Issue 3


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

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

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

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

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

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

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

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

Study of Occurrence of Polycystic Ovarian Syndrome Among Infertile Women

Hanaa Rahman Eleawi; Enas Talib Abdul-Karim; Anam Rasheed AL- Salihi

Iraqi Postgraduate Medical Journal, 2015, Volume 14, Issue 3, Pages 329-336

ABSTRACT:
BACKGROUND:
Most women with polycystic ovary syndrome PCOS don’t even know that they have it ,and do not get a diagnosis until they begin trying to get pregnant.
OBJECTIVE:
To identify the prevalence of the polycystic ovary syndrome (PCOS) among infertile women attending the Institute of Embryo Research and Infertility Treatment in AL-KadhymiaBaghdad, and to identify some of the common characteristics of infertile women with PCOS and others without PCOS .
METHODOLOGY:
A cross sectional study was conducted for about four months,during which a review of records of all the women attending the Institute during the year 2010 (six hundred women) .
RESULTS:
Results showed that the most common factors of infertility in infertile women is the PCOS, PCOS had a higher frequency among women aged 20-29 years, Slightly higher frequency of diabetes mellitus and hypertension among them than other group. higher frequency of acne & hirsutism among the PCOS cases than other causes group, and a higher frequency of increased prolactin level& LH level in the PCOS cases.
CONCLUSION:
PCOS infertility comprises more than one fourth of causes of infertility and is associated mainly with primary infertility & among younger age group(20-29years) .

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

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

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

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

Outcome of Endonasal Endoscopic Dacryocystorhinostomy in Nasolacrimal Duct Obstruction

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

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

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

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.

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.

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

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

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

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

Resection and Reconstruction of Cervical Tracheal Stenosis

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

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

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

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.

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 .

Prognostic Indicators in Patients with Relapsing Remitting Multiple Sclerosis

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

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

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