Volume 9, Issue 4, Autumn 2010, Page 430-582

Level of Resistin in Acute Myocardial Infarcti on Patients and its Relation to Lipid profile and Cardic Troponin I

Ammal Esmaeel Ibrahim; Hadef Dhafer EL-Yassin; Hamid Kareem Sachit AL-Janabi

Iraqi Postgraduate Medical Journal, 2010, Volume 9, Issue 4, Pages 430-435

Inflammatory responses are involved in the initiation and progression of atherosclerotic plaques.
Myocardial Infarction (MI) is most commonly due to occlusion of a coronary artery following the
rupture of a vulnerable atherosclerotic plaque. It has been suggested that the adipose tissue may
play an important role in mediating this chronic inflammatory process. Resistin is a cysteine-rich
polypeptide that is expressed at relatively lower levels in human adipocytes but higher levels in
macrophages. Troponin is found in cardiac muscle and used for diagnosis of AMI.
To investigate the level of resistin and its effect on lipid profile and Troponin I levels in acute
myocardial infarction patients.
The study included 50 patients with AMI and forty healthy subjects as control group. In this study
resistin , lipid profile and Troponin I were measured.
The levels of resistin, cholesterol, LDL-C were significantly elevated with (p<0.001), while HDLC
was significantly lower with (p<0.001), there was positive correlation between resistin with
cholesterol, LDL-C, triglyceride and VLDL, while there was negative correlation between
resistin with HDL in acute myocardial infarction.
There was a significant increase in resistin level, in acute myocardial infarction patients and this
increase may be related to inflammation. Resistin negatively correlated with HDL and positively
correlated with triglyceride and LDL this relationship makes us consider this hormone as possible
atherosclerotic factor

Study of Serum Uric Acid in a Group of Insuline Dependant Diabetes Mellitus Iraqi Patients .

Dhammyaa H. Salih; Wifaq M.Ali Al-Watar

Iraqi Postgraduate Medical Journal, 2010, Volume 9, Issue 4, Pages 436-440

The long duration of insulin dependant diabetes mellitus eventually ends with complications like renal
impairment especially if it was badly controlled ,the first sign of renal involvement is the elevation of
serum uric acid above or near upper normal values(1).
One hundred and thirty type1 diabetic patients were enrolled in the study, they represent a selected sample
of patients who attend the Specialized Center for Endocrinology and Diabetes (Baghdad Russafa
Directorate) during the period from November 2006 to April 2007 compared with forty healthy
individuals as control group of similar age group.
The determination of fasting blood sugar ,uric acid and blood urea were done by enzymatic colorimetric
test following the Procedure performed by manufacturers.
The level of serum uric acid and blood urea were normal in all cases of juvenile diabetes but as the
duration of the disease increases the values of the serum uric acid started to raise and could be the first
sign of renal impairment in diabetic patients even before albuminuria..
The concentration of uric acid in the blood is an independent marker of failing kidneys and may even play
a causative role in the decline of renal function

Pancytopenia Adult Patients At Baghdad Teaching Hospital

Khudair Abbas Al-Khalisi; Azher Sebieh Al-Zubaidy; Majid Rhaima

Iraqi Postgraduate Medical Journal, 2010, Volume 9, Issue 4, Pages 441-448

pancytopnia is a triad of findings caused by different diseases affecting bone marrow primarily or
secondarily, causing manifestations of anemia, thrombocytopenia, and/ or leucopenia
To identify causes, and presenting symptoms of pancytopnia in patients attending Baghdad teaching
One hundred and five patients, found on complete blood count having Pancytopenia were included,
excluding patients that had been exposed to chemotherapy, and/or radiotherapy
Causes in decreasing frequency were acute leukemia (30.47%), aplastic anemia (17.14%),
megaloblastic anemia (13.33%), NHL (14.47%), MDS (8.57%), PNH (4.76%), TB, SLE, HD
(2.58%) for each, and kalazar, and MM and HCL (1.9%) for each.
Manifestations were fatigability (67.6%), bleeding tendency (55.8%), and fever (48%).
Incidence of Pancytopenia may vary according to geographical, and genetic factors, and depending
on parameters, and criteria of inclusion and exclusion. Acute leukemia was found the most common
cause, followed by megaloblastic anemia.

Correlation of Angiographic Findings and Clinical Presentations in Unstable Angina

Ali Abdulamir Mohammad AL.Mossawi; Kasim Abbas Ismail; Majid Hameed AL Maini; Adil Siwan Aqabi; Azher Sabih Zubaidy; Jawad K. mnuti; Fadhil A. AL- Abbudi; Amira H. Shubbar; DEFINITION GERD is described as any symptomatic or histopathological alteration resulting from episodes of gastroesophageal reflux; Layth Rafea Taqa; INTRODUCTION; Reflux esophagitis describes the subset of GERD patient with histopathological changes of; Sawsan Sati; Najat Abul; Razak; Noor Mustafa; Razeqa Abd Ali; Suhaila Saadallah; Raji H AL-Hadithi; Darya Akram Faqe Mahmood; Ari R. Qader; Kurdo A. Mohmmad; Dawood Salman Hameed Alazzawi; Entissar Hadi AL- Shimery; Jaafar Muhamed Hassan; AL- Ghabban; Haider Abdul Muhsin; Huda Adnan Habib; Maysaloun Muhammed Abdulla; Selwa Elias Yacoub; Abdulrazak H. Alnakash; Shaema Jafar; Yousef Abdul-Raheem; Alaa Hussein Ali; Montadhar Hameed Nima; Rasha Abbas Azeez; Jassim Mohammad Alkhazraji; Hussein Mahmood Gazi; Mohammed Shafik Tawfeek; Nabeel Ghazi Hashim; Hayder Hadi Lazim; Maysoon Mohammad Najeeb Mohammad Saleem; Arieg Abdul Wahab Mohammad; Majid Syki Jabir; Kareem Al-Tameemi; Malak A. Al-Yawer; Adel Rabea Alsaadawi; ABSTRACT; Issraa A. Hussein; Osama E. Hudder; Thukaa T. Yahya

Iraqi Postgraduate Medical Journal, 2010, Volume 9, Issue 4, Pages 449-455

Unstable angina is usually related to acute thrombosis superimposed on a disrupted plaque. The highest;
level of Braunwald classification of unstable angina can be used to assess the severity of clinical
presentation. However the highest classes have not been directly correlated with thrombotic and complex
The study was done to clarify the correlation between angiographic findings and the most acute and / or
severe clinical presentation in unstable angina.
We conducted a prospective study of 110 patients of unstable angina at Ibn-Albitar Center for Cardiac
Surgery. All of these patients underwent cardiac catheterization, culprit lesion was identified in 80
patients and in 30 patients there was no an identifiable culprit lesion .Complex lesions including complex
morphology, intracoronary thrombus, or total occlusion were also quantitatively analyzed and
Thrombolysis in Myocardial Infarction (TIMI) flow grade was assessed. Patients were classified
according to Braunwald classification in instable angina .We compared patients with and those with no
culprit lesions in regarding Braunwald classification. We sequentially compared the highest Braunwald
classes II, C, 3 with classes


braunwald classification
unstable angina

Hypolipoproteinemia as Biological Marker in Acute Leukemia

Majid Hameed AL Maini; Adil Siwan Aqabi; Azher Sabih Zubaidy

Iraqi Postgraduate Medical Journal, 2010, Volume 9, Issue 4, Pages 456-459

Acute leukemia is a clonal hematopoietic malignant disease that arises from malignant transformation
of an early hematopoietic stem cells .Seeking for biochemical markers that are associated with acute
leukemia may help us for better understanding of the leukemic process &improve our lines of
management.Hypolipoproteinemia is one of these markers&it is the target of this study.
To study the association between the hypolipoproteinemia ´ leukemia &the ability of using
hypolipoproteinemia as a biological marker that is helpful in follow up of acute leukemia.
A total of fifty patients with acute leukemia diagnosed by blood film&bone marrow examination were
compared with control group of twenty healthy persons regarding fasting lipid profile(TC total
cholesterol,LDL low density lipoprotein,HDL high density lipoprotein,TG triglyceride).
In this study there is close association between hypolipoproteinemia´ leukemia. The mean values
of lipoproteins were significantly lower in patient with acute leukemia compared to control group(P
value is 0.0001 for total cholesterol&0.045 for triglyceride).
These data suggest that hypolipoproteinemia could be useful as a marker for follow up of acute

Hepatitis C Virus Infection Assessment Among Chronic Hemodialysis Patients in AL-Kadhmiya Teaching Hospital

Jawad K. mnuti; Fadhil A. AL- Abbudi

Iraqi Postgraduate Medical Journal, 2010, Volume 9, Issue 4, Pages 460-464

Hepatitis C virus (HCV) has been recognized as an emerging problem in dialysis patients, and viral
hepatitis remains a major hazard for both patients and medical staff of hemodialysis (HD) units.
The reported yearly incidence of anti-HCV antibody worldwide between HD patients ranges from
10.5% to 24%, while the prevalence of anti-HCV antibody among dialysis patients varies in
different countries (5-85%) worldwide, and may exceed 95% in the Middle East
To asses the prevalence of anti-hepatitis C virus (HCV) among the hemodialysis unit in ALKadhmiya
Teaching Hospital and to identify the risk factors of infection in relation to age, sex, blood
transfusions and duration of dialysis
Across-sectional study was conducted in AL-Nahrain College of Medicine in AL-Kadhmiya
Teaching Hospital in dialysis unit during the period from April 2008 to December 2010. 100
patients(58 male and 42 female their ages ranged from (15—75). are known cases of end stage renal
failure on regular haemodialysis. All patients underwent a history and physical examination at
baseline and investigations include blood urea nitrogen, creatinine, serum calcium, phosphorus, liver
function test and screen for hepatitis C virus antibodies were tested by using Murex anti-HCV
ELISA , Positive cases were confirmed by polymerase chain reaction
The prevalence of HCV infection in patients in the dialysis unit was 41%. This study showed that
there was an association between the history of blood transfusions, duration of the dialysis and
kidney transplantation and the prevalence of HCV infection,( P.value <0.001.)
Although the levels of AST and ALT were higher in the positive HCV marker group, there was no
statistically significant difference between them.
HCV infection is high in hemodialysis unit in alkadhmiya teaching hospital, HCV-related liver
disease in patients on long-term dialysis often appears clinically mild, with only modest elevations in
AST and ALT levels but most of them asymptomatic. Observation of appropriate preventive
measures in the hemodialysis center is highly recommended.

Gastro-Esophageal Reflux Disease in a Sample of Healthy Iraqi Population Amira H. Shubbar* ,Layth Rafea Taqa** INTRODUCTION: DEFINITION GERD is described as any symptomatic or histopathological alteration resulting from episodes of gastroesophageal reflux, Reflux esophagitis describes the subset of GERD patient with histopathological changes of the esophageal mucosa(1). The clinical diagnosis of GERD is fairly straight forward, if the patient reports a substernal burning sensation radiating upwards the neck, which is promptly relived (albeit transiently) by the ingestion of antacids (2,5). EPIDEMIOLOGY Symptoms consistent with GERD occur in more than one third of the American adults on a monthly basis and weekly in as many as 10%, while 4-10% *Department of Medicine Al-Mustansiriya University. **Ibn AL Bitar for Cardiac Surgery on daily basis (2,3,5,6). Spechler reviewed the epidimiology and natural history of GERD in Orlando and he reported that 20-40% of the adults population experienced heartburn which is the cardinal symptom of GERD, but only some 2% of adults have objective evidence of reflux esophagitis, the incidence of GERD increases with the age, rising dramatically after 40 years of age(7). Also there is a wide geographical variation in prevalence(5,7). While the complications of the GERD (ulcer, stricture and barretts esophagus) are found in up to 20% of patient with esophagitis. The annual mortality of GERD is 1 death per 100 000 patients(8). 33% Healthy Britons had experienced heartburn; 10% had monthly basis symptoms and 3% had daily symptoms (8).In Finland Isolari et. al. estimated the prevalence of symptoms suggestive of GERD in an adult population by questionnaires concerned with the heartburn, regurgitation, ABSTRACT

Amira H. Shubbar; DEFINITION GERD is described as any symptomatic or histopathological alteration resulting from episodes of gastroesophageal reflux; Layth Rafea Taqa; INTRODUCTION; Reflux esophagitis describes the subset of GERD patient with histopathological changes of

Iraqi Postgraduate Medical Journal, 2010, Volume 9, Issue 4, Pages 465-472

Symptoms consistent with GERD occur in more than one third of the American adults on a
monthly basis and weekly in as many as 10%, while 4-10% on daily basis
To survey the prevalence of symptoms of GERD in a sample of healthy Iraqi population sample.
Prospective study from Jan 2000- Jun 2000 at the deferent wards of Al-Yarmook teaching hospital,
Questionnaires were distributed to 950 healthy persons of different age group attending Al-
Yarmouk teaching or visiting their patient at the hospital.
The questionnaire included:
Taking full history of symptoms suggestive of GERD, including habits and Body Mass Index.
Heartburn was experienced by 239 (40.6%) once or more in their life, 30.6% on monthly basis,
11% on weekly basis, 8.3% on daily basis.6.2% of the respondents fulfill the criteria of the
European expert panel (EPAGE) criteria for diagnosis of symptomatic GERD.
Symptomatic GERD is common in our population.
Chronic duration of the illness was recognized in one third of them predisposing them to the risk of
barrett’s esophagus.
Early referral is indicated for better

Homocysteine ,Folic acid ,Vitamin B12 and Pyridoxine : Effects on Vaso-Occlusive Crisis in Sickle Cell Anemia and Sickle –Thalassemia

Sawsan Sati; Najat Abul; Razak; Noor Mustafa; Razeqa Abd Ali

Iraqi Postgraduate Medical Journal, 2010, Volume 9, Issue 4, Pages 473-479

Hemoglubiopathies include sickle cell anemia and the Thalassemia . S/ β0- Thalassemia have a
clinical course similar to HbSS. Elevated concentration of Homocysteine contribute to thrombosis , a
frequent event in sickle cell anemia . Vitamin B12, Pyridoxine , and folic acid deficiencies lead to
dangerous increase in plasma Homocysteine.
1- To test whether children with sickle cell anemia and Sickle cell – Thalassemia have elevated
concentration of serum Homocysteine with diminished level of folate, B6, B12.
2- To determine whether hyperomocysteinaemia has a correlation with the frequency of Vasoocclusive
A case- control study was carried over a period of one year from Jan.- Dec. 2010 inclusive, 30
patients were collected from the Thalassemia centre in Ibn –AL-Baldy Hospital together with
healthy 30 cases, age and sex matched ,were taken from AL- Kadhimiyia Teaching Hospital.
Venous blood sample were aspirated from both groups to estimate serum Homocysteine, Folic acid,
B12 and B6 level. Statistical analysis was done, using the student T-test ( P. value < 0.05 is considered
as statistically significant) . Pearson correlation analysis was performed.
The age of the patients range between (5-29) years, the majority of the patients were between ( 10 -
19 ) years , 10 cases ( 38 .46 %). More than one half were male ,16 cases ( 61.54 %) . Sickle cell –
Thalassemia constitute 20 cases (76.93%). Vaso-occlusive crisis was mainly involving the large
joints, 15 cases (57.69 %). Mild attacks constitute more than half of the patients, 16 cases (61.54
%).Homocysteine level was higher in the patients group compared with control group with a mean
and standard deviation of (44.52 ± 23.008) and (18.65 ± 4.56)μmol/L respectively . Folic acid level
was lower, B12 level was higher, B6 level was lower in the patients group compared with control
group with a mean and standard deviation of (11.32± 3.23) and (14.71 ± 3.39)ng /ml, (172.57±
61.34) and (103.45 ± 30.45)pg /ml, (4.43± 3.93) and (10.23 ± 2.30) ng/ml respectively, the results
were statistically not significant, P. value > 0.05. Significant inverse correlation was found between
Homocysteine level and B6 level. A strong positive correlation between Homocysteine level and the
frequency of Vaso-occlusive crisis was found.
Patients with sickle cell disease have high serum level of Homocysteine with low level of folic acid
and pyridoxine. This Hyperomocysteinaemia is significantly inversely correlated with pyridoxine
deficiency , but positively correlated with the frequency of Vaso-occlusive crisis

The Detection of Neutrophiles in Gastric Mucosa of Patients Suspected to be Infected with Helicobacter Pylori Using Leukostix Nassir Enssief Mohsun*,

Suhaila Saadallah; Raji H AL-Hadithi

Iraqi Postgraduate Medical Journal, 2010, Volume 9, Issue 4, Pages 480-483

Helicobacter pylori has been detected in many populations and associated with inflammation of
gastro duodenal mucosa. Colonization of the stomach by Helicobacter pylori occurs in more than
half of human population worldwide. It is the principle cause of chronic active gastritis, peptic ulcer
and gastric cancer.
To detect neutrophiles in homogenates biopsied gastric mucosa semiquantitatively using rapid
leukocyte strip test (leukostix).
A total of 115 patients (74 males, 41 females) referred to The Gastrointestinal Tract Center and
Gastroscopy Department of Baghdad Medical City and subjected to gastroscopy were included in this
study during the period from November 2004 to May 2005.
The sensitivity and specificity of leukostix at the initial examination were 95.8%, 88.23%
The leukostix test, using biopsied samples of gastric mucosa was excellent for quantitative
determination of neutrophils in patients infected with H pylori.

Prosthesis-Patient Mismatches in Aortic Valve Replacement a Study in Ibn Al-Bitar Hospital for Cardiac Surgery

Darya Akram Faqe Mahmood

Iraqi Postgraduate Medical Journal, 2010, Volume 9, Issue 4, Pages 484-492

Use of new generation small prostheses for aortic valve replacement has decreased the need for annular
enlargement and rarely increased the incidence of severe patient-prosthesis mismatch;
Of this study is to evaluate the impact of using this type of prosthesis (St.Jude. HP, Regent) on
operative mortality.
We reviewed our experience (59) consecutive patients who had isolated and combined aortic valve
replacement in our hospital between February 2001 and February 2007.
The mean age was 36, and 60 % of patients were female.valvular disease was primarily pure aortic
regurgitation 47%, combined aortic disease 29% and pure aortic stenosis was present in 24%.
Evaluation of the impact of newly designed small prosthesis on thirty-day mortality revealed: thirty-day
mortality was 8% and the strongest independent predictors in multivariate analysis in decreasing order of
statistical power were functional class IV, patient-prosthesis mismatch, advanced age (65 year), very
small valve size (labeled valve size 17-mm), isolated aortic valve replacement surgery without other
concomitant procedure (P=0.022) and obese patients (body mass index >33 kg/ m²).

Evaluation of Vermilion-Mucosa Flaps for Reconstruction of Oral Commissure Burn Microstomia

Ari R. Qader; Kurdo A. Mohmmad

Iraqi Postgraduate Medical Journal, 2010, Volume 9, Issue 4, Pages 493-498

The reconstruction of the oral commissure microstomia is one of the complex tasks in plastic surgery
and the most important issue to be considered is to provide a good functional and acceptable aesthetic
result. Various local and regional flaps have been described for this purpose. The vermilion - mucosa
flaps are frequently used flaps in reconstruction of small to medium sized microstomia. The reliable
blood supply, minimal donor site morbidity and excellent texture and color match are some of the
advantages of these flaps.
This study is to evaluate our results with vermilion-mucosa flaps in the reconstruction of oral
This prospective study was done in Sulaimani plastic, reconstructive and burn hospital from April
2008 to September 2009 with minimum follow-ups of 6 months. The total number of patients was
fifteen, the age of patient arranged between 1month to 47 years, the flaps designed as vermillion
advancement flaps in 7 cases, vermilion-mucosa flaps in 4 cases, and tri -lobes buccal mucosal flaps
in 4 cases. The cause of the deformities was , post burn scaring and contracture involving oral
commissure, of which twelve cases treated bilaterally, and only three cases treated by unilateral
The flaps were survived and most of the patients were satisfied with the outcome of the operation.
Marginal necrosis of one flap was encountered; drooling was encountered in only one patient and it
gradually disappeared with time.
The oral vermilion mucosa flaps are reliable tools for reconstruction of small to moderate- sized
commissure microstomia. The flaps provide good functional and aesthetic results with reduced
necessity for prolonged splinting and secondary procedure and minimal donor site morbidity

Mortality Rate Among Low Birth Weight Infants in Al- Battool Teaching Hospital , Diyala Province, Iraq

Dawood Salman Hameed Alazzawi

Iraqi Postgraduate Medical Journal, 2010, Volume 9, Issue 4, Pages 499-503

An analytic cross-sectional study through which a review for the records of all patients admitted to
neonatal nursery in Al-Battool teaching hospital,Diyala province, Iraq during the first six months of
2003 and 2009 were performed.
To demnstrate the deterioration of the condition of low birth weight infants.
This study about mortality rate among low birth weight infants who delivered in Al-Battool teaching
hospital Diyala governorate including the records of 366 patients admitted during first six months of
2003 and compared with records of 558 patients admitted during the same period of 2009. Information
has been studied extensively for gestational age, birth weight, predisposing factors and mortality.
Mortality rate is increased to 30% during 2009, while it was 12% during 2003.
Increase percentage of low birth weight infants (28-36wks) during first 6months 2009 (49%), as
compared to first 6 months 2003 (45%).
Increase in congenital abnormalities rate (ranging from cleft palate to congenital heart diseases) (42%)
on 2009 as compared to (29%) on 2003.
Increase number of low birth weight infants to total deliveries at hospital (13.1%) during 2009 as
compared to (11.7%) during 2003.
High mortality rate, increase percentage of low birth weight infants and increase cases of congenital
abnormalities during 2009, to be studied extensively and thoroughly regarding the environmental
causes and health services availability.

Autism Among Children Attending Pediatric Psychiatric Department in Child's Central Teaching Hospital in Baghdad: a Descreptive Study

Entissar Hadi AL- Shimery; Jaafar Muhamed Hassan; AL- Ghabban; Haider Abdul Muhsin

Iraqi Postgraduate Medical Journal, 2010, Volume 9, Issue 4, Pages 504-511

Autism is a spectrum of neuropsychiatric disorders that affects children from all ethnic and
socioeconomic backgrounds. The diagnosis is based on their developmental and medical history as well
as observations of their social, communicative, and play behaviors that usually begin before age of three
A descriptive study of autism to describe the prevalence of autism among childhood psychiatric
disorders, the age for diagnosis of autism, sex distribution, family history and the clinical features of
A cross-sectional study included a sample of 208 children with psychiatric disorder, who were
attending pediatric psychiatric department evaluated for the criteria of autism. Data collected were
including (the age at the diagnosis, sex, family history and clinical characters included the main clinical
features and other associated features of autism).
Of the 208 patients registered psychiatric problem, 33(15.87%) met criteria for autism, the mean age for
the diagnosis of autism was 5.45 years with the boys more predominant than girls. Three main clinical
features of autism are communication abnormality, social abnormality and behavioral abnormality. The
communication abnormality were the most commonest features. Other associated features included
enuresis (the commonest), encopresis, sleep problems, over activity and anxiety. Macrocephaly and
seizure are important clinical characters of autism presented in 12% and 9.1% respectively.
Autism is not rare and autistic children represent a significant subgroup of children with serious
psychiatric disturbance. Speech delay and abnormalities in language are the hallmark features of
autistic disturbance.

Knowledge and Preference of Mothers Delivering at ALKadhumyia Teaching Hospital Regarding Caesarean Section and Normal Vaginal Delivery

Huda Adnan Habib; Maysaloun Muhammed Abdulla; Selwa Elias Yacoub

Iraqi Postgraduate Medical Journal, 2010, Volume 9, Issue 4, Pages 512-518

Caesarean section rates are progressively rising in many parts of the world. One suggested reason is
increasing requests by women for caesarean section in the absence of clear medical indications.
To determined the medical and non medical reasons behind the caesarean section. To identify the
mothers preference to the mode of delivary and reasons behind this preference.
Across sectional study of 480 mothers was interviewed .The data was collected using a questionnaire
form includes information under two main headings: 1) Information related to the mother; these
include demographic and some obstetrical information, obstetrical 2) Knowledge of mothers
regarding reasons behind their caesarean section.3) Information related to mother preference.
The majority of mothers 317(66%) were delivered by Caesarean section ,the majority of Caesarean
section mothers (41%) were of (36-45) years of age , (47.3%) completed primary education., ( 89%)
of them reported medical reasons behind their Caeserean section, (25.9%) of mothers with medical
reasons reported a history of Caeserean section as the main medical reason .Regarding the non
medical reasons the majority of mothers (45.7%) reported Fear of vaginal delivery as the main non
medical reasons . The majority 384(80%) of mothers prefer NVD while only (20%) reported their
preference to C-section
The caesarean section rate was high, history of Caeserean section were the main medical reason
behind caesarean section , fear of vaginal delivary was the main non medicval reason behind
caesarean section. Majority of mothers prefer NVD than C-section

Whether Selective or Routine Episiotomy is more Useful to Protect Anal Sphincter in Primiparous Women

Abdulrazak H. Alnakash; Shaema Jafar; Yousef Abdul-Raheem

Iraqi Postgraduate Medical Journal, 2010, Volume 9, Issue 4, Pages 519-525

Perineal trauma is a common event, affecting up to 90% of first time mothers. It is a cause for concern
for many women and in some countries has led to a large increase in the numbers of women
requesting elective caesarean section.
To highlight when episiotomy can be useful in preventing anal sphincter injury in primiparous
This study is a prospective interventional clinical study conducted at AL-Elwiya Maternity Teaching
Hospital in Baghdad throughout the period between Jan. 2009- Dec. 2009.
Three hundred term primiparous ladies at time of their delivery with cephalic presentation were
collected and subdivided into 3 equal groups randomly.
The first group, women who were subjected to routine mediolateral episiotomy, while the second
group of the participants were delivered without doing episiotomy, and the third group, a mediolateral
episiotomy was done selectively to them when we found it is necessary (selective episiotomy).
State of the perineum, length of 2nd stage, weight of the baby, fetal head position and the occurrence
of anal sphincter injury were all notified and carefully recorded on special form designed for the
Selective episiotomy was found to be more useful than routine episiotomy in preventing anal
sphincter injury (the incidence of anal sphincter injury was 2% for those in whom episiotomy was
performed selectively, while it is 8% for those with routine episiotomy and 7% for those delivered
without episiotomy), and the difference is statistically significant (P value 0.045).
There was a significant effect of the length of second stage of labour on the incidence of anal
sphincter injury (P value 0.017), similarly for the weight of baby (P value 0.017).
Selective episiotomy is more useful interv

Intraoperative Albumin Plus Crystalloid Solution Versus Crystalloid Alone in Renal Transplant Surgery

Alaa Hussein Ali

Iraqi Postgraduate Medical Journal, 2010, Volume 9, Issue 4, Pages 526-530

Chronic renal failure is defined as an irreversible deterioration in renal function which classically
develops over a period of months or years. renal transplantation is the treatment of choice for end
stage renal failure and during surgery the maintenance and restoration of intravascular volume are
essential tasks to achieve sufficient organ function in renal transplants.
To study the comparison between normal saline 0.9% with glucose 5 % and normal saline 0.9% ,
glucose 5 % with albumin in renal transplantation.
The study data from 50 patients 47 patients underwent living donor kidney transplants three were
excluded because they are diabetics .twenty three patients received normal saline 0.9% , glucose
saline 5%,and twenty four received normal saline 0.9 with glucose 5% and albumin 100 milliliter .
There was no statistical difference between the two groups in the primary measurement of outcome
measure in the urine output in the 1st day and the serum creatinine in the 1stand 3rd day .
Although statistically there was no difference in the two groups, it might be its useful to combine a
colloid with a crystalloid in the fluid management regimen to improve microcirculation, oxygen
perfusion and to ovoid large volumes of crystalloid

The Role of P53 nuclear Protein in Prediction of Progression and Recurrence of Superficial Tumor of the Bladder in Response to Intravesical Chemotherapy

Montadhar Hameed Nima; Rasha Abbas Azeez

Iraqi Postgraduate Medical Journal, 2010, Volume 9, Issue 4, Pages 531-535

p53 gene is the most common mutation in human cancers.In bladder cancer, p53 mutations have been
associated with high tumor grades and advanced stages.Moreover,p53 nuclear over expression
appears to be an independent predictor of disease progression and decreased survival after
To identify the role of p53 nuclear protein in prediction the progression and recurrence of superficial
tumor of the bladder in response to intravesical chemotherapy
The expression of p53 protien was studied by immunohistochemical analysis from 71 patients with
superficial tumor bladder and all of them were treated by intravesical chemotherapy followed
periodically every three months by cystoscopy
P53 over expression was observed in 38out of 71(54%) patients with superficial tumor of the bladder.
A statisticaly significant relation was noticed between P53 over expression and tumor grades ,
however statistical significant relation between p53 negative expression and response to intravesical
mitomycin C chemotherapy was noticed , moreover , patients who received intravesical mitomycin
C chemotherapy , 71% showed response with in 3 month , while 29% showed recurrence .
Moreover, it seems that P53 status did predict response to intravesical mitomycin C chemotherapy.
The response of intravesical chemotherapy in patients with superficial transitional cell carcinoma was
higher in p53 negative expression.

Bladder Mucosal Pathological Changes Accompany High Grade and Squamous Cell Bladder Tumors

Jassim Mohammad Alkhazraji

Iraqi Postgraduate Medical Journal, 2010, Volume 9, Issue 4, Pages 536-541

Carcinoma of the bladder is the second most common cancer in Iraq. The status of the bladder
urothelium other than the principal lesions can provide distinct diagnostic information with regard to
treatment response and outcome. Positive mucosal biopsy results are a significant indicator of
intravesical recurrence. Currently, in our urological practice, the importance of performing this step in
cystoscopy is relatively underestimated.
The objective of this study is to carry out a histological assessment of 'extra-tumor' bladder mucosa for
dysplasia, and correlate the resulting findings of dysplasia with the grade, the type, and the macroscopic
appearance of the tumor.
A total of 350 biopsies were taken by cystoscopy from 68 patients admitted with bladder tumors, either
by cold-cupped biopsy forceps or resectoscope as part of TUR of the tumor. Normal-looking mucosa of
the bladder was included in each patient's biopsy in a four quadrant way. All biopsies were examined
by the same histopathologist. All patients were managed according to their presentation, cystoscopic
and histopathological findings.
Statistical analysis showed that the highest significant difference was obtained in patients with tumor
grade, low against high grade (p<0.005). However, a noticeable difference was found in the other two
comparison groups, namely, the type, transitional against squamous and the macroscopic appearance,
papillary against solid (p<0.05).
The high grade, solid tumors and squamous cell carcinoma are associated with general bladder mucosal
dysplastic changes which may exclude the bladder preserving procedures as an option of surgical
treatment. In Iraq, more extensive studies are necessary to come out with appropriate guidelines for a
better treatment and outcome of bladder carcinoma which is a major health problem.

Medico-Legal Applications of Multiplex STR System to Show Allel Frequencies of D16S 539, D13S317, and D7S820 in Iraqis

Hussein Mahmood Gazi; Mohammed Shafik Tawfeek; Nabeel Ghazi Hashim; Hayder Hadi Lazim

Iraqi Postgraduate Medical Journal, 2010, Volume 9, Issue 4, Pages 542-548

Disputed paternity is one of the most important medico-legal problems in Iraq. In addition to
identification of unknown corpses. Paternity cases are resolved by doing ABO typing and HLA
serotyping and both are less accurate than DNA typing. To our knowledge this is the first study of such
type in Iraq.
To show the medico-legal importance of determination of allel frequencies in Iraqi population.
Whole blood was obtained in EDTA tubes by venepuncture from 38 individuals. The DNA was extracted
using the Wizard Genomic DNA Purification Kit and the quantity was estimated by UV-absorbance. The
multiplex analysis of D16S539, D7S720, and D13S317 was performed using the Gene Print STR
Multiplex system. Amplification was performed in eppendorf thermal cycler. The PCR products were
typed by vertical electrophoresis on 0.4 mm thick 7% denaturing polyacrylamide gel and silver staining.
In our study the DNA fingerprinting test has high accuracy rate.
Since the DNA typing is the most accurate method so it can be routinely used as a paternity test, it is the
only test that can meet the increasingly imperative demand to resolve the social and judicial problems
involved in paternity suits and other medico-legal problems.

Serum Enzyme Activities in Human Thyroid Diseases

Maysoon Mohammad Najeeb Mohammad Saleem; Arieg Abdul Wahab Mohammad; Majid Syki Jabir

Iraqi Postgraduate Medical Journal, 2010, Volume 9, Issue 4, Pages 549-554

The study enrolled a total of 76 patients with thyroid gland diseases, hyperthyroidism and
hypothyroidism. The activities of the enzyme amylase, gamma glutamyltransferase and alkaline
phosphatase were evaluated in these diseases state and were compared with normal healthy thyroid
gland. The specimens were obtained from different hospitals in Baghdad and from routine clinical
Diagnosis of patients with thyroid gland diseases hyper and hypothyroidism by evaluation of
enzymes activity of amylase, GGT and ALP.
Two groups of patients were used: The first consists of 38 patients with hyperthyroidism, the
second consists of also 38 are patients with hypothyroidism. Twenty five of each group was
investigated for amylase, GGT, ALP and were compared with third group of 25 normal healthy
thyroid gland. The remaining 13 out of 38 patients of each group were tested for enzymes,
amylase, GGT, ALP, GOT, GPT and evaluate the hormones, they were compared with third group
of 10 normal healthy thyroid gland.
There was a highly significant increase and decrease in the activity of amylase, GGT and ALP in
hyper and hypothyroidism patients (P<0.001) when compared with third group normal.
Diagnosis of patients with thyroid gland diseases can be confirmed by enzymes investigation in
blood serum and hormonal assay

Etiologies of Adult Onset Epilepsy: Clinical and Paraclinical Study in the Governorate of Babylon.

Kareem Al-Tameemi

Iraqi Postgraduate Medical Journal, 2010, Volume 9, Issue 4, Pages 555-561

Adult onset epilepsy (AOE) is considered the epilepsy that start after the age of 18 years. It is a
common disorder, and it’s etiology is variable from one place to another.
to study the etiologies, diagnosis and treatment of AOE in one governorate of Iraq and to compare
it’s different clinical and paraclinical abnormalities in different age groups.
106 patients with AOE were enrolled in this prospective study, and included all patients who
developed seizure after the age 18. The study was done in a heavy neurological clinic in north of
Babylon governorate, Iraq, for 3 years from Sept. 2007 to Sept. 2010.
A total of 102 patients met the criteria. Brain tumors were found in 24 (23.5%). No cause could be
found in 25 (24.5%) of cases. Generalized tonic clonic seizure was registered in 47 patients (46%).
EEG was positive in (57.3%) of cases and the MRI was conclusive in 63.7% of them.
Brain tumors, CVD, post traumatic and inflammatory disease are the four major causes of AOE in
Iraq. The most common type of seizure among different groups of etiologies of AOE is focal

Effects of Herbs – Containing Phytoestrogens on Rat Testis: A Histological, Histochemical and Biochemical Study

Malak A. Al-Yawer

Iraqi Postgraduate Medical Journal, 2010, Volume 9, Issue 4, Pages 562-572

Estrogens has traditionally been known as the female hormone, but this idea has been challenged in
early 1990’s and an essential physiological role for estrogen in male fertility was identified.
Phytoestrogens are naturally occurring non-steroidal plant chemicals that can act like the female
hormone estrogen. The herbs ( anise alfalfa and vervain ) chosen in this study contain
Previous studies demonstrated controversy of the effects of phytoestrogens on the rat testes .Hence,
the present investigation was undertaken to investigate the influence of typical dose of herbs containing
phytoestrogen on the rat testis.
Twenty-four apparently normal mature male rats were divided into four groups of 6 animals each. The
first "control" group received only 4ml of distilled water as a placebo. The second group received
40mg/kg of anise seed; the third group received 53.3 mg/kg of dried herb of vervain and the fourth
group received 400 mg /kg of alfalfa seeds. All experimental groups received the doses through orogastric
tube daily for fourteen days. Testicular histology was evaluated by light and enzyme
histochemistry. Plasma FSH and testosterone concentrations were taken to support our results.
Histological examination of anise, alfalfa and vervain – treated groups showed an increase in the height
of germinal epithelia. There was marked lipoprotein lipase activity in the whole of the interstitial tissue
which is more in amount in experimental groups than that in control group. Acid phosphatase granules
were infiltered the seminiferous epithelia mildly in control group , moderately in anise and vervain
groups and markedly in alfalfa group. The number of interstitial cells showing marked acid
phosphatase activity was higher in all experimental groups than that in control group. Alkaline
phosphatase exhibited intense activity in the boundary tissue of the seminiferous tubules in testes of
control and experimental groups but it appeared thicker in the latter.
The low dose and short duration of treatment used in our study made these phytoestrogen – containing
herbs to have a stimulatory effect on leydig cell steroidogenesis. This study also demonstrated that
aniseed being the most potent of the three herbs followed by alfalfa in stimulating testosterone
synthesis. This is possibly attributed to the coumarin constituent of aniseed and alfalfa

Undifferentiated (Embryonal) Sarcoma of the Liver. Case Report and Review of Literature Mohammed S. Saeed

ABSTRACT; Issraa A. Hussein; Osama E. Hudder; Thukaa T. Yahya

Iraqi Postgraduate Medical Journal, 2010, Volume 9, Issue 4, Pages 576-582

Undifferentiated (embryonal) sarcoma of the liver
was first defined as a separate clinicopathological
entity in 1978. it is uncommon hepatic tumor of
mesenchymal origin, usually observed in children
and teenage, but also infrequently encounter in
adult. It represent about 9-15% of all hepatic tumor
in children. We report a case of undifferentiated
embryonal sarcoma of the liver in a 6 year old girl
who presented with non specific right
hypochondrial pain and mass with fever.
Laboratory studies of the liver function were
normal and the other tests were non specific.
Ultrasonography and CT scan showed a large
heterogeneous mass ranging from cystic tissue with
multiple septa to more predominant solid
component in the right lobe of the liver.
Exploratory laparotomy was performed and
revealed a large mass in the right lobe and part of
the left lobe of the liver. Tumor resection was
performed and about 70% of the total liver was
resected. Macroscopically, tumor was large
solitary globular firm predominant solid mass
weighing 1100gm and measuring 18 x 12 x 8 cm,
with variegated cut surface of solid, cystic,
necrotic and hemorrhagic areas. Microscopically,
the tumor has a variable but distinctive
sarcomatous appearance, composed of spindle,
oval and stellate-shaped sarcomatous cells, with
marked nuclear pleomorphism, closely packed in
whorls or scattered loosely in a myxoid ground
substance. Numerous bizarre multinucleated giant
cells, containing large intracytoplasmic hyaline
globules with ample mitosis many of which are
atypical. Tumor cells entrapped hyperplastic bile
ducts. Accordingly the diagnosis of