy is the treatment of choice in resectable cases, while gastrojujenostomy can be used in advanced cases.

Demographic and Pathological Study in a Sample of Bronchogenic Carcinoma Patients in Baghdad Teaching Hospital , During 2006-2008

Hamza Abdullah Al Sabah; Mustafa Ahmed Kattaa; Abdulla Janger Alfarttoosi

Iraqi Postgraduate Medical Journal, 2015, Volume 14, Issue 1, Pages 28-37

ABSTRACT:
BACKGROUND:
The incidence of Lung cancer is increasing rapidly throughout developing countries. Lung cancer is the most commonly occurring cancer in men and the fifth in women.
OBJECTIVE:
To study the demographical and pathological profile of lung cancer among sample of Iraqi patients.
PATIENTS AND METHODS:
A retrospective descriptive study depending on review of records of diagnosed patients during 2006 - 2008.This study was conducted at the Baghdad teaching hospital, Baghdad-Iraq, during a period from 1st March 2012 to 1st January 2013.A total of 284 patients’ records all with proven lung cancer were selected retrospectively, reviewed and checked.
RESULTS:
There were 284 patients recruited in this study, the overall mean age was (62.1 ± 12.8) years and range was (18 – 100) years. Smokers were 232 (81.7%), Non-smokers were 32 (11.3 %) and Ex-smokers were 20 (7%). All cases had cough, almost (93%) chest pain, (88.4%) presented with shortness of breath..
Regarding the types of carcinoma, squamous cell carcinoma was present in 112 patients (39.4%), adenocarcinoma in 96 patients (33.8%), small cell carcinoma in 41 patients (14.5%), while large cell carcinoma in 31 patients (10.9%), and undifferentiated carcinoma was present in 4 patients (1.5%).
Regarding treatment for lung cancer among study groups, it had been noticed that 166 patients (58.5%) were subjected to chemotherapy, 115 patients (40.4%) were subjected to radiotherapy and only 3 patients (1.1%) were treated surgically.
CONCLUSION:
Lung cancer is more common among males and more frequent among those aged 50 years or more. The study demostrate that Sequamous cell carcinoma is the most common type of primary lung cancer in Iraqi patients (39.4%), adenocarcinoma is the second common type (33.8%). The five year survival was very low, only (0.4%) survive for five years after diagnosis, the majority of cases died within two years.

Comparison between Transurethral Holmium :YAG Laser Cystolithotripsy and Percutaneous Suprapubic Cystolithotomy in the Management of Bladder Stones in Children

Jasim A.Al Mayali; Mohamed N. AL Mosawi; Safa G. Almaliki; Ammar Sabah Al kaabi

Iraqi Postgraduate Medical Journal, 2015, Volume 14, Issue 1, Pages 136-139

ABSTRACT:
BACKGROUND:
Vesical stones in children are common in developing countries. Historically, open cystolithotomy has been the treatment of choice in the management of bladder calculi. Recently there are different treatmrnt of vesical stones like Transurethral Holmium laser cystolithotripsy and Percutaneous cystolithotripsy.
OBJECTIVE:
To Compare between transurethral Holmium :YAG laser cystolithotripsy and percutaneous suprapubic cystolithotomy in the management of bladder stones in children.
PATIENTS AND METHODS :
A total of 33 children (31 boys and 2 girls) with vesical stones were treated at Urology Department of Al-Sadder Medical City in Najaf between January 2013 and June 2014 . Mean patient age at the time of diagnosis was 4.2 years (range 8 months to 10 years). The patients were divided into 2 groups according to the procedure of stone removal. Group 1 (15 patients) underwent percutanous suprapubic cystolithotomy and group 2 (18 patients) underwent transurethral Holmium :YAG laser cystolithotripsy. Stone size ranged from 7 to 25 mm (mean 16.2mm).
RESULTS:
Operative time ranged from 10 to 25 minutes (mean 18 minutes) in percutanous suprapubic cystolithotomy (group 1) and was ranged from 15 to 70 minutes (mean 30 minutes) in transurethral Holmium :YAG laser cystolithotripsy (group 2). The day of catheter removal was 24 to 96 hours (mean 36 hours) in group 1, while it range 0 to 48 hours (mean 8 hours) in group 2. The hospital stay was shorter after transurethral Holmium :YAG laser compared to percutanous suprapubic cystolithotomy (30 vs. 72 hours). No significant intraoperative or postoperative complication was encountered except prolong urinary leak in two patients (13.3) in group 1 and transient mild haematuria in three children (16.6%) and low grade fever in two children (11%) in group 2. In all cases (100%) the stones were removed successfully in first session in group 1 while one patient (5.5%) need second session due to residual small stone in group 2.
CONCLUSION:
Transurethral Holmium :YAG laser and percutanous suprapubic cystolithotomy management of vesical stones in children are efficient, with a low incidence of complications. Transurethral Holmium :YAG laser offers a shorter hospital stay and urethral catheterization but longer operative time compared to percutanous suprapubic cystolithotomy.

Evaluation of Health Information System Performance in Iraq,2013

Mazin Gh Alrubaey; Thaer E M

Iraqi Postgraduate Medical Journal, 2015, Volume 14, Issue 1, Pages 145-150

ABSTRACT:
BACKGROUND :
Health information systems in most countries are inadequate in providing the needed management support and the current health information systems are therefore widely seen as management obstacles rather than as tools.
OBJECTIVE:
The current study is an attempt to assess Health information system performance in Iraq.
METHODS:
A cross-sectional study was conducted with a total of seven districts selected from six Iraqi governorates by simple random sampling , and a total of twenty six health centers were selected from the seven districts, also by simple random sampling. The performance Diagnostic tool was used to measure Health information system performance, it is one of the PRISM package tools that are used to assess the Health information system performance.
RESULTS:
The data accuracy at the facilities was 29.03%, while at the districts was 55.35%, the completeness rate at the facility level was 96.38% and at the district level was 98.23%. For that of the timeliness, the results revealed 70.43% timeliness at the district level; the information use for a given feedback at the facility was 50% and at the district was 82.12% and for observed meeting records it was 41.6% for the facility and 50% for the district level.
CONCLUSION:
Health information system has a low data quality in the form of accuracy at the facility and district levels. The timeliness is relatively weak at the district level, while it is good in the form of completeness at both facility and district level; on the other hand information use at the district level was better than that of the facility level.

Hepatotoxicity of Combined Therapy of Atorvastatin with Platelet P2Y12-ADP Receptor Antagonist in Coronary Heart Disease Treated Patients

Feryal Hashim Rada; Najat Abdulrazzaq Hasan; Mohammed Hasan Al Baghdadi

Iraqi Postgraduate Medical Journal, 2015, Volume 14, Issue 1, Pages 108-113

ABSTRACT :
BACKGROUND:
Clopidogrel, an adenosine diphosphate receptor blocker, is widely used as an adjunctive antiplatelet therapy in coronary disease and percutaneous coronary stenting. It appears to be a safe drug with few occurrences of liver side-effects that usually resolved after drug withdrawal.
OBJECTIVE:
The goal of this study was to investigate whether the co-administration of atorvastatin could aggravate the hepatic - toxicity of clopidogrel.
PATIENTS AND METHODS:
Eighty patients with coronary disease were included in this study. All patients received a dose of 75 mg/day of clopidogrel. Forty patients group A with recent treatment (˂ 3 months) of clopidogrel; other forty patients group B with (˃ 1 year) treatment of clopidogrel. Liver function tests were measured and studied at baseline (clopidogrel without atorvastatin) and at 2, 4, 6 weeks of clopidogrel with atorvastatin (40 mg/day) afterwards.
RESULTS:
Liver function tests with co-therapy showed high significant elevation in mean serum total alkaline phosphatase (P˂0.001), significant decrease (P˂ 0.05) in mean serum gamma-glutamyl transferase ,significant elevation (P˂ 0.05) in mean serum direct bilirubin and insignificant elevation (P˃0.05) in mean serum total bilirubin , whereas the results appeared within normal range in mean serum levels of alanine aminotransferase, aspartate aminotransferase ,glutamate dehydrogenase -1,and total protein .
CONCLUSION:
Combination of atorvastatin and clopidogrel may induce hepatic injury cholestatic type resulting from abnormal bile flow caused by either drugs or its metabolites.
KEYWORDS: clopidogrel; atorvastatin; liver function tests.

A comparative Study between Open Excision and Modified Bascom's Technique in Sacro- Coccygeal Pilonidal Sinus

Mohammed Hillu Surriah

Iraqi Postgraduate Medical Journal, 2015, Volume 14, Issue 1, Pages 53-61

ABSTRACT:
BACKGROUND:
Pilonidal sinus is a common disabling disease of young adults involving the sacro- coccygeal area, in the natal cleft , consisting of one or more, usually non-infected, midline openings, which communicate with a fibrous track lined by granulation tissue and containing hair lying loosely within the lumen. Many of the standard surgical procedures are associated with a significant risk both of delayed healing and of recurrent disease.
OBJECTIVE:
The study aimed to comparing the results of excision and packing method with those of lateral approach (Modified Bascom's procedure) in the treatment of sacro - coccygeal pilonidal sinus in regard to the hospital stay, time required for complete healing , time required to return to daily job or activity, early complications (infection, wound hematoma or seroma ) and late complications (scar and recurrence) .
METHODS :
Eighty patients were operated on electively for pilonidal sinus, (62) male, (18) female who underwent elective operations of sacro-coccygeal pilonidal sinus at AL-Karama Teaching Hospital between June 2009 - June 2014 . Two surgical procedures were carried out, excision and packing (40 patients, group A) and modified Bascom's procedure (lateral approach) (40 patients, group B)" Five patients omitted from further follow 'up, two cases related to excision and packing and three of modified Bascom's procedure .
RESULTS :
It has been found that the third decade of life is the most frequent age group at which patient presenting symptoms was discharge (61.2%) and pain (26.2%) although both present in combination in most cases' 75% and 52%) of patients had discharge and pain respectively during the presenting period . The duration of the disease was from one month to two years.
It has been concluded that there was no significant difference in the occurrence of the early complication ( infection , seroma / hematoma) 25% for group A and 37.5% group B, and recurrence rate l0.5 % for group A and 16.2% for group B , thus patients in group B provided a significantly quicker healing time { mean 49 days for group A and 28 days for group B }.
Shorter time - work { mean 47.8 days for group A and 28 days for group B } with better patient convenience (more pain free period), needs only simple oral analgesia , no patient needed hospital admission for pain control no dressing required and less risk of wound break down .
CONCLUSION :
The study had shown that modified Bascom's procedure for pilonidal sinus is safe and feasible as day-care surgery and is associated with potential cost saving.

Peritoneal Dialysis in Children with Acute Renal Failure in Ibn Al-Balady Hospital

Salim Zyarah Abdullah

Iraqi Postgraduate Medical Journal, 2015, Volume 14, Issue 1, Pages 1-6

ABSTRACT:
BACKGROUND :
Acute renal failure (ARF) is most important condition in pediatric nephrology units with variable causes vary from place to place and peritoneal dialysis(PD) is the easy and feasible modality of treatment for acute renal failure in small and young children and hemodynamically unstable patients were other modalities not suitable for them.
OBJECTIVE:
To stady the aetiology and prognosis of the patients with acute renal that required peritoneal dialysis in ibn al balady hospital.
METHODS:
A retrospective study involved 82 patients with acute renal failure admitted to dialysis in Ibn Al-Balady hospital for a period of 32 months from August 2011 to April 2014 . Data were collected from patients records and involved clinical parameters of the patients, causes of ARF , indications of PD ,complications of PD and the outcome of PD(deaths).
RESULTS :
The study involved 82 children of whom 47(57.3%) male ,with a mean age of 13 +19.5 months . Azotemia was presented in all patients (100%) with oliguria in 60(73.2%) or unuria in 26 pateints (31.7%) , volume overlaod in 32(39%) , encephalopathy in 28 pateints (32.9%). Sepsis was the most common cause of ARF in 32 pateints (39%) while gastroentritis in 16 pateints (19.5%) , glomerulonephritis in 10 pateints (12.2%) and hemolytic uremic syndrome ( HUS) in 9 pateints (11%). Peritonitis is the commenest complication of PD represents 33(40.2%) of pateints. The overall mortality was 32.9 % mostly related to septicemia (63%) and the presence of fluid overlaod, peritonitis,encephalopathy and unuria (66.7,66.7,63 and 59.3% ) respectivly.
CONCLUSION :
Peritoneal dialysis is the preferred modality of renal replacement therapy (RRT) for children with acute renal failure( ARF) because its simple and feasible especially neonates and young infants and hemodynamically unstable patients. Septicemia and severity of ARF are contributory factors to high mortality in pediatric ARF.Early detection and referral of patients at risk is of great value for reducing mortality.

Posterior-Stabilized Total Knee Arthroplasty: Short Term Clinical and Radiological Outcome

Mohammed H. Salal

Iraqi Postgraduate Medical Journal, 2015, Volume 14, Issue 1, Pages 70-82

ABSTRACT:
BACKGROUND:
To prevent posterior subluxation of the tibia and to improve range of motion and stair climbing ability, total knee prosthesis was modified to the posterior stabilized (PS) one in 1978 and further modifications followed. The Knee Society in 1989 introduced a rating score for TKA named the Knee Society Score (KSS), it's widely used and revised in 2012.
OBJECTIVE:
To study the clinical and radiological results of PS/ TKA.
PATIENT AND METHOD:
We prospectively studied 30 patients with PS/TKA. The mean age was 63 years and mean follow-up was 12 months, 24 knees had osteoarthritis (OA) and 6 knees were rheumatoid (RA). All were unstable and malaligned. The results assessed using the scoring system of Insall et al. and the KSS. Postoperative radiological assessment performed using weight-bearing AP and supine lateral radiographs.
RESULTS:
At last visit, 9 knees (30%) had excellent result, 18 (60%) had good result and 3 (10%) had fair result. The mean KSS improvement was from 31 points preoperatively to 89 points postoperatively. The mean ROM (flexion) preoperatively was 68.5o improved postoperatively to 106o. Postoperatively all knees were stable in AP direction only 4 (13.3%) had mild lateral instability. The ideal position for femoral component within (6-10o) valgus was obtained in 24 knees (80%), it was within (0-5o) valgus in 6 knees (20%). In 93% (28 knees) the tibial component were within 2o of varus or valgus, 6.6% (2 knees) was in greater than 2o varus. Knee function score improved from a mean 27.5 points preoperatively to 58 points postoperatively and patients were able to walk more than 500 meters.
CONCLUSION:
PS/TKA increases range of motion, increases joint stability and improved gait. Both OA and RA patients responded well to its use with nearly same end results. We strongly recommend the use of PS/TKA for primary total knee replacement.

Vascular Cognitive Impairment in Ischemic Stroke Patients

Salman Isa Haza; Nawfal Madhi Sheaheed; Akram M. Al-Mahdawi

Iraqi Postgraduate Medical Journal, 2014, Volume 13, Issue 4, Pages 532-537

ABSTRACT:
BACKGROUND:
Stroke is associated with considerable physical and psychological impairment. Cognitive impairment is common sequel of stroke and small vessel ischemic disease. Potentially modifiable risk factors for vascular cognitive impairment (VCI) include hypertension, DM, hyperlipidemia and others. Because of the close association of these factors with stroke, prevention of VCI is largely tied to control of stroke risk factors.
OBJECTIVE:
The main aims of the study were to ascertain the significant determinants of cognitive impairment in stroke patients and the associated risk factors.
PATIENTS AND METHODS:
This is a case series descriptive study that enrolled 100 patients whose ages were 50 years and above with stroke attending at Al-Yarmouk Teaching Hospital in Baghdad-Iraq during the period between the 1st of January 2007 to the 31st of January 2008. All of the patients were asked about demographic and atherogenic risk factors and subjected to cognitive assessment by MMSE and executive function also the patients subjected to thorough clinical assessment, laboratory investigations and radiological studies.
RESULTS:
This study revealed that distribution of VCI in stroke patients was 27%, the patients with vascular CIND represent 19% and those with VaD represent 8%. The mean age of the patients was 65. The most common risk factors were hypertension 25%, hypercholesterolemia 20%, smoking 17%, acute myocardial infarction 10%, diabetes 10% and atrial fibrillation 5%. We observed that increasing age, low level of education and acute myocardial infarction were significant determinants of cognitive impairment in stroke patients.
CONCLUSION:
Considerable proportion of stroke patients presented with cognitive impairment which is determined by modifiable risk factors like atherogenic and demographic risk factors.

Treatment of Mallet Finger; Conservative or Operative

Alaa A. Dawood

Iraqi Postgraduate Medical Journal, 2014, Volume 13, Issue 4, Pages 466-474

ABSTRACT:
BACKGROUND:
Mallet finger injuries, still represent a controversy as the best way of treatment, when to treat conservatively and when to go for surgical management .
OBJECTIVE:
This prospective study was undertaken to evaluate functional outcome of conservative versus surgical treatment of acute and chronic mallet finger injuries.
PATIENTS AND METHODS:
A prospective study was conducted between November 2011 and December 2013 . Forty six patients with mallet finger deformity were treated,21 by non-operative technique and 20 were treated surgically, the time between injury and commencement of treatment ranges from 3 days to 3 years mean ( 17 weeks).Follow up ranges from 12 months to 18 months mean( 15 months).
RESULTS:
Successful outcome was found in 57.15% of mallet fingers treated conservatively by splintage .patient satisfaction with conservative treatment was 66.7%. Successful outcome of surgical treatment was 65% while patient satisfaction was found in75% of cases treated surgically. Patients started conservative treatment within 4 weeks of injury had better outcome (success rate 81.8%) than those started treatment after 4 weeks (success rate 30%). Mallet finger injuries treated after 4 weeks from injury, show a better functional outcome in surgically treated group(success rate 61.5%), than injuries treated by splint (success rate 30%).
CONCLUSION:
Conservative treatment is safe, effective well tolerated, method of treatment for early closed and uncomplicated cases, with better outcome in patient started treatment within 4 weeks of injury than those started treatment after 4 weeks .Surgical treatment is required for open ,chronic cases and those complicated by swan neck deformity. Mallet injuries presented after 4 weeks show a better outcome if surgical treatment is undertaken.

Surgical Difficulties of Cochlear Implantation in Children

Muhamed Dheia Ahmed; Muthana Saleemabdalamer

Iraqi Postgraduate Medical Journal, 2014, Volume 13, Issue 4, Pages 493-498

ABSTRACT:
BACKGROUND:
Cochlear implantation is a recent surgical treatment of deaf children, surgical difficulties may arise and has impact on outcome of implant.
OBJECTIVE:
To define the difficulties encountered during surgery and how the surgeon deals with them.
METHODS:
120 patients of bilateral severe to profound hearing loss who all had implantation in the department of otorhinolaryngology, medical city, during the period from July 2010 to September 2011. All of them received the Nucleus Freedom cochlear implant with Contour Advance Electrode, model CI24RE.
They are classified into two groups according to difficulty arises during surgery :(group a ) those identified during access to cochlea.(group b) those associated with difficult electrode insertion.
RESULTS:
Difficulties encountered during access occurred in 8 patients (6, 66%); Difficulties encountered during insertion of electrode occurred in 16 patients (13.33%).
CONCLUSION:
We concluded that although cochlear implant (C.I.) surgery is now well practiced , and difficulties during surgery are infrequent, the Surgical management of certain obstacles encountered during surgery demands expert knowledge of surgical technique for successful implantation .

A Comparative Study Between Ventriculoperitoneal Shunt and Endoscopic Third Ventriculostomy in the Manegment of Obstructive Hydrocephalus

Abdulameer Alkhafaji; Samir Faissal Hassan

Iraqi Postgraduate Medical Journal, 2014, Volume 13, Issue 4, Pages 486-492

ABSTRACT:
BACKGROUND:
Uncertainty persists on the best treatment for patients with obstructive hydrocephalus: endoscopic third ventriculostomy (ETV) or V-P shunt. Most patients with obstructive hydrocephalus are treated with ventriculo-peritoneal (VP) shunt placement.
OBJECTIVE:
Of this study is to compare between V-P shunt and ETV in the manegment of obstructive hydrocephalus in relation to the degree of complication.
METHODS:
This is a prospective study of 90 patients with obstructive hydrocephalus of various etiologies operated by V-P shunt or Endoscopic 3rdventriculostomy in the Department of Neurosurgery in Al-Khdhemia Teaching Hospital, Neurosciences Teaching Hospital and Neurosurgical Teaching Hospital from October 2011 to December 2012. Presenting symptoms and signs, clinical shunt function, operative findings and outcome were recorded.
RESULTS:
Common presenting features were headache, vomiting, irritability and general toxic look of patients. Male to female ratio was 1.14:1. Patients with obstructive hydrocephalus were treated with V-P shunt or with endoscopic third ventriculostomy and followed for 6 months as an average. In patients with V-P shunts, upper end block was a common problem followed by wound dehiscence and valve exposure and other complications such as lower end obstruction, slipped catheter, subdural hematoma, and subcutaneous CSF collection. While in patients with ETV spontaneous closure of the stoma was more frequent than other complications. The complication rate in ETV is lower than that of V-P shunt (30% in V-P shunt and 17% in ETV). However ETV is less successful in patients below 2 years old and in those with normal pressure hydrocephalus.
CONCLUSION:
Endoscopic third ventriculostomy is becoming more popular as an alternative to shunting in the management of obstructive-type hydrocephalus. Obstructive hydrocephalus is the main indication for endoscopic third ventriculostomy. However, in cases where this procedure is indicated, good knowledge of third ventricle anatomy, surgeon preference and experience with endoscopic surgery can yield success rates of up to 80%.

How to Reduce Time Delays in Presentation and Treatment of Testicular Torsion; the Role of Public and Practitioners Education

Saad Dakhil Farhan Daraji

Iraqi Postgraduate Medical Journal, 2014, Volume 13, Issue 4, Pages 499-503

ABSTRACT:
BACKGROUND:
Testicular torsion (TT) requires prompt diagnosis and treatment to avoid testicular Loss. Most studies have focused on the ideal work up to rule TT out in cases of acute scrotum. A long response time to the scrotal pain was related to high orchidectomy rate during surgery for acute torsion.
OBJECTIVE:
We attempted here to highlight the causes behind high orchidectomy rate during the surgery for testicular torsion and the advices to decrease this problem.
PATIENTS AND METHODS:
Surgical exploration which was done for suspected testicular torsion in 50 consecutive males with their age (range 1-20 years. All patients were evaluated with detailed history, physical examination and Basic Laparotory investigations, some patients underwent scrotal ultrasound scan with color-Doppler preoperatively when possible. Patient age, site of pain, duration of symptoms, ultrasound finding, approximate time from admission to surgery, operative findings, and type of the operation and causes of delay for orchidectomy group were recorded.
RESULTS:
Intra operative Testicular torsion was documented in 36 patients, orchidectomy and orchidopexy was performed equally, Delays to reach the hospital for more than 4 hours after the onset of pain significantly associated with increase the risk of orchidectomy .The risk of orchidectomy significantly increased with increased patient age. Parents neglect appear the most important cause for small age group while self ignorance, social fear and false medical advices for older ages.
CONCLUSION:
A long response time to the scrotal pain and a high orchidectomy rate were exposed by this study. This was thought to be due to ignorance, which could be eliminated through public education.

Unipolar Versus Bipolar Hip Hemiarthroplasty in the Treatment of Femoral Neck Fractures in the Elderly

Ali A. Ali; Saad M. Rashed; Mushtaq T. Hussien

Iraqi Postgraduate Medical Journal, 2014, Volume 13, Issue 4, Pages 475-485

ABSTRACT:
BACKGROUND:
Hip fractures are associated with high morbidity and mortality, which require a treatment plan that ensures a good outcome with minimal complications. Different treatment modalities and arthroplasty prosthesis are available and widely used.
OBJECTIVE:
The aim of this study was to compare the short outcome of surgical treatment of femoral neck fractures in elderly using unipolar and bipolar hip hemiarthroplasty.
PATIENTS AND METHODS:
Thirty four patients with intracapsular femoral neck fractures ranging from Garden’s class II to class IV were enrolled in the study for surgical intervention using either unipolar hemiarthroplasty (Group A: 14females, 6 males) or bipolar hemiarthroplasty (Group B: 10 females, 4 males). Patients were followed up for up to 2 years by Harris Hip Score to assess the outcome of the surgery.
RESULTS:
The average hip score for patients per group over the whole follow-up period showed better results in group B than in group A. Average score results were higher in all grades among group B patients. However, the difference from scores of group A patients was statistically insignificant (p>0.05). Patients of both groups had a negative correlation of age to score outcome regardless of sex and grade of fracture. In group A patients, score points for pain, stiffness, range of motion and support/locomotion were all higher during the first six months of follow up. The scores started to decline gradually after 18 months towards the end of the follow up period. In group B patients, the score points for the same parameters were all significantly lower than Group A patients during the first 3-6 months of follow up but started to increase to significantly higher levels towards the end of the follow up period.
CONCLUSION:
The short-term advantages of unipolar hemiarthroplasty may outweigh its long-term complications in elderly patients with limited daily activities and/or associated serious medical illnesses. In younger age patients with more ambulatory activities and greater life expectancy, bipolar hemiarthroplasty offers a better solution.

eamodynamic Changes During Airway Managment in Hypertensive Patients Undergoing Abdominoplasty Surgery

Ali Abdulhamed Mohamed; Abbas Mohamed Suhan

Iraqi Postgraduate Medical Journal, 2014, Volume 13, Issue 4, Pages 509-514

ABSTRACT:
BACKGROUND:
Avoidance of heamodynamic changes in hypertensive patients receiving general anesthesia is a goal including patients undergoing abdominoplasty surgery.
OBJECTIVE:
To compare haemodynamic responses to use of a classic laryngeal
mask airway (LMA) versus endotracheal tube (ETT) in hypertensive females undergoing abdominoplasty surgery.
PATIENT AND METHODS:
Place and Duration of study: Al-Amaal private hospital from march. 2012 to march 2014.
Fifty hypertensive female patient undergoing abdominoplasty surgery were randomly distrusted into two equal groups using alternate patient technique endotracheal tube( ETT ) and laryngeal mask airway (LMA) ( n=25 each). Patients in both groups were received general anaesthesia using standard anesthetic technique.
Patients in ETT group underwent laryngoscopy and ETT intubation, whereas patients in LMA group received LMA without laryngoscopy for their airway maintenance. Haemodynamic variables, (pulse, systolic, diastolic and mean arterial pressures) were measured using non-invasive monitoring technique at various intervals before and after intubation or LMA placement , before and after extubation or LMA removal.
CONCLUSION:
Laryngeal mask airway provide more stable heamodynaics parameter than endotracheal tube during incertion and removal in hypertensive patients receving general anesthesia for abdominoplasty surgery.

The Effect of Metformin on Serum Lipids in Overweight and Obese Patients with Polycystic Ovary Syndrome

Asma Zuhair Fadhil; Foud AL-Dahhan

Iraqi Postgraduate Medical Journal, 2014, Volume 13, Issue 3, Pages 342-347

ABSTRACT:
BACKGROUND:
Polycystic ovary syndrome is a very common condition affecting 4% to 18% of women. Polycystic ovary syndrome is associated with metabolic features and diabetes and cardiovascular disease.
OBJECTIVE:
To evaluate the effect of metformin on serum lipids in overweight and obese women with polycystic ovary syndrome.
METHODS:
An observational prospective study conducted at AL- Diwanyia Maternity and child Hospital from May 2011 to March 2013. All women in this study have BMI >27 (range) so, they are all overweight and obese .The women randomized into two group; one group were recieved metformin therapy for 4 months duration and the other group were kept on no therapy and followed for the same period. All studied women were subjected to measurement of fasting Blood sugar, and measurement of overnight fasting lipid profile which include total cholesterol, triglycerides, high density lipoprotein cholesterol and low density lipoprotein cholesterol.
RESULTS:
For women who received metformin, there was significant increase in the level of high density lipoprotein P = 0.04. The value of triglyceride although decreased after metformin treatment, the difference was not significant P > 0.05.
Other parameters (cholesterol, low density lipoprotein cholesterol) showed no difference. Fasting blood sugar was not changed during the study.
CONCLUSION:
Metformin have been shown to improve the lipid profiles leading to increase the high density lipoprotein cholesterol, the main predictive of cardiovascular disease in the women with polycystic ovary syndrome.

Prevention of Postcircumcision Meatal Stenosis

Ehab Jasim Mohammad; Mohammad Maher Al.Ani; Abdulsattar Jubair Ali

Iraqi Postgraduate Medical Journal, 2014, Volume 13, Issue 3, Pages 365-369

ABSTRACT:
BACKGROUND:
Meatal stenosis is a condition that almost always is acquired after neonatal circumcision. Circumcision is one of the most common surgical operations throughout the world, and meatal stenosis is one its late complications. We evaluated the topical use of a lubricant jelly after circumcision in boys in order to reduce the risk of meatal stenosis.
OBJECTIVE:
To evaluate the use of lubricant in prevention of postcircumcision meatal stenosis and other complications.
MATERIALS AND METHODS:
From April 2010 to September 2012, 300 boys younger than 2 year old referred to AL-RAMADI TEACHING HOSPITAL IN ANBAR,IRAQ and my clinic, were involved in a randomized controlled trial. They were referred for circumcision. The parents in the study group were instructed to use petroleum jelly on the circumcision site after each diaper change for 6 months. In the control group, no topical medication was used. The children were followed up regularly and evaluated for meatal stenosis, bleeding, infection, and recovery time.
RESULTS:
Three hundred boys younger than 2 years old participated in the study.
None of the children in the lubricant group developed meatal stenosis, while 91 (60.6%) in the control group developed postcircumcision meatal stenosis (P 0 .0000) which is statistically highly significant. Infection of the circumcision site was observed in 2 (1.3%) and 14 (9.3%) children of the lubricant and control groups, respectively (P 0 .0004) which is statistically highly significant . Two boys (1.3%) in the lubricant group and 29 (19.3%) in the control group had postcircumcision bleeding (P 0 .0007) which is statistically highly significant.
Finally, the mean time of recovery in the lubricant group was 3.8 ± 1.2 days, while it was 6.9 ± 4.2 days in the control group (P = 0.03).
CONCLUSION:
Based on the findings of this study we can conclude that using petroleum jelly after circumcision is considerably effective for reducing postcircumcision meatal stenosis and other complications.

Immunohistochemical Expression of Her2/Neu Receptor in Human Colorectal Carcinoma (A Clinicopathological Study)

Kifah Hamdan AbdulGhafour

Iraqi Postgraduate Medical Journal, 2014, Volume 13, Issue 3, Pages 424-429

ABSTRACT:
BACKGROUND:
Colorectal adenocarcinoma is the most common type of gastrointestinal cancers in Iraq, and according to the Iraqi cancer registry (ICR) reports, the incidence of colorectal carcinoma was 2.99% of whole body malignancies (ICR 2010). In males, it’s the 5th common cancer while in females it’s the 4th most common cancer.
Her2/neu is an important oncogene in breast cancer, but its prevalence and significance in colorectal carcinoma have been documented.
OBJECTIVE:
To determine the frequency and the pattern of Her2/neu expression in colorectal adenocarcinoma by immunohistochemical technique and to correlate this expression with different clinicopathological parameters.
MATERIAL AND METHOD:
Twenty five cases of colorectal adenocarcinoma were studied, these cases were diagnosed in private laboratories in Baghdad/Iraq from November 2011 to march 2013. Clinicopathological parameters such as age, gender, pathological diagnosis, including the tumor site, size, lymph nodes status, grade and stage of tumor were taken from patients file. Sections of 4 µm stained by H&E stain and immunohistochemical stained for Her2/neu.
Using infiltrative ductal carcinoma of the breast as control positive, evaluation of Her2/neu expression by immunohistochemistry in all cases was performed.
RESULTS:
Fourteen (56%) of the cases were males, 11 (44%) case were females, with age distribution ranging from (24-89) years, with a mean age of 56.5 years. Tumor size ranges between 2.5-10 cm, with mean of 6.25 cm. Seven (28%) cases were localized in the cecum, 5 (20%) from each rectum, sigmoid and left colon, respectively and 3 (12%) involving more than one segment of the colon.
Histologically the tumor grade ranges from moderately differentiated in 23 (92%) cases and poorly differentiated in 2 (8%) cases. Regarding pathological staging (TNM system), 5 (20%) were stage T2, 17 (68%) were stage T3 and 3 (12%) were T4. Lymph node involvement found in 10(40%) of the cases and distant metastasis was found in 2 (12%) cases. Her2/neu expression was present in 4(16%) cases of 25 colorectal adenocarcinoma; there was no correlation with age, sex, histopathological grade, location, lymph nodes status and tumor invasion.
CONCLUSION:
Concerning data exists about the prevalence of her2/new expression in colorectal adenocarcinoma, there was no significant correlation between her2/neu over expression and tumor size, grade, localization of the primary tumor, lymph nodes status and depth of invasion.

Immunophenotyping of Bone Marrow Biopsies in 26 Patients with Non-Hodgkin's Lymphoma, Using Anti-CD3, CD8, CD19 and CD20 Monoclonal Antibodies

Faris. H. Jaafer; Raad Jaber Musa M

Iraqi Postgraduate Medical Journal, 2014, Volume 13, Issue 3, Pages 430-433

ABSTRACT:
BACKGROUND:
Immunophenotyping with monoclonal antibodies (MoAbs) directed against lymphoid-associated antigens, immunohistochemical staining on paraffin-embedded BM biopsy material, and molecular studies of Ig genes/T-cell receptor genes or lymphoma-associated gene translocations should be used in the global approach to the patient with malignant lymphoma.
OBJECTIVE:
1. To determine the subtypes of non-Hodgkin lymphomas (B- or T cell) in the bone marrow using anti-CD3, CD8 monoclonal antibodies for T-cell and anti-CD19 and CD20 for B-cells.
2. Correlation of the subtypes of NHL (B- or T cell) with the morphology and pattern of bone marrow infiltration.
PATIENTS, MATERIALS AND METHODS:
A retrospective study, done in Al-Kadhymia teaching hospital during the period from 1/10/2010 to1/2/2011.The study consisted 26 adult patients, who were diagnosed as Non-Hodgkin lymphomas by undergoing a BM biopsy. Immunohistochemical staining of the paraffin-embedded sections of BM trephine biopsies was performed in all cases and used standard techniques with monoclonal anti-CD8, CD20 and dual immunofluorscence-labelled CD3, and CD19 antibodies and also all stained with Hematoxylin and Eosin (H&E) for morphologic assessment.
RESULTS:
The 26 cases of NHL comprised of 14 male (54%) and 12 female patients (46%) . The median age was (57.32) year ranged from 27-85 years. There were 23 cases of B-cell cases (88.5%) and 3 cases of T-cell lineage (11.5%) of all the cases. Among all the B-cell lymphomas, 15 cases showed interstitial infiltration in the bone marrow, while among the T-cell lymphoma two cases showed diffuse infiltration.
CONCLUSION:
1. In these 26 cases NHL patients with marrow involvement, B cell phenotype comprised 88% of cases.
2. B-cell NHLs had predominance of interstitial infiltration in bone marrow biopsies in comparison with the T-cell lymphoma, in which diffuse infiltration was predominant.
.

The Impact of Long Term Prognosis of Troponine in High Risk Unstable Angina

Haitham Noaman Al-Koubaisy

Iraqi Postgraduate Medical Journal, 2014, Volume 13, Issue 3, Pages 306-309

ABSTRACT:
BACKGROUND :
To evaluate the long term prognosis (6 months of follow up) regarding mortality , acute myocardial infarction and coronary angiography results in patients with troponin positive or negative in high risk unstable angina pectoris .
METHODS :
All patients included in this study were adults, 73 patients, 52(71.24%) male versus 21(28.76%) female of different ages . All had clinical features of ischemic chest pain of high risk unstable angina. They attended private clinic in HIT city, Anbar Governorate ( West of Iraq ) during the period January 2010 – December 2012. All had planner ST-segment depression in electrocardiography (ECG) according to concordant ECG leads other ECG findings of T- wave inversion or ST- elevation myocardial infarction were excluded, measurement of serum troponin test was done for all patients. All patients included in the study were admitted to coronary care unit (CCU) and received full treatment including heparin and discharged from hospital when they were clinically stable. Coronary angiography was done for all patients and followed up for 6 months.
RESULTS :
From all patients included in this study 27(36.98 % ) were troponin positive unstable angina, 3 (11.12%) patients of them were died and 24 (88.88 % ) patients of them survived. Their coronary angiography were sever type in 11(40.74 %) patients and they did coronary artery bypass surgery(CABG) and 13(48.14 % ) patients had multiple lesions in more than one vessels and need more than one balloon and stent(Percutaneous trans luminal coronary angioplasty PTCA) .While those whom troponin negative unstable angina were 46( 63.02 %) patients all were survived, only 5 (10.86 %) of them need coronary artery bypass surgery, 27 (58.69 %) patients need single or multiple stents , 4(11.5 %) patients had non critical coronary artery lesion only for medical treatment and the remaining 11 ( 41.81 %) patients were had normal coronary angiography .
CONCLUSION :
Troponin positive high risk unstable angina carry poor prognosis where has 3 times more mortality risk and more likely to be in need for surgery and difficult stenting and may not be able to be treated surgically or by stenting but medically without intervention than negative troponin high risk unstable angina .

Antibiotic Treatment in Patients with Chronic Low Back Pain and Vertebral Bone Edema (Modic Type I Changes): A Randomized Clinical Controlled Trial of Efficacy

Mohanned A. Al-Falahi; Mohammed H. Salal; Dhiaa M. Abdul-Wahab

Iraqi Postgraduate Medical Journal, 2014, Volume 13, Issue 3, Pages 390-397

ABSTRACT:
BACKGROUND:
Modic type I changes/bone edema in the vertebrae are present in 6 % of the general population and 35–40 % of the low back pain population. It is strongly associated with low back pain. Chronic Low back pain (CLBP) is a leading cause of disability. It occurs in similar proportions in all cultures, interferes with quality of life and work performance, and is the most common reason for medical consultations.A new method of treatment included the use of antibiotic in management of CLBP with Modic type I changes has proved to be effective in some cases.
OBJECTIVE:
The aim was to test the efficacy of antibiotic treatment in patients with chronic low back pain (>6 months) and Modic type I changes (bone edema).
PATIENTS AND METHODS:
The study was a randomized clinical trial(RCT) with 71 patients whose only known illness was chronic LBP of greater than 6 months duration occurring after a previous disc herniation and who also had bone edema demonstrated as Modic type I changes in the vertebrae adjacent to the previous herniation. Patients were randomized to either 100 days of antibiotic treatment or placebo and were evaluated at baseline, and end of treatment.
Outcome measures: are the disease-specific disability Questionnaire, which is Roland Morris Disability Questionnaire (RMDQ) and lumbar pain.
RESULTS:
43 of the 71 original patients were evaluated at baseline and at end of treatment follow-up. The two groups were similar at baseline. The antibiotic group had better improvement on the outcome measures and improvement continued after end of treatment. At baseline, 100 days follow-up the means of the disease specific disability-RMDQ changed: antibiotic 15.5, 12; placebo: 15, 14.8. For Lumbar pain: antibiotics 6.4, 4.8; placebo 6.1, 6.0.
CONCLUSION:
The antibiotic protocol in this study was more effective for this group of patients (CLBP associated with Modic changes type I) than placebo in the outcomes.

Topical Steroid Misuse on the Face: A Medical and Social Problem in Iraq

Ammar Faisal Hameed

Iraqi Postgraduate Medical Journal, 2014, Volume 13, Issue 3, Pages 413-417

ABSTRACT:
BACKGROUND:
The use of topical steroids on the face should be carefully selected by the dermatologist, however its misuse still occur producing dermatological problem resembling rosacea.
OBJECTIVE:
To highlight the clinical aspects of misusing topical corticosteroid on the face and to search for the causes behind this medical and social problem.
METHODS:
In this prospective study, 110 Iraqi patients with steroid rosacea or perioral dermatitis with history of topical steroid use on their faces for at least 1-3 months were evaluated at Department of Dermatology -Baghdad Teaching Hospital between January 2011 to December 2013.
RESULTS:
Majority of patients were young, poorly-educated women who used a combinations of potent and very potent topical steroid for average period of 0.25-12 years. Facial erythema (92.7%) and hotness (89%), dryness (62.7%), telangiectasia (53.6%) and rebound phenomenon (86.3%) with or without papulopustular eruption were the main clinical complaints. Searching for beauty and facial fairness in 51(46%) of patients, hyperpigmentory problems like melisma in 40(36%) patients were the main indications for steroid misuse on the face mostly accomplished through recommendations from non-medical personnel.
CONCLUSION:
Topical steroid should not be used on the face unless it is under strict dermatological supervision and the easy access to topical steroid preparations must be controlled by the health penalties.

Role of Nucleated Red Blood Cells in Umbilical Cord Blood as A Marker of Neonatal Asphyxia with Meconium Stained Amniotic Fluid

Maha M. AL-Bayati; Asmaa Mohammed Abid; a Anees Wahbi; Maisa

Iraqi Postgraduate Medical Journal, 2014, Volume 13, Issue 3, Pages 336-341

ABSTRACT:
BACKGROUND:
Neonatal asphyxia is a major cause of neurologic morbidity and mortality. Recent studies suggest increased nucleated red blood cells in neonates with meconium aspiration syndrome, supporting that the pregnancy with meconium stained amniotic fluid is at high risk of fetal hypoxia.
OBJECTIVE:
To evaluate the role of umbilical cord nucleated red blood cells as a marker of neonatal asphyxia with meconium stained amniotic fluid.
PATIENTS AND METHODS:
This study was conducted at the Department of Obstetrics and Gynecology and Nursery Department in AL- Kadhymia Teaching Hospital from April 2010 through April 2011as prospective case controlled study. The study included one hundred pregnant women, who were admitted to the delivery ward, they were arranged into two groups. Group one included fifty women with meconium stained amniotic fluid, considered as study group and the other group included fifty women with clear amniotic fluid, considered as control group. This for determination of umbilical cord nucleated red blood cells and comparison between two groups.
RESULTS:
The percentage of abnormal nucleated red blood cells count (NRBCs) in the study group (30%) was significantly more than the control group (18%) (P value =0.002).The mean nucleated red blood cells count (NRBCs) difference was 3.69 units and it was significantly higher in the study group than the control group (P value =0.0002).
CONCLUSION:
The nucleated red blood cells (NRBCs) count increase in cord blood of neonates with meconium stained amniotic fluid compared to neonates of clear amniotic fluid.

Dyslipidemia in Young Adults Aged (20-40) Years Attending Baghdad Teaching Hospital and Al-Mansour Primary Health Care Center in Baghdad City

Hamza A. Al-Sabah; Nibras H. Hussain; Dalia Tariq Ali

Iraqi Postgraduate Medical Journal, 2014, Volume 13, Issue 3, Pages 320-327

ABSTRACT:
BACKGROUND:
Hyperlipidemia is a condition characterized by high quantities of lipids in the blood stream. Lipids include cholesterol, triglycerides and phospholipids. Fats and cholesterol are generally processed in the liver and carried on proteins in the blood, forming lipoproteins. Its complications include pancreatitis, atherosclerosis, coronary artery diseases and stroke.
OBJECTIVE:
Is to estimate the prevalence of hyperlipidemia in the Iraqi young adults aged 20-40 years and to shed a light on any significant association between some socio-demographic and life style variables with hyperlipidemia.
SUBJECTS & METHODS :
A cross-sectional study was conducted from the first of December 2011 to the first of June 2012.
RESULTS :
The prevalence rate of any lipid abnormality (at least one abnormality) was 75%.The prevalence rates of elevated serum total cholesterol, low serum high density lipoprotein cholesterol, elevated serum triglyceride and elevated serum low density lipoprotein cholesterol were (32.5%, 38.5%, 29.5%, 30%), respectively. The prevalence rate of elevated TC/HDL ratio was 61%.
CONCLUSION :
There is a high prevalence of lipid abnormality in young adults of whom males had higher prevalence than females but the difference was not significant.The significant associated risk factors with hyperlipidemia were age, BMI, newly diagnosed or uncontrolled diabetic and hypertensive patients, cholesterol/fat rich diet and type of cooking oil.

Expression of Serum Cytokines (IL-6 & IL-8) and Oxidative Stress Marker (MDA) in Patients with Knee Osteoarthritis

Munaf S. Daoud; Israa A.Abdul Kareem; Mohammed I. Hamzah

Iraqi Postgraduate Medical Journal, 2014, Volume 13, Issue 2, Pages 187-194

ABSTRACT:
BACKGROUND:
Osteoarthritis is a degenerative joint disease, occurring primarily in older persons. Although many factors initiate this disease, progress to overt OA needs many biological substances like IL-6 and IL-8 that reduce cartilage repair ability or like reactive species that induce cartilage destruction through direct degradation of matrix components.
OBJECTIVE:
To shed the light on the expression of serum IL-6 and IL-8 levels, and production of serum malondialdehyde level (marker of oxidative stress), then estimation of the correlation among serum IL-6, IL-8 and MDA levels in patients with knee osteoarthritis.
PATIENTS AND METHODS:
This study was conducted in AL-Kadhemiya Teaching Hospital during the period from April 2011 to December 2011. The study included two groups: knee osteoarthritis( KOA) group of patients and the control group. Each group was further sub-divided into: obese & non-obese according to their BMIs. Sixty osteoarthritic patients aged 40-70 years were chosen depending on medical history, clinical examination, and radiographic observations. 10 ml of blood needed for assessment of the above makers. Thirty healthy control (age and sex-matched) were enrolled in this study.
RESULTS:
Mean serum IL-6 and IL-8 levels were significantly higher in KOA patients compared to control group for both (P<0.001), with the highest levels seen in the obese KOA group. Mean serum MDA level was significantly higher in patients with KOA compared with that in control (P<0.001). Significant negative correlation was observed between serum IL-6 and IL-8 levels.
CONCLUSION:
IL-6, IL-8 & MDA have important role in the pathogenesis of KOA. Receptors of IL-6 and IL-8 on chondrocytes could be considered as target for future therapy of any arthritic inflammation and also to consider MDA reduction in patients with knee osteoarthritis, as part of treatment of osteoarthritis.

Management Approaches of Splenic Surgery

Issam Salih Abduljabbar Al-Janabi; Maha Abduljabbar Lattuf Al-Rudaini; Hareth Abbas Hassan

Iraqi Postgraduate Medical Journal, 2014, Volume 13, Issue 2, Pages 235-242

ABSTRACT:
BACKGROUND:
Splenic surgery is common surgical procedure with different indications and approaches that carries some potential complications which can be avoided.
OBJECTIVE:
To analyze the indications, management and complications of splenic surgery.
PATIENTS AND METHOD:
Prospective study conducted in the 3rd unit of general surgery department of Baghdad teaching hospital & private hospital over a period of 3 years, from the first of January 2008 till the end of December 2011. Ninety six patients with traumatic and non traumatic splenic pathologies were evaluated and followed up.
RESULTS:
This study includes ninety six patients with different splenic pathologies were included in this study with mean age of 23.69 ± 14.853 years. Sixty five patients with non traumatic pathology were treated by elective surgery with mean age of 20.25 ± 12.857 years, fifty eight of them by open splenectomy, four by laparoscopic splenectomy, two cystectomy of hydatid disease of the spleen and one by drainage of splenic abscess. Idiopathic thrombocytopenic purpura (I.T.P.) was the most common indication of non-traumatic splenectomy followed by thalassemia. Thirty one patients with trauma with mean age of 30.90 ± 16.325 years (16 of them had penetrating injury and 15 had blunt trauma) were treated by emergency splenectomy in 24 patients, splenorrhaphy in 5 and conservative treatment in 2 of them. Post-operative complications occurred in 25(26%) patients, pulmonary complication was the most common one, and the overall mortality was 5.2%.
CONCLUSION:
Splenectomy still the most common option in traumatic cases but the availability of new diagnostic imaging might improve the future results to conserve some injured spleen and there is a place for laparoscopic approach in selected cases of elective splenectomy and splenic preservation in some splenic hydatid cyst.

Comparism Between Transvaginal Cervical Length Measurement and Digital Examination in Prediction of Imminent preterm Delivery

Maha M. AL-Bayati; Asmaa Mohammed Abid; Shaima Kadhim Jasim

Iraqi Postgraduate Medical Journal, 2014, Volume 13, Issue 2, Pages 195-201

ABSTRACT:
BACKGROUND:
Preterm labour is a major cause of perinatal morbidity and mortality, so it is important to predict preterm delivery using the clinical examination of the cervix and uterine contraction frequency. New markers for the prediction of preterm birth have been developed such as transvaginal ultrasound measurement of cervical length as this method is widely available.
OBJECTIVE:
To determine, whether transvaginal cervical length measurement predicts imminent preterm delivery better than digital cervical length measurement in women presented with preterm labour and intact membranes.
PATIENTS AND METHODS:
Two hundred women presented with preterm labour between 24 and 36+6 weeks of gestation were included in this study. All women subjected for digital and transvaginal ultrasound cervical length measurement and the outcome measures were occurrence of preterm delivery within 48 hours and within 7 days.
RESULTS:
Assessment of cervical length measurement using transvaginal ultrasound for the 200 women presented with preterm labour with intact membrane revealed that 8 (4%) delivered within 48 hours and 16 (8%) delivered within 7 days. According to the Bishop score, the test was positive if the Bishop score was ≥8, or 4-7 with cervical length ≤30 mm. The cut-off value for transvaginal ultrasound cervical length considered as 30 mm in the study group.
CONCLUSION:
Transvaginal sonographic measurement of cervical length can predict imminent preterm delivery in women presented with preterm uterine contractions and Bishop score between 4 - 7 compared with digital cervical length measurement.

Serum Interleukin-8 and Hs-C Reactive Protein Determination in Iraqi Multiple Sclerosis Patients: Case Control Study

Khawla A. A. AL-Sammariey

Iraqi Postgraduate Medical Journal, 2014, Volume 13, Issue 2, Pages 153-155

ABSTRACT:
BACKGROUND:
Multiple sclerosis (MS) is an autoimmune disease caused by a complex disorder that cluster many common diseases in children and adults, leading to chronic inflammatory disease of the central nervous system with morphological hallmarks of inflammation, demylination, axonal loss and gliosis .Factors responsible for MS and its progression are still not fully understood, but it has been suggested that both environmental determinants and genetic susceptibility are involved.
OBJECTIVE :
The aim of this study is to evaluate the role of inflammatory markers ;hs-CRP and IL-8 in pathogenesis of MS and to see the correlation between them.
PATIENTS AND METHODS:
Twenty one MS Patients (7male,14 female) attending the MS Clinic at Baghdad teaching hospital, their ages range between( 20-32) years (15) age- and sex- matched healthy control participated in the study. Investigations included serum measurements of high sensitive C-reactive protein (hs- CRP) and interleukin-8 in patients and control groups.
RESULTS:
The result of the present study showed significant increase in both CRP(p<0.001 ) and IL-8 (p< 0.001 ) in the serum of MS patients compared to control.
CONCLUSION:
There is evidence that neuroinflammatory process due to elevation of CRP and IL-8 has an important role in MS .

EEG Changes in Patients with Migraine

Majeed Salih Hamad; Nawfal M. Sheaheed; Sarmed Mohammad Abdulrasool; Akram M. Almahdawi

Iraqi Postgraduate Medical Journal, 2014, Volume 13, Issue 2, Pages 156-160

ABSTRACT:
BACKGROUND :
migraine is a recurring syndrome of headache, nausea, vomiting, and/or other symptoms of neurological dysfunction in varying admixtures. Migraine, is one of the most common causes of headache, afflicts approximately 15% of women and 6% of men.
OBJECTIVE:
This study was designed to determine the EEG changes in a sample of migraineurs with their relation to its types.
PATIENTS AND METHODS:
This cross-sectional study was conducted in the department of neurology of Baghdad teaching hospital from December 2007 to February 2008. A total of 60 migraineurs were taken, aging (10-40) years, diagnosed according to International headache society (IHS) criteria. Patients with history of epilepsy, head injury, brain lesion and recurrent headaches not Compatible with IHS criteria were excluded from the study . EEG was performed, whenever possible, during headache and between attacks of headache.
RESULTS:
Sixty Iraqi patients with migraine were evaluated. Twenty patients (33.3%) were having migraine with aura (MWA) while 40 patients (66.7%) had migraine without aura (MWOA). Of the sixty studied patients 15 were having electroencephalographic finding. Among patients with MWA, 8 of them have abnormal EEG (40%), while in patients with MWOA, 7 of them have abnormal EEG (17.5%). Slow waves were found in 10 patients (52.64%), sharp waves in 8 (42.10%), and spikes in one patient (5.26%). It has been found that 9 patients (50%) have abnormality in occipital region, 6 of them (33.34%) in frontal region, and 3 of them (16.66%) in temporal region.
CONCLUSION:
EEG is not useful as a diagnostic tool for migraine, as the EEG changes found in migraine are not specific, they are infrequently associated, and there is no EEG difference between MWA and MWOA. So, clinical criteria are the only way for diagnosis of migraine.
KEYWORDS: migraine, headache, EEG

The Role of Ultrasound in the Diagnosis of Acute Appendicitis: A Prospective Study

Mumtaz Khudhur Hanna; Zuhair Bashir Kamal; Laith Naif Hindosh; Wisam Abdullteef Hussein

Iraqi Postgraduate Medical Journal, 2014, Volume 13, Issue 2, Pages 226-229

ABSTRACT:
BACKGROUND:
Misdiagnosis of acute appendicitis is a common and crucial problem in general surgery, as the mortality and morbidity increase from 3 – 15 folds if appendix is perforated. Graded compression ultrasonography is one of the new diagnostic techniques that were introduced to improve the diagnostic accuracy and consequently the clinical outcome.
OBJECTIVE:
The aim of the current study is to assess the diagnostic accuracy of ultrasound in the diagnosis of suspected acute appendicitis.
METHODS:
One hundred-eighty patients admitted to the general surgical ward at Al Kindy Teaching Hospital from 1 June 2009 to 28 Feb. 2010. All patients were complaining of right iliac fossa pain and tenderness with a suspicion of acute appendicitis, a clinical assessment done for them by using modified Alvarado score (only patients with Alvarado score 5 and below were included). All patients were investigated by WBC count and general urine analysis. When the diagnosis of acute appendicitis was clinically equivocal, an abdominal ultrasound performed within 4 hours of admission. A dilated, Non- compressible appendix greater than 6 mm diameter, and edema and asymmetry of the appendicular wall were considered positive for the diagnosis of acute appendicitis. A normal appendix on histopathological examination with positive ultrasonographic findings was considered false positive result.
RESULTS:
The findings according to histopathological examination shows that 160 cases were true positive cases,14 cases were found to be true negative , 1 cases was false positive and 5 cases were false negative cases.:
Ultrasonography yielded a sensitivity rate of 96% and specificity rate of 93%.
CONCLUSION:
Ultrasound by graded compression technique provides highly accurate, sensitive and specific test for clinically equivocal acute appendicitis.
.

Prevalence of Erosions in Metacarpophalangeal Joints and Proximal Interphalangeal Joints in Rheumatoid Arthritis Patients

Khudir Z. Mayouf; Faiq. I. Gorial; Warda S. Lasso

Iraqi Postgraduate Medical Journal, 2014, Volume 13, Issue 1, Pages 110-114

ABSTRACT:
BACKGROUND:
Bone erosion is a central pathophysiological process and an important outcome parameter in rheumatoid arthritis (RA).
OBJECTIVE:
To assess prevalence of erosions in metacarpophalangeal joints (MCPJs) & proximal interphalangeal joints (PIPJs) in RA using ultrasonography and to evaluate the associates if present.
PATIENTS AND METHODS:
Ninety two patients with RA diagnosed according to The 1987 American College of Rheumatology (ACR) classification criteria for RA were compared with 158 healthy individuals matched for age and sex. Disease activity score 28 joints (DAS28), erythrocyte sedimentation rate (ESR), C-reactive protein (CRP), and rheumatoid factor (RF) were measured. Ultrasonography was performed using Seimens Elegra with 7.5 MHz linear array transducer by radiologist for MCPJs and PIPJs.
RESULTS:
Erosions in RA were significantly more than those of controls (44 (47.8%) versus 0(0%) (p = 0.000). Erosions in MCPJs were more than PIPJs and both MCPJs & PIPJs (33(75% ) versus 4(9.1% ) versus 7(15.9%) respectively) (p=0.005). High ESR, positive CRP, and positive RF were significant associates with the erosions (p= 0.008, p= 0.000, p= 0.002 respectively).
CONCLUSION:
Prevalence of erosions in MCPJs and PIPJs of RA patients was high (47.8%).High ESR, positive CRP, and positive RF were significant associates with erosions.

Reduction Versus Non-Reduction Technique in Low Grade Spondylolisthesis; Functional Outcome

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

Iraqi Postgraduate Medical Journal, 2014, Volume 13, Issue 1, Pages 115-121

ABSTRACT:
BACKGROUND:
Spondylolisthesis is a condition in which a vertebra slips anteriorly in relation to the vertebra below as a result of pars defect or degenerative disease. The slipped segment produces abnormal positioning of the vertebrae in relation to each other along the spinal column that causing back pain and neurologic deficit.
OBJECTIVE:
There are debates about surgical maneuvers regarding low grade spondylolisthesis (grades I and II according to Meyerding classification) whether to reduce the slipped segment or not, the aim of this study is to determine the short and long term difference in the functional outcome between these methods.
PATIENTS AND METHODS:
This randomized prospective study consist of 32 patients aged between 42-63 years old (11 males and 21 females) treated for symptomatic low grade spondylolisthesis between October 2009 to November 2011 and followed up for 24 months. All patients were randomly divided into two groups: Group I (15 patients) underwent surgical reduction of the slipped segment, and Group II (17 patients) who underwent in-situ fusion without reduction. Both groups had the same pre and postoperative management.
RESULTS:
Early postoperative minor complications including one case in each group had superficial wound infection (6.6% and 5.8% in Group I and II respectively) which was controlled in the hospital, and one case in each group (6.6% and 5.8% in Group I and II respectively) had dural tear intraoperatively that was repaired during the operation; none of patients had CSF leak postoperatively. There were two cases in Group I (13.3%) and one case in Group II (5.8%) had postoperative transient sciatic pain due to nerve irritation. Depending on the Oswestry Disability Index (ODI), there was a significant statistical difference between both groups in the short term (p-value = 0.04), but there was no significant statistical difference in the long term follow up between them (p-value =0.33) regarding the functional outcome.
CONCLUSION:
Surgical treatment of low grade symptomatic spondylolisthesis usually include neural decompression, fixation and fusion; however reduction of the slipped segment is not necessary for these patients as the ultimate outcome is similar to those who underwent in-situ fusion only.

Performance of Ultrasound as a Second Line Test to Serum Ca125 in Ovarian Cancer Screening in Postmenopausal Women

Nada Salih Amin; Asmaa Mohammed Abid

Iraqi Postgraduate Medical Journal, 2014, Volume 13, Issue 1, Pages 29-36

ABSTRACT:
BACKGROUND:
Epithelial ovarian cancer is uncommon before 40 years of age but the incidence then rises steeply until the mid sixth and seventh decades for which performance of transvaginal ultrasonography as a screening test for ovarian cancer in asymptomatic postmenopausal women with an elevated serum CA 125 had been performed.
OBJECTIVE:
Prospective ovarian cancer screening trial had been performed to estimate sensitivity, specifity and positive predictive value of different ultrasound criteria for detection of index cancer (e.g. primary invasive epithelial carcinoma of ovary) in postmenopausal women.
PATIENTS AND METHODS:
This study was carried out at the department of obstetrics and gynecology in AL-Yarmouk Teaching Hospital from October 2002 through October2003.The study included 110 Postmenopausal women ≥ 45 years, they underwent measurement of serum CA125.Women with CA 125 of 30 IU/ml (or more) were recalled for an ultrasound examination.
RESULTS:
Of the 110 women included in this study, 9 women underwent 30 scans during a follow up of one year. The sensitivity for detection of ovarian cancer of different ultrasound criteria was 100% for abnormal ovarian morphology, 100% for abnormal ovarian volume and 50% for complex abnormal ovarian morphology. The highest specificity (100%) and positive predictive value (100 %) was achieved by using complex abnormal ovarian morphology.
CONCLUSION:
A variety of ultrasound criteria had achieved high sensitivity, specificity and positive predictive value for ovarian cancer screening in postmenopausal women with an elevated CA 125. Ovarian morphology and ovarian volume used to interpret ultrasound had achieved increased sensitivity for ovarian cancer screening. While complex abnormal ovarian morphology had achieved increased in the specificity and the positive predictive value for ovarian cancer screening.
KEYWORDS: ovarian cancer, CA125, transvaginal ultrasound.

CT-guided Drainage of Pelvic Collection Following Acute Appendicitis: Technical Success and Possible Complications

Mohammed Abd Kadhim

Iraqi Postgraduate Medical Journal, 2014, Volume 13, Issue 1, Pages 12-17

ABSTRACT:
BACKGROUND:
Acute appendicitis is a common clinical problem with an incidence of approximately 1 case per 1,000 persons per year. Perforation is a common complication of appendiceal inflammation, with an overall incidence of approximately 30% in pediatric populations and as high as 66% in children younger than 5 years and up to 100% in 1-year-olds. Computed tomography (CT)-guided abscess drainage has also been shown to provide definitive treatment for 70–90% of abdominal abscesses
OBJECTIVE:
The aims were to report the role of CT-guided drainage of pelvic collection following acute appendicitis, technical success and possible complications.
PATIENTS AND METHODS:
A prospective study was done in Al-Kadhimyia teaching hospital,between March 2009 and November 2012. The study included 48 consecutive patients with pelvic abscess following appendicectomy for acute appendicitis. Age range was 10–58 years; 26 male, 12 female. All patients underwent sonography and contrast-enhanced abdominal CT was performed to confirm the diagnosis. CT guided drainage with a pigtail multi-sidehole catheter of 12 – 14 French was done. Post-drainage scans were obtained to assess the position of the catheter and to exclude early complications (e.g., hematoma). Catheters were flushed with 10-15 ml of 0.9% sterile saline every 8 hr. to maintain patency.
The decision for catheter removal was based on the following criteria: clinical improvement (normal body temperature and white blood cell (WBC) count, no clinical symptoms), drainage output of 10 mL/d or less, and ultrasound findings of complete resolution of the target fluid collection.
RESULTS:
The study included 48 patients. The depth of the collections was ranged from 4-8cm (mean of 6cm). Of the 48 patients, 40 had single drainage procedure, and 8 returned for a second procedure. The (8/48) necessitated a second drainage procedure (5cases of catheter displacement and 3 cases of catheter obstruction). Treatment failure was seen in 3/48 (6.25%) patients and were treated with surgical drainage. Clinical success of the procedures was (93.75%). The volume of fluid drained ranged from 200 ml to 4,500 ml (mean 440 ml). Fluid culture reveals Escherichia coli in 27%, and Enterococcus spp in 15% and polymicrobial in 58% of cases. hospital stay was 13±6.4 days (8–28 days), while those who underwent two procedures had an average stay of 20.2±6.5 days. No catheter-related wound sepsis was noted at the time of discharge or follow-up, and no catheter tract failed to close spontaneously.
CONCLUSION:
CT _guided drainage of pelvic abscess following acute appendicitis is an effective method of treatment with no catheter-related wound sepsis and no major periprocedural complications.

Prevalence of Color Vision Deficiency among Adult Males from Baghdad Province

Bassam Musa Sadik Al-Musawi

Iraqi Postgraduate Medical Journal, 2014, Volume 13, Issue 1, Pages 134-139

ABSTRACT:
BACKGROUND:
Color Vision Deficiency (CVD) is mostly an inherited trait and is not an uncommon problem. Prevalence of CVD differs among different ethnic and geographic properties of the population that affect their genetic constitution. Ishihara plates remain an internationally accepted tool for screening red-green CVD.
OBJECTIVE:
To determine the prevalence of red-green CVD among adult males from Baghdad province.
PATIENTS AND METHODS:
One thousand and five (1005) adult males were enrolled in this study, using a systematic sampling technique, and were screened for CVD utilizing 24-plate Ishihara plates and re-tested by EnChroma 39-Color plates. All males were residing in Baghdad and the center of Iraq.
RESULTS:
Among all tested males, 948 reside in Baghdad province; of them, 64 showed red-green CVD; thus making prevalence rate of 6.75% in Baghdad province. The deutan/protan ratio was 2.79:1.
CONCLUSION:
Prevalence of CVD among the people of Baghdad lies within the published range for Caucasian males worldwide. Screening children/adult males for CVD from other provinces is recommended.

Comparison Between Endoscopic Band Ligation and Sclerotherapy in Management of Upper Gastro-Intestinal Hemorrhage Due to Esophageal Varices

Ahmed Hamid Jasim; Akram Ajeel Najeeb

Iraqi Postgraduate Medical Journal, 2014, Volume 13, Issue 1, Pages 25-28

ABSTRACT:
BACKGROUND:
Upper gastrointestinal bleeding is serious complication of portal hypertension which can be treated by different medical and surgical methods with possibility of failure, re-bleeding and death.
OBJECTIVE:
To evaluate the efficacy of band ligation and Sclerotherapy in controlling initial bleeding, failure of control (during first 24 hours) and re-bleeding within 5 days.
PATIENTS AND METHODS:
this prospective study was conducted at Gastroenterology and Hepatology Teaching Hospital in Medical city complex in Baghdad from the 1st of January 2010 to the 1st of March 2012.
The study engaged 100 consecutive patients who were divided equally into two groups (50 patients each), first group were treated with banding procedure while patients in second group were treated with sclerotherapy and both groups were followed up for 5 days.
RESULTS:
Neither failure to control bleeding (during first 24 hours) nor death occurred in both groups.
Successfulness (no re-bleeding within 5 days) was more common in Band ligation group (94%) rather than sclerotherapy group (90%). On the other hand, 8 patients in both groups all were child-pugh C developed re-bleeding, 3 patients (6%) in Band group and 5 patients (10%) in sclerotherapy group and need second session which was successful in all patients in both procedures , comparison statistically was significant and Band procedure was better than Sclerotherapy procedure, (P. value=0.029) .
CONCLUSION:
Endoscopic Band ligation is more effective than Sclerotherapy in controlling initial attacks of esophageal varices bleeding and decreasing recurrent attacks of bleeding.
KEYWORDS: upper gastro-intestinal bleeding, esophageal varices, liver cirrhosis, portal hypertension.

Evaluation of Direct Trocar Insertion Technique at Laparoscopic Surgery

Ali Jaliel Awad; Abdul Ameer Jaliel Awad; Husain Kareem

Iraqi Postgraduate Medical Journal, 2014, Volume 13, Issue 1, Pages 7-11

ABSTRACT:
BACKGROUND:
Commonly we utilize veress needle in laparoscopic surgery as usual to start with introduction of pneumoperitoneum in the abdomen (classic pneumoperitoneum], but there are alternatives to it for better and fast work even in obese patients.
OBJECTIVE:
The purpose of this study is to compare direct trocar (DT) to Veress needle (VN) entry for tie creation of pneumoperitoneum during laparoscopy with regard to the duration of the procedure (trocar and Veress placement time), volume of gas used, ease of performance, and frequency of complications through a randomized clinical study in Al-Karama hospital and some other private Baghdad hospitals.
PATIENTS AND METHODS:
60 patients scheduled to undergo diagnostic and therapeutic laparoscopy (general surgery and gynecology cases), 45 cases divided into DT (group A = 25) and VN (group B = 20), the other 15 cases were obese patients BMI>30, subdivided into two subgroups (1, 2) submitted for the study, they were randomly allocated to either DT or VN entry for pneumoperitoneum. The laparoscopic procedures performed by the same surgeon.
RESULTS:
The trocar and Veress placement time, volume of gas consumption, ease of performance and frequency of complications were analyzed. The mean trocar and Veress placement time was significantly shorter in group A and subgroup 1 than in group B and subgroup 2. The mean gas consumption was significantly less in group A (2-3Iiters) and subgroup 1 than in group B and subgroup 2 (4-6 liters). No major complications (bowel, vessels injury) in both groups were encountered. Minor complications (failure pneumoperitoneum) were significantly less in group A and subgroup 1 than in group B and subgroup 2.
CONCLUSION:
DT entry is a safe alternative to the VN entry technique for the creation of pneumoperitoneum. This approach has further advantages with less cost and instrumentation along with rapid creation of pneumoperitoneum even in obese patients.
.

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.

National Biochemical Reference Ranges for Adult's Age Group

Noaman Abdulateef Abdulrazzaq; Shatha Hamed

Iraqi Postgraduate Medical Journal, 2014, Volume 13, Issue 1, Pages 44-50

ABSTRACT:
BACKGROUND:
Reference range basically originates in what is most prevalent in a reference group taken from the healthy population. It is a basis for a physician or other health professional to interpret a set of results for a particular patient. In our country it's preferable to redistribute a normal list of values instead of the old one, taking into consideration a specific reference ranges for population with any factor that may affects their measurement as, climate, type of food, and race. It should comprise both sexes; all age groups and between which 95% of values of a reference group fall into after enrollment of the inclusion/exclusion criteria.
OBJECTIVE:
To establish a reference ranges of some biochemical parameters for healthy adults' population.
METHODS:
one thousand healthy individual (aged 20-40 year), with 450 male and 550 female, selected from Baghdad city, from AL-Mammon University College and Ministry of Health, were recruited for the study between march.2011-april.2012 after they were subjected to an inclusion/exclusion criteria, reference ranges of some biochemical parameters was constructed by using the parametric methods to estimate 2.5 and 97.5 percentiles of distribution.
RESULTS:
Specific ranges for some biochemical parameters shows somewhat a little bit difference in comparison to their counterparts from other countries. Moreover it was clearly noticed that the present dependent-format missed many important parameters as (HDL-Cholesterol), (LDL-Cholesterol) in addition to missing sex and age difference. Results also shows statistically significant higher values in female than male for (HDL-Cholesterol) (p=0.000), (Total Protein) (p=0.000), and lower values in females than male for (Uric Acid) (p=0.000), (CREAT) (p=0.000), (Blood Urea) (p=0.000).
CONCLUSION:
There is a need for the national clinical chemistry laboratory to establish its own ranges for both sexes to all age groups, and to redistributes them in a new format.
.

Relationship Between Tei index and Left Ventricular Geometric Patterns in Hypertensive Patients

Talib Hashim Salim; Basil Najeeb Saeed

Iraqi Postgraduate Medical Journal, 2014, Volume 13, Issue 1, Pages 70-74

ABSTRACT:
BACKGROUND :
Various left ventricular geometric patterns occur in hypertension and may affect the cardiovascular risk profile of hypertensive subjects. Tei index is a combined index of systolic and diastolic functions and has been shown to be a predictor of cardiovascular outcome in heart diseases.
OBJECTIVE:
The aim of this study was to investigate the relationship between Tei index and left ventricular (LV) geometry in hypertensive patients.
METHODS :
Two dimensional-guided M-mode echocardiography and Doppler study were performed in 122 hypertensive patients and 67 control subjects. This study was conducted at Baghdad Medical City / Teaching Hospital and Alshahed Mohammed B. Alhakem Hospital in Alshulla city . According to the value of relative wall thickness (RWT) and left ventricular mass index (LVMI), hypertensive patients were subdivided into four geometric patterns. The Tei index was obtained from the summation of isovolumic relaxation time (IVRT) and isovolumic contraction time (IVCT), divided by the ejection time. Statistical analysis was done using SPSS 17.0.
RESULTS:
This study showed that the Tei index was significantly higher among the hypertensive patients with concentric hypertrophy(CH), eccentric hypertrophy(EH), concentric remodeling and normal geometry compared with the control group(0.81±1.1, 0.78±0.3, 0.69±0.3, 0.59±0.5 respectively). Tei index was correlated to the left ventricular ejection fraction (LVEF), left ventricular fractional shortening(LVFS), mitral E/A ratio, heart rate(HR), LVMI and RWT.
CONCLUSION:
The Tei index are impaired in all subgroups of hypertensive patients according to their LV geometry compared to control group. This impairment is more advanced in patients with concentric and eccentric hypertrophy.
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Clinical, Electrocardiographic, and Angiographic Characteristics as Predictors of Procedural Success in Patients with Coronary Chronic Total Occlusions A Single-Center Experience

Muataz Fawzi Hussein

Iraqi Postgraduate Medical Journal, 2013, Volume 12, Issue 0, Pages 659-667

ABSTRACT:
BACKGROUND:
Percutaneous coronary intervention for chronic total occlusion lesions is technically difficult despite equipment advances. Changes in electrocardiographic patterns such as Q wave during total occlusion can provide information about procedural success and myocardial viability.
OBJECTIVE:
The aims of study are to investigate clinical, electrocardiographic and procedural characteristics of chronic total occlusion and the relation of these variables to the procedural success rate.
PATIENTS AND METHODS:
In this study, clinical, electrocardiographic and coronary angiographic data of (100) patients with chronic total occlusion lesions who underwent percutanous coronary intervention between May 2010 and March 2011 at the Iraqi center for heart diseases were analyzed. The clinical data were collected using the patients’ files and angiographic data by the observation of their films. Chronic total occlusion was diagnosed from clinical events including myocardial infarction or worsening of their symptoms or previous angiography.
RESULTS:
There were 100 patients with chronic total occlusion. Successful recanalization with stent deployment was accomplished in 65 patients (65%), while unsuccessful recanalization was found in 35 patients (35%). No major cardiovascular events occurred among both groups. The success rate of PCI was significantly more in lesions shorter than 15 mm, presence of tapered stump, angulations less than 45 degree, duration less than 3 months and TIMI 1 flow grade (p values were significant). Presence of Q wave was associated with severe angina , decreased left ventricular ejection fraction, critical lesions other than chronic total occlusion, T wave inversion and more regional wall motion abnormalities ( p values were significant). The most common cause of procedural failure was inability of guide wire to cross through the totally occluded segment.
CONCLUSION:
Percutaneous coronary intervention is a safe and useful procedure for revascularization of coronary chronic total occlusion lesion. The procedural success rate was related to certain features of the totally occluded lesions.
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Comparison between Total Intravenous Anesthesia (TIVA) and Conventional General Anesthesia in Day Case Surgical Procedures

Iyad Abbas Salman; Ali Yousif Mohammad

Iraqi Postgraduate Medical Journal, 2013, Volume 12, Issue 0, Pages 700-705

ABSTRACT:
BACKGROUND:
Day case surgery should be of short duration, rapid recovery, and with low incidence of postoperative complications. For long time was done with conventional inhalational based anesthesia, in last year's, TIVA began to be used in these surgeries.
OBJECTIVE:
To evaluate total intravenous anesthesia (TIVA), as an aesthetic technique for day case procedures and to compare it with conventional inhalational based technique in terms of intra and postoperative hemodynamic and respiratory changes, postoperative recovery and postoperative vomiting.
PATIENTS AND METHODS:
This is a prospective randomized study has been done on 100 patient who underwent general anesthesia for short duration surgical procedure in AL- Jumhory teaching hospital in Al-Mosul city in Iraq, during the period between Nov 1st, 2011 and March 1st, 2012 , All patients were allocated into either TIVA or inhalational (INH) groups, of 50 patient each. In TIVA group: induction and maintenance of anesthesia done by propofol. While in INH group: maintenance of anesthesia done by halothane. Blood pressure, pulse rate, respiratory rate were monitored at a specific time. Recovery time was recorded according to Aldrete score. Any episode of vomiting was recorded.
RESULTS:
Aldrete score of ≥ 9 was achieved earlier in the TIVA group than in the INH group. It was also observed that there was initial fall in HR, MAP and respiratory rate in the both group, and post operative vomiting was less in the TIVA group.
CONCLUSION:
The time needed for recovery and episodes of postoperative vomiting in TIVA is less than in inhalational anesthesia.
KEYWORDS: TIVA, propofol, day case surgery.

The Role of Lumbar Puncture in Children Less Than Five Years Who Presented with Fever and Fit a Hospital Based Study

Mahjoob Al-Naddawi; Mohammad F. Ibraheem; Kamal Majeed Mohammed

Iraqi Postgraduate Medical Journal, 2013, Volume 12, Issue 0, Pages 675-679

ABSTRACT:
BACKGROUND:
Lumbar puncture is a procedure that is commonly performed to diagnose meningitis, encephalitis, and subarachnoid hemorrhage and it is helpful in evaluating demyelinating, degenerative and collagen vascular diseases and the presence of tumour cells within the subarachnoid space. It is the test of choice to diagnose pseudo tumor cerebri.
OBJECTIVE:
To highlight the important role of lumbar puncture in excluding serious central nervous system infections in patients presented with fever and fit.
PATIENTS AND METHODS:
A prospective study was carried out on 67 patients who were less than five years of age, presented with fever and fit from the 1st of April 2011till thirty first of October 2011, who were admitted to the Children Welfare Teaching Hospital/ medical city / Baghdad for evaluation and management. All the patients underwent lumbar puncture.
RESULTS :
There were 67 patients with male predominant (52%) , the common age of presentation was between one month to one year ; 42 (62%) , 38 (56%) of patients presented with high grade fever and fit , 42 (62%) patients presented with simple fit , 25 (38%) presented with complex fit , 40 (59%) presented with generalized fit , 27 ( 41%) presented with focal fit , 28 ( 42%) patients presented as first attack and 39 (58%) presented as a recurrent attack ,in 11 (17%) the result of gram stain was positive while 56 (83%) the results were negative , 9 (14%) the results of cerebral spinal fluid culture showed growth of bacteria while 58 (86%) showed no growth.
CONCLUSION:
The lumbar puncture is necessary in patients presented with fever and fit especially in infancy and those presented with high grade fever and recurrent and complex fit to exclude central nervous system infection.
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Calculation of the Amount of Fluids Given During Neonatal & Pediatric Surgical Operations (New Formula: Ry Formula)

Riyadh Khudeir Hamed

Iraqi Postgraduate Medical Journal, 2013, Volume 12, Issue 0, Pages 688-692

ABSTRACT:
BACKGROUND:
A new formula (RY formula) for calculation of intra operative fluids given in neonatal & pediatric life threatening surgical operations was enrolled in this study.
OBJECTIVE:
To find a correct , simple ,easily applicable & understandable formula to avoid all unwanted dangerous mistakes in calculation of fluid requirements in all types of neonatal& pediatric surgical operations .
PATIENTS:
(Five Thousands Patients) including neonates , infants & pediatric age group presented to CWTH /Medical city /Baghdad for different types of surgical operations were enrolled in this study divided to 3 groups ( Group A ) Life threatening conditions 2300 patients , (Group B) Major& super major operations 700 patients &( Group C ) Different types of elective surgical operations 2000 patients .
METHODS:
In this new (RY formula) intra operative fluid requirements calculated as :
Pre existing deficit (Fasting) : 20 ml/kg this amount is divided over 3 hours : ½ the amount given in the 1st hour of operation , and ¼ the amount is given for each the 2nd& 3rd hours of operations. Maintenance fluid requirements : 4 ml/kg/hr for all weights. 3rd Space replacement : 8 ml/kg/hr for major& super major operations & 4 ml/kg/hr for minor operations .
RESULTS :
By comparison of this new (RY formula) with most of other anesthesia text books fluid formulas and anesthetic references regarding this aspects the results is that the difference in the amounts of fluid requirements was minute and regarded as negligible difference .
CONCLUSION:
This new formula has been used for the last six years(2005-2010) in neonatal & pediatric anesthetic department in CWTH/ Baghdad Medical City complex for 5000 neonates ,infants & pediatric patients without any complications.This new formula is correct, simpler, safer ,easily applicable understandable than other formulas. The most important point in this new(RY formula) is that it can be summarized by just 2 numbers( 22- 17)
22 ml/kg for the 1st hour & 17 ml for the 2nd&3rd hour of operation for major operations.

Chemical Peeling in the Treatment of Xeroderma Pigmentosum

Saadallah M. Alzacko; Basil H. Abdulrazaq

Iraqi Postgraduate Medical Journal, 2013, Volume 12, Issue 0, Pages 732-738

ABSTRACT:
BACKGROUND:
Xeroderma pigmentosum is a rare autosomal recessive disease characterized by abnormal sensitivity to ultraviolet radiation with early appearance of variable premalignant and malignant skin lesions leading to a reduction in life expectancy because of tumor metastasis .
OBJECTIVE:
To assess the role of chemical peels in clearing the skin background in patients with xeroderma pigmentosum.
PATIENTS AND METHODS:
To achieve the objective of the present study, a case-series design was adopted covering 14 patients with xeroderma pigmentosum. They were treated in the Plastic Surgery Unit at Al-Jumhori Teaching Hospital in Mosul, for the period from March 2011 to May 2012. Surgical excision was done first for the malignant skin lesions then chemical peeling of the face, using 30% trichloro- acetic acid was done. Assessment of the results was performed by the patients or their caregivers and by two plastic surgeons, depending on the number of lesions and the degree of pigmentation which were classified into 3 degrees, as poor, (no changes occur), moderate and good (depending on the improvement in skin background by the decrease in freckling and lightening of the pigmentation.
RESULTS:
Fourteen patients with xeroderma pigmentosum were enrolled in this study, 9 males and 5 females, their age range was 1 to 30 years. Malignant lesions were treated by excision and split- thickness skin graft or local flaps. The evaluated results of facial skin improvement after chemical peeling were poor in 2 patients, moderate in 7 patients and good improvement was shown in 5 patients. No significant complications developed, except scarring in one case and hyperpigmentation in 2 cases.
CONCLUSION:
Chemical peel is a simple procedure which was tolerated by the patients and can be used to improve the facial skin background and eliminate all subclinical premalignant lesions .

Outcome of Neonatal Jaundice In ABO Incompatible Pregnancies

Shatha Hussain Ali; Kamal Ismail Mashallah; lamia Abdul Karrim

Iraqi Postgraduate Medical Journal, 2013, Volume 12, Issue 0, Pages 680-687

ABSTRACT:
BACKGROUND:
Blood group mismatch between the mother and newborn carries substantial risk for neonatal jaundice
OBJECTIVE:
To study the outcome of neonatal jaundice due to ABO hemolytic disease of the newborn (ABO HDN) and study the relation of epidemiological risk factors and laboratory findings with it´s severity.
PATIENTS AND METHODS:
In this prospective study, 64 neonates with neonatal jaundice associated with ABO incompatibility were studies. Cases of ABO HDN were diagnosed as those with anemia, reticulocytosis and spherocytes or polychromasia on blood film with or without positive direct Coombs test. Severity of jaundice was regarded according to the type of treatment (phototherapy or exchange transfusion).
RESULTS:
Forty two patients (65.6%) were males, 46 patients (71.9%) were full term infants, 6 patients (9.4%) had family history of neonatal jaundice treated by exchange transfusion.
Only 9 patients (14.1%) presented with TSB level ≥ 20 mg/dl, 8 patients (12.2% ) had PCV level < 45%, 8 patient (12.5%) had reticulocyte count ≥ 5%. Direct Coombs test was negative in all the patients. Twelve patients (18.8%) had abnormal blood film findings .
Eight cases (12.5%) had the features of ABO HDN and represented 2.9% from the total admitted cases of neonatal jaundice.
Full term babies, positive family history of exchange transfusion, abnormal blood film findings and reticulocyte count were found as significant risk factors for the severity of the jaundice, while gender, body weight, blood group, mode of delivery and parity of the mothers had no significant effect on the severity of the jaundice.
CONCLUSION:
Not all the cases of ABO incompatibility developed ABO HDN, so laboratory confirmation is required.

Chylous Ascites Following Choledochal Cyst Excision

Raafat Raoof Amed; Moayad Kadhum Alnakeeb; Wisam Khaleel Faraj

Iraqi Postgraduate Medical Journal, 2013, Volume 12, Issue 0, Pages 765-767

ABSTRACT:

Chylous ascites is accumulation of triglyceride rich fluid in peritoneal cavity. Apart from spontaneous causes, the iatrogenic type usually result from retroperitoneal operations. This is a case report of an eleven year old girl, who developed chylous ascites after choledochal cyst excision and roux-en- y hepatico-jejunostomy. The condition discovered in the seventh post-operative day and treated by percutaneous drain, low-fat diet, and octreotide . The condition was resolved after two weeks.

Bilateral Nephrone Sparing Surgery for Patient with Bilateral Wilms Tumor

Saad Dakhil Farhan

Iraqi Postgraduate Medical Journal, 2013, Volume 12, Issue 0, Pages 768-770

ABSTRACT:

Synchronous bilateral Wilms tumors occur in 5% to 7% of children with Wilms tumor , Children with bilateral tumors should not undergo initial radical nephrectomy. These children should receive preoperative chemotherapy with the goal of tumor shrinkage and renal-sparing surgery. Preservation of renal tissue is important to decrease the incidence of renal failure.(1,2)
We report the case of bilateral renal sparing surgery for 5years old child with bilateral wilms tumor (Stage 5) nephroblastoma.
KEYWORDS:wilmstumors,nephroblastoma, partial nephrectomy.

Aiming For Emmetropia after Cataract Surgery

Ahmed Majeed Rasheed

Iraqi Postgraduate Medical Journal, 2013, Volume 12, Issue 0, Pages 721-726

ABSTRACT:
BACKGROUND:
Emmetropia after cataract removal and posterior chamber intraocular lens implantation is vital for the achievement of a clear postoperative vision . Any significant deviation from this target leads to patient dissatisfaction.
OBJECTIVE:
The aim of this study is to evaluate the importance of various factors in causing deviation from post-cataract surgery emmetropia.
Design: prospective non comparative observational study.
METHODS:
114 eyes from 114 patients with uncomplicated cataract were enrolled for this study, biometry was done for the patients then they were operated on by phacoemulsification and foldable posterior chamber intraocular lens implantation .After one month from the surgery retinoscopy and manual refraction was done for all patients.
RESULTS:
Operated patients had a mean age of 61.4±5.6 years. Of the 114 eyes, 73 eyes (64.03%) were within 1 diopter (D) spherical equivalent (SE) of emmetropia. The number of eyes with postoperative astigmatism was 104 (91.22%); the mean absolute postoperative astigmatism amplitude was 1.346 D±0.421(SD). The mean absolute biometry prediction error was 1.007 D±0.246 (SD). The number of eyes with biometry error was 65 eyes (62.5%).
CONCLUSION:
Emmetropia is the goal in most cataract surgeries but only 64.03% of eyes were within 1.0 D (SE) of this target. Factors precluding emmetropia include postoperative astigmatism and biometry prediction errors.

Some Maternal Factors Affecting Anthropometric Measurments of Newborns

Qusay A. Al-Rahim

Iraqi Postgraduate Medical Journal, 2007, Volume 6, Issue 2, Pages 118-124

ABSTRACT:
BACKGROUND:
Fetal growth may at any time during gestational period be affected by several factors that may cause diseases to fetuses or neonates, and interfere with neonatal morbidity and mortality. Among these factors are racial, genetic, socioeconomic factors and maternal malnutrition and illnesses like diabetes, preeclampsia and anemia.
OBJECTIVES:
Our aim is to study the effect of maternal height, age, and illnesses on the anthropometric measurements of full term singleton newborns.
METHODS:
Two hundred full term singleton newborns were studied cross-sectionally in the maternity wards of 2 hospitals in the medical city /Baghdad .They were assessed by measuring the newborn weight, length and occipitofrontal circumference using standard methods of measurements. The gestational age was assessed by simplified Ballard-Dubowitz method. Mother's height was also measured. The maternal illnesses during pregnancy were listed in special questionnaire form. Statistical analysis was done by statistician.
RESULTS:
Of 200 full term singleton newborns, 109 (54.5%) were females and 91 (45.5%) were males. Mean body weight of males was 2850 grams, while that of females was 2600 grams. Mean length of males was 48.75 cms, while that of females was 48 cms. Mean OFC of males was 34.5 cms, while that of females was 33.5 cms. The weight of males was more than that of females at maternal height of 140-150 cms, 161-170 cms and 171-180 cms. Males were longer at maternal height of 161-180 cms. Males had higher OFC than females at maternal height of 161-180 cms. Males were lighter in weight than females of preeclamptic mothers, but no such effect on length and OFC. Maternal anemia also affect mainly newborn s` weight. There is no effect of other maternal diseases on weight, length, and OFC. The largest number and heaviest weight of newborns were at maternal age of 26-35 years, while male newborns of extreme maternal ages being longer than females. No effect of maternal age on OFC.
CONCLUSIONS:
In this study, we found more female newborns than males, and the mean weight, length and OFC of males were greater than that of females, and the heaviest newborns were at maternal height of 170-180 cms .Maternal preeclampsia and anemia affecting newborns weight mainly. Maternal age of 26-35 years gave heavier newborns. We recommend improving the maternal antenatal care, nutrition, and controlling maternal illnesses to improve the neonatal anthropometric measurements, and also recommend making wide national study to construct and apply local intrauterine growth curves specific to our country