Volume 20, Issue 3, Summer 2021, Page 209-309


A Clinical and Histopathological Study of Skin Cancer in Patients At Al-Kindy Teaching Hospital

Hyam Raouf Al-Hamamy; Rania Haider Faiz; Saja Haleem Shaker; Tabark Adnan Yousif

Iraqi Postgraduate Medical Journal, 2021, Volume 20, Issue 3, Pages 213-220
DOI: 10.52573/ipmj.2020.169709

BACKGROUND:
Skin cancer is an uncontrolled skin cell growth. It most often forms on regions of the skin that are exposed to the rays of the sun. Skin cancer impacts people of all colors and races although there is a higher risk for those with fair skin who develop quick sun burns. Basal cell carcinoma, squamous cell carcinoma, and melanoma are three major types.
STUDY OBJECTIVE:
To study the outcomes of histopathological analysis of skin biopsies and their correlation with age, patient gender and frequency of the three types of skin cancer.
PATIENTS AND PROCEDURES:
A Retrospective cross sectional study was carried out in the Al-Kindy teaching hospital's clinical laboratory. In this study, surgical specimens of skin lesions that were collected from 2015 through 2018 by open biopsy of all patients were selected. Seventy cases of 39 female and 31 male patients have been reviewed.
RESULTS:
Out of 70 sample of skin biopsies, female percentage was 55.71% (no:39), while male percentage was 44.29% (no:31). The commonest type of skin cancer was basal cell carcinoma (68.6%) followed by squamous cell carcinoma (22.9%), followed by melanoma (8.6%). The peak incidence of BCC was at age 50-59 yrs. & 60-69 yrs. The peak incidence of SCC was at age 60-69 yrs. While melanoma  occur in different groups of age mostly in 30-39 and 60-69 years age group. The peak incidence of BCC and SCC was at year 2016.
CONCLUSION:
Skin cancer is more in female than male and more at age 50-70 year. The commonest type of skin cancer was BCC followed by SCC followed by melanoma.
 
 

Association of Insulin Resistance with Overactive Bladder Syndrome in Female Patients

Anwar Noori AL- Bassam; Hadeel Kadham Kareem; Saba Reyadh Shaker

Iraqi Postgraduate Medical Journal, 2021, Volume 20, Issue 3, Pages 221-226
DOI: 10.52573/ipmj.2020.169710

BACKGROUND:
Overactive bladder Syndrome refers to a group of lower urinary tract symptoms related to the storage of urine in the bladder. Normally the bladder fills and stores urine without discomfort or leakage. The sensation of bladder fullness gradually increases until the need to void comes to conscious awareness. In those who have overactive bladder, however, the sensation to void is altered (and generally delayed) to the extent that involuntary urination may occur. current evidence suggests that it may be associated with insulin resistance  .
AIM OF STUDY:
We aimed to investigate the association of insulin resistance with overactive bladder in female patients.
PATIENT AND METHODS :
We prospectively conducted the study in our urogynecological department. Female patients aged between 30 and 76 years with or without overactive bladder syndrome  OABS symptoms were enrolled.  Fifty patients with OABS and  fifty age-matched controls without OABS were included in the study. Fasting serum insulin and fasting blood sugar  were measured. Insulin resistance value was obtained via the homeostasis model assessment of insulin resistance (HOMA-IR) calculator.
RESULTS:
There was no significant difference in the age, and mode of delivery ‎between ‎women with or ‎without overactive bladder (OAB), while BMI and parity ‎number ‎were significantly higher in OABS ‎women‎. FBS, fasting insulin (‎11.2‎‏ ‏vs‎. ‎7.9 𝛍U/ml‎‏)‏ ‎, HOMA-IR value (‎2.62‎‏ vs‎. ‎1.77) and insulin ‎resistance (IR) was ‎significantly higher in OABS women‎, in which 50% had IR while ‎‎12% had IR in ‎women with or without OABS.‎ In multivariate analysis insulin resistance (IR≥2.5) , age, increased BMI, higher parity, and CS ‎history were independent predictors of overactive bladder‎.
CONCLUSION:
-    insulin resistance is associated with overactive bladder syndrome, and about half of the women with overactive bladder presented with insulin resistance
-   Hyperinsulinemia is strongly associated with overactive bladder
-   Obesity is an independent predictor of overactive bladder
-   HOMA-IR equation can be used as diagnostic methods that assist in confirmation of overactive bladder diagnosis by 20 – 25% additional increase in the index of suspicion.
 
 

Intrathecal Baclofen Therapy Effectiveness and Side Effects: A Retrospective Study

Abd Al-Ameer Jasim Al-Khafaji; Aws Saad Hilal

Iraqi Postgraduate Medical Journal, 2021, Volume 20, Issue 3, Pages 227-232
DOI: 10.52573/ipmj.2020.169711

BACKGROUND:
Spasticity is a motor disorder characterized by a velocity-dependent increase in muscle tone with exaggerated tendon jerks, resulting from hyperexcitability of the stretch reflex, as a component of the upper motor neuron syndrome.
OBJECTIVE:
To evaluate the effect of intrathecal baclofen therapy after one to five years of treatment.
PATIENTS AND METHODS:
Aretrospective questionnaire-based study was done including 20 patients operated for intrathecal baclofen pump insertion at neurosciences hospital from 1/1/2013 to 1/1/2018,
RESULTS:
According to GMFCS in C.P, only those who were grade 4 or 3 had benefit, while grade 5 patients only improved easier diapering and transfer. From 8 spinal cord injury cases, 7 had improvement, while both M.S. cases were improved, but one of them started to have tolerance four years after implantation.  Eighteen out of 20 patients were satisfied from ITB therapy
One patient suffered from side effects (nausea, drowsiness) only after the test dose, and no side effects were mentioned during continuous therapy.
Two patients had drug tolerance were required to increase the dose.
CONCLUSION:
Intrathecal baclofen is a good treatment for spasticity, it can be considered safe as it caused no serious side effects, intrathecal baclofen is safer than oral baclofen because is uses a smaller dose, and it regarding tolerance, it occurs but not in every patient.
 

The Value of CT Severity Score versus Symptoms Severity Score in Adult Patients with Chronic Rhino-Sinusitis

Mohammed Abd Kadhim; Rasha Majid Ahmed

Iraqi Postgraduate Medical Journal, 2021, Volume 20, Issue 3, Pages 233-239
DOI: 10.52573/ipmj.2020.169712

 
BACKGROUND:
Chronic rhinosinusitis (CRS) is an inflammatory disorder of paranasal sinuses. The computerized tomography (CT) scan remains the common diagnostic modality for diagnosis of paranasal diseases.   
AIM OF STUDY:
To evaluate the value of CT scan in the management of chronic rhinosinusitis by correlating preoperative symptoms severity score as well as overall disease severity score of CRS depending on radiological findings on CT scan.
PATIENTS AND METHODS:
A cross-sectional analytic study conducted in Computerized Tomography (CT) unit of Al-Emamain Al Kadhimain Medical City in Baghdad/Iraq during the period from 1st of July to 31th of December, 2019 on sample of 100 CRS patients (58 male - 42 female). The diagnosis of CRS disease was done by Otolaryngology Specialist depending on history and clinical examination the data were collected from the patients directly and filled in a prepared questionnaire.
RESULTS:
There was a strong positive significant correlation between CT scan Lund Mackay (L-M) score of CRS patients and CS score (r=0.89, p<0.001). Mean L-M score was significantly higher among CRS patients with high risk of CS score (>40) (p<0.001). L-M CT score was higher in males (1.3:1 ) and in extremes  of age .The acceptable cut off points and the corresponding validity values for L-M score level in prediction of high risk was 11.5 with acceptable validity results (90% sensitivity, 80% specificity and 86% accuracy).
CONCLUSION:
The computerized tomography scans Lund Mackay score had good correlation with clinical symptoms of chronic rhinosinusitis.
 
 

Nail Changes in Psoriatic Patients and their Association with Disease Severity

Zahraa Saeed Al-Taie; Hayder Raouf Al-Hamamy

Iraqi Postgraduate Medical Journal, 2021, Volume 20, Issue 3, Pages 240-247
DOI: 10.52573/ipmj.2020.169714

 
BACKGROUND:
Nail psoriasis occurs in both adults and children. Nail involvement is associated with significant physical and psychological consequences for a substantial number of patients. The prevalence of nail changes among patients with psoriasis varies between 10 and 55 percent. In most patients, nail involvement follows or is concurrent with onset of cutaneous psoriasis. 
OBJECTIVE:
To evaluate nail changes in a sample of Iraqi patients with psoriasis and study their association with                the disease severity.
PATIENTS AND METHODS:
The study is a clinico-epidemiological observational cross-sectional study. It was conducted at                       the outpatient clinic at the Center of Dermatology and Venerology/ Medical City Teaching Hospital between May 2018 and August 2019.  A total of 94 patients were enrolled in this study. The severity of psoriasis was assessed using Psoriasis Activity Score Index (PASI), Body Surface Area (BSA), and Dermatology Life Quality Index (DLQI) scores whereas the severity of nail involvement was assessed by Nijmegen Nail Psoriasis Activity Index Tool (N-NAIL) and then compared against psoriasis scores. The patients were divided into two groups; patients with (group A) and without (group B) nail involvement.
RESULTS:
The study sample included 41 males (43.62%) and 53 females (56.38%). The mean age at presentation was 32.59±16.32 years. The number of patients in group A was 69 patients (73.4%). The mean ±SD for PASI score was 6.6±7.71 and the mean ±SD for DLQI score was 11.36 ±7.93.While the number of patients in group B was 25 patients (26.6%). The mean ±SD for PASI score was 4.38±3.02 and the mean ± SD for DLQI score was 8.48±4.77.There were no statistical differences between group A and group B regarding age, duration of the disease, PASI score and DLQI score. The patients in group A were subdivided into two groups: the first group included patients with mild psoriasis; 37 patients (PASI score ≤ 10) and the second group included patients with moderate to severe psoriasis; 10 patients (PASI score > 10).The patients with severe cutaneous psoriasis had more severe nail changes. In patients with mild psoriasis, the N-NAIL score was 25.62±23.96 while in patients with moderate to severe psoriasis, the N-NAIL score was 48.8±27.95 (p value =0.011). Crumbling, onycholysis and subungual hyperkeratosis were more frequent in this group. In general, pitting was the most frequently observed finding (52.13%) followed by onycholysis and crumbling.
CONCLUSION:
This is the first study of nail changes in psoriasis patients in Iraq. Nail changes were observed in 73.4% of patients with pitting as the most frequent nail finding. The patients with severe psoriasis had more severe nail changes with higher N-NAIL scores than patients with mild psoriasis.
 
 

Ponseti Method in the Management of Syndromic and Arthrogrypotic Clubfoot: Outcome of Treatment in Iraqi Patients

Ali Bakir Al-Hilli

Iraqi Postgraduate Medical Journal, 2021, Volume 20, Issue 3, Pages -
DOI: 10.52573/ipmj.2020.169727

 
BACKGROUND:
Clubfoot is one of the most common congenital birth defects, most occuras an isolated birth defect and are considered idiopathic. The Ponseti method of serial casting has gained widespread popularity in recent years for the treatment of idiopathic clubfoot.Non-idiopathic clubfeet are thought to be too rigid to correct by casting alone, it is often treated primarily with surgical extensiveSoft tissuereleases, and the use of Ponseti method for the treatment of non-idiopathic clubfoot has not been extensively reported.
AIM OF THE STUDY:
To study the effectiveness of Ponseti method to achieve correction in non-idiopathic clubfoot, and to follow the patient for relapses.
PATIENTS AND METHOD:
During the period from February 2013 to December 2017, 16 infants with clubfeet associated with other congenital deformities were managed by Ponseti method, and followed for a minimum of 10 months and maximum of 60 months (mean ± SD= 32.94±17.39 ). All patients were treated at medical city center in Baghdad/Iraq.
RESULTS:  
16 patients with syndromic clubfoot, 9 of them diagnosed as arthrogryposis and the rest as other syndromic types. 12 of them were males(75.0%) and 4 of them were females (25.0%). 14 of cases had bilateral deformities (87.5%) and 2 unilateral deformities (12.5%).5 patients required 4- 5 casts to achieve initial correction (31.2%) and 11 patients required 6-8 (68.8%).In arthrogryposis only 55.6% of cases required 5 and more casting, while in other syndromic cases 85.7% of cases required 5 and more casting. All patients required additional minor surgical procedures. Initial Pirani score of pre casting to the right and left was (mean±SD) 4.83±0.81 and 5.03±0.85 respectively, Pirani score after removal of final cast(pre surgery) to the right and left was (mean±SD) 1.03±0.74 and 1.3±0.7 respectively (p –value ˂ 0.001).Follow-up for minimum 10 months and maximum 60 months (mean±SD/ 32.94±17.39) .Half of our patients got plantigrade, pain free, and flexible foot at last follow up with no relapse, another half of patients developed relapse at subsequent  follow up. Most relapses occurred in arthrogryposis cases (66.7%),while in other syndromic cases relapses occurred in (28.6%).Two of relapsing cases(25%) treated by repeated casting, another two cases(25%) treated by repeated casting and heel cord release, and four cases (50%) treated by salvage procedure (talectomy) after failed repeated casting due to rigid and stiff feet.
CONCLUSION:
The Ponseti method is effective treatment for syndromic clubfootto achieve flexible, pain free and plantigrade foot and to minimize the extensive future surgeries.
 

The Effect of Posterior Corneal Astigmatism on Ocular Residual Astigmatism in Virgin Eyes

Alya’a Abood Kareem; Ghazwan Hameed Rasheed

Iraqi Postgraduate Medical Journal, 2021, Volume 20, Issue 3, Pages 255-261
DOI: 10.52573/ipmj.2020.169728

 
BACKGROUND:
Ocular astigmatism is the sum of corneal astigmatism and internal astigmatism. The component of ocular astigmatism that cannot be a attributed to the anterior corneal surface is referred to as ocular residual astigmatism.
OBJECTIVE:
To evaluate the difference between ocular residual astigmatism and total ocular residual astigmatism in normal virgin eyes with refractive errors.
PATIENTS AND METHODS:
Eighty four patients ( 135 virgin eyes) with refractive errors were enrolled consecutively in this study at the Lasik clinic in Ibn Al- Haitham Teaching Eye Hospital. Measurement of astigmatism was done by
manifest refraction and corneal topography using Oculus Pentacam, and these measurements were used for calculating ocular residual astigmatism and total ocular residual astigmatism with comparison between them.
RESULTS:
The study showed a significant difference between the means of ocular residual astigmatism (-0.7416 ± 0.4341 ) and the total ocular residual astigmatism (-0.6223 ± 0.401) in with the rule astigmatism (P value < 0.001), and the means of ocular residual astigmatism (-0.8113 ± 0.38517) versus the means
of total ocular residual astigmatism (-0.6658 ± 0.3844) in against the rule astigmatism (P value <0.001).
CONCLUSION:
The ocular residual astigmatism based on the total corneal topographic astigmatism corresponds better with manifest refractive cylinder than the ocular residual astigmatism based solely on anterior corneal
topographic astigmatism .
KEY WORDS: Ocular residual astigmatism, Posterior corneal astigmatism.
 
ABSTRACT:
BACKGROUND:
Ocular astigmatism is the sum of corneal astigmatism and internal astigmatism. The component of ocular astigmatism that cannot be a attributed to the anterior corneal surface is referred to as ocular residual astigmatism.
OBJECTIVE:
To evaluate the difference between ocular residual astigmatism and total ocular residual astigmatism in normal virgin eyes with refractive errors.
PATIENTS AND METHODS:
Eighty four patients ( 135 virgin eyes) with refractive errors were enrolled consecutively in this study at the Lasik clinic in Ibn Al- Haitham Teaching Eye Hospital. Measurement of astigmatism was done by
manifest refraction and corneal topography using Oculus Pentacam, and these measurements were used for calculating ocular residual astigmatism and total ocular residual astigmatism with comparison between them.
RESULTS:
The study showed a significant difference between the means of ocular residual astigmatism (-0.7416 ± 0.4341 ) and the total ocular residual astigmatism (-0.6223 ± 0.401) in with the rule astigmatism (P value < 0.001), and the means of ocular residual astigmatism (-0.8113 ± 0.38517) versus the means
of total ocular residual astigmatism (-0.6658 ± 0.3844) in against the rule astigmatism (P value <0.001).
CONCLUSION:
The ocular residual astigmatism based on the total corneal topographic astigmatism corresponds better with manifest refractive cylinder than the ocular residual astigmatism based solely on anterior corneal
topographic astigmatism .
 

Trends in Neonatal Mortality Rates in Iraq During the Period of 2008-2017

Murad Thamir Mehmoud; Jamal Al-Khudhairi

Iraqi Postgraduate Medical Journal, 2021, Volume 20, Issue 3, Pages 262-269
DOI: 10.52573/ipmj.2020.169729

BACKGROUND:
Neonatal mortality is mainly caused by infections, birth asphyxia and pneumonia (developing nations). Determinants included socioeconomic-demographic factors, healthcare system and culture. Risk factors: low birth weight, prematurity, insufficient antenatal care, repeated caesarian deliveries. Limited neonatal deaths research in Iraq justified this study.
AIM OF THE STUDY:
Describe and plot the neonatal mortality trend during the period of 2008-2017, and finding relation with key determinants and risk factors.
METHODS:
 Retrospective software and hardcopy neonatal medical records review & analysis (February-June 2019) in MOH, Central Statistical Organization, Baghdad's Health directorates, International Health Organizations, & 2-3 conveniently selected hospitals in health directorate. Records studied: Annual Statistical Reports, "Neonatal deaths Statistics Form", "Born", admission files, intensive care units' logbooks, death certificates, international organizations’ estimates & Multiple Indicator Cluster Surveys.
RESULTS:
Highest mortality rate was in West region 2015 (18.38/1000), lowest in east 2014 (3.78/1000) excluding Kurdistan; the decline during 2014-2015. Highest admission deaths: males (57.8%), cesarean deliveries (52%), extreme low birth weight (8.5%), preterm (71.2%), >31 years (20.2%). Top death cause: Respiratory distress syndrome (51.9%), & late death: sepsis (33.36%).
CONCLUSION:
Mortality rate declined to lowest in 2014, followed by a rise attributed to increased registration; highest in west 2015, lowest in east 2014. Respiratory distress & sepsis were the most common causes. Most deaths in: preterm neonates, males, extremely low birth weight, operative deliveries & >31 years maternal age.

Music As An Alternative Therapy to Midazolam for Sedation in Patients Undergoing Elective Pelvic and Lower Limb Surgery Under Spinal Anesthesia

Murad Hameed Mola; Aimen Hameed Latef

Iraqi Postgraduate Medical Journal, 2021, Volume 20, Issue 3, Pages 270-276
DOI: 10.52573/ipmj.2020.169734

BACKGROUND:
Almost in all types of surgical operations, patients experienced some kinds of anxiety which is reflected by a perceptible change in some vital signs. Music therapy is an emerging nonpharmacological intervention that had proven effectiveness in different medical conditions.
OBJECTIVE:
To assess the effect of music intervention on some vital signs in patients undergoing elective pelvic and lower limb surgery under spinal anesthesia.
PATIENTS AND METHODS:
A prospective randomized study was conducted including a total of 100 patients scheduled for elective pelvic and lower limb surgery under spinal anesthesia. Patients were randomly assigned into two equals groups: the intervention group, and non-music group. Spinal anesthesia was standardized to all patients. Patients in music group were given headphone set connected to CD player and listened to a soft music immediately after the induction of spinal anesthesia until the end of the operation. Patients in non-music group were given midazolam in divided doses each with 1 mg as required. Hemodynamic parameters and respiratory rate were recorded at the entrance of operating room and then 5, 10, 15, 20, 30, 40, 50 and 60-minute post anesthesia induction.
RESULTS:
During all the time period after anesthesia induction until the end of operation, there were no significant differences between intervention group and non-music group in the all included vital signs (heart rate, systolic pressure, diastolic pressure, and mean blood pressure).
CONCLUSION:
music intervention can be used as a nonpharmacological alternative midazolam to control the vital signs after spinal anesthesia.