Issue 4

Surgical Experience in Mediastinal Cysts: At the Thoracic and Vascular Department in Ghazi Al Hariri, Surgical Subspecialties Hospital, Medical City,Baghdad, Iraq

Iraqi Postgraduate Medical Journal, 2018, Volume 17, Issue 4, Pages 315-321

Cystic lesions of the mediastinum are not uncommon, comprising 20% to 32% of all primary
mediastinal tumors. They are particularly significant because of the difficulty in making a
differential diagnosis: they can simulate multiple lesions, both benign and malignant.
The objectives of this study were to review the clinical presentations and the results of surgery in
patients with mediastinal cysts.
A retrospective study of twenty-two patients with mediastinal cysts, who were admitted and
surgically treated at Ghazi Al-Hariri for surgical sub specialties hospital during ten years from
January 2003 to December 2013. Clinical features, imaging techniques, surgical approaches,
morbidity, mortality and follow-up were analyzed.
Out of twenty-two patients with mediastinal cysts, there were 13 males (59.09%) and 9 females
(40.9%) patients. There were 12 pediatric (54.54%) patients ≤ 16 years of age and 10 adults
(45.45%) patients (age range, 36 days to 40 years; average age, 20 years). All patients with
mediastinal cysts were symptomatic. Overall common symptoms were dyspnea (68.1%), followed
by cough (50%), chest pain (31.8%), tachypnea (4.5%), dysphagia (4.5%), vomiting (4.5%), and
fever (4.5%). Cysts excision were performed in all cases with an uneventful recovery and with no
recurrence during the follow up period.
Most of mediastinal cysts located at middle compartment, Surgery for mediastinal cysts is
associated with low morbidity and mortality rates and a very low recurrence rate. It offers a
definitive diagnosis and cure.

Age of Spontaneous Regeneration of Glucose-6-Phosphate Dehydrogenase Among Children in Baghdad.

Iraqi Postgraduate Medical Journal, 2018, Volume 17, Issue 4, Pages 322-327

Glugose-6- phosphate dehydrogenase deficiency is the most common human enzyme deficiency in
the world andlead to hemolytic anemia as early sign.
To determine the age of the patient with G6PD deficiency in which can the enzyme return to
normal activity indifferent areas of Baghdad and to study if there is sex predilection for
spontaneous regeneration of the enzyme.
Case control study carried on patients at AL-kadhyimia teaching hospital and patientscollected
from different areas of Baghdad city during period from 1st of April 2012 to 31st of December
2012, 159 patients of G6PD disease, the range of their age 2-17years old age and 121(76%) of
them were male and 38(24%) were female. Another 100 normal children of different sex and age
range from 6-17 years were regard as control group, they were collected from different schools in
Baghdadcity ,all of them had normal enzyme activity.
Age of spontaneous regeneration of G6PD wasstatistically significant becauseP value
=<0.001(highly significant)i.e. as patient becomes older ( >14year) he has a very good chance for
the enzyme to return to normal activity.
The age of spontaneous regeneration of G6PD enzyme in children was above 14 yearsandthere is
no sex predilection.

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

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

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

Evaluation of Predisposing Risk Factors for Gallstone Formation Following Bariatric Surgery

Iraqi Postgraduate Medical Journal, 2018, Volume 17, Issue 4, Pages 335-339

The risk factors for development of gallstones have been studied extensively in the general
population. They are different when it comes to patients who underwent bariatric operations.
Obesity and rapid weight loss induced by weight-reducing surgery are well recognized for the
development of gallbladder stones. There is no standard policy whether to perform prophylactic
cholecystectomy at the time of the bariatric operation or to give postoperative treatment to decrease
the risk.
The aim of the study is to evaluate the predictors of gallstone formation post-Bariatric surgery and
associated risk factors. The implication behind it will help decide how to follow up postoperatively
and whom are at increased risk to develop cholelithasis.
This prospective study was performed on 100 patients who underwent weight-reducing operations
at Al-Imamain Al-Kadimiyen Teaching Hospital. They were followed for 12 months
postoperatively. Ultrasonography examination was done for those who developed symptoms
suggestive of gallstone formation.
Twenty percent of them were found to have gallstones. Of the the parameters enrolled in the study
(age, gender, type of surgery, preoperative body mass index, percentage of excess body weight
loss), only the factor of the percentage of excess weight loss was the most significant of predicting
development of gallstone post-bariatric procedures (p value = 0.002). The preoperative BMI, age,
gender and type of operation were found were not found to be statistically significant in terms of its
relationship with gallstone formation.
Concomitant cholecystectomy along with the bariatric procedure is not recommended. Surveillance
by ultrasonography for those with excess weight loss more than 25% of their original weight is
advised for 1 year postoperatively.

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

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

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

Trends of Neonatal Mortality and Factors Related with Neonatal Mortality Among Neonates admitted to the Neonatal Care Unit of Fatima Al Zahraa Hospital in Baghdad During 2017

Iraqi Postgraduate Medical Journal, 2018, Volume 17, Issue 4, Pages 348-354

The neonatal mortality rate is a key outcome indicator for newborn care and directly reflects
prenatal, natal, and postnatal care. Early neonatal deaths are more closely associated with
pregnancy related factors and maternal health, whereas late neonatal deaths are associated
more with factors in the newborn`s environment.
To find out the neonatal mortality rate and to identify the factors related with neonatal
mortality among neonates admitted in the Aseptic Neonatal Care Unit of Fatema AL Zahraa
A cross - sectional hospital-based study was done depending on data collected from records of
the Aseptic Neonatal Care Unit (ANCU) of Fatema AL Zahraa Hospital in Baghdad, to find
out the number of deaths within the neonatal period (0-28 days) that was conducted from 1st of
Jan 2017 to 31st of Dec 2017. Data was also, collected from Obstetrical Ward to determine the
number of live births for the same period. The data was collected by using special form
including; the number of deaths in neonatal period, cause of death, neonatal gender, gestational
age, birth weight, mother`s age, educational level, history of congenital anomaly in previous
pregnancy , antenatal care, parity, consanguinity, type of delivery, pregnancy outcome, total
number of live births, and history of medical disease during pregnancy .
The Neonatal Mortality Rate (NMR) was 14.37 per 1000 live birth. NMR was very high
among low-birth-weight preterm infants, (50%) of mothers completed the primary school,
(71.89 %) of mothers had positive history for Consanguinity,15% of mothers had positive
history of congenital anomaly in previous pregnancy,(70.41%) of mothers were in the (20-35
years) age group. Normal vaginal delivery (NVD) in (63.01%) of cases. The most common
cause of neonatal deaths in the preterm delivery was respiratory distress syndrome (RDS), and
in the full term delivery was asphyxia.
The neonatal mortality rate was 14.37 per 1000 live birth. The maternal and neonatal
demographic data that were related with increased NMR were prematurity, lack of antenatal
care, multipara mother, repeated CS, mother`s hypertension, and consanguineous marriage.

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

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

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

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

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

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

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

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

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

The Value of C-Reactive Protein Concentration in the Blood in Early Diagnosis of Neonatal Sepsis

Iraqi Postgraduate Medical Journal, 2018, Volume 17, Issue 4, Pages 373-376

Neonatal sepsis refers to systemic infections which include septicemia, pneumonia, arthritis,
osteomyelitis and urinary tract infection.
Infections are important cause of neonatal and infant morbidity and mortality as many as 2% of
fetuses are infected in utero also is responsible for 30-50% of total neonatal deaths.
To evaluate the role of C- reactive protein concentration in early diagnosis of neonatal sepsis
and to determine the duration and follow up of treatment.
A cross sectional study was performed in the neonatal intensive care unit (N.I.C.U) at Ibn
Al-Balady hospital in Baghdad governorate. One hundred sixty five neonates less than 30 days
with birth weigh more than 1500 gram suspected clinically to have neonatal sepsis and blood
was drawn for C-reactive protein and blood culture. Also blood was drawn for complete blood
count including WBC and differential count which was of little or no value in the diagnosis.
C- reactive protein was sensitive (62%) (by immunometric test) a method for early diagnosis
and for treatment and follow up of neonatal sepsis.
C- reactive protein was good predictor and sensitive (62%) for diagnosis of neonatal sepsis and
could detect the duration of antibiotic therapy. Hematological profile was not significant in
diagnosis of neonatal sepsis.

Recurrent Pneumonia in Children at a Tertiary–Pediatric Hospital in Baghdad

Iraqi Postgraduate Medical Journal, 2018, Volume 17, Issue 4, Pages 377-383

There are many children suffering from Recurrent Pneumonia (RP). Children with RP may present a
difficult diagnostic challenge.
This study was performed to evaluate the frequency levels and underlying causes of RP in Children
Welfare Teaching Hospital (CWTH)/Medical City/Baghdad.
In this prospective hospital-based cross-sectional study, 107 children admitted with RP in CWTH in
the period from March to July 2014. Children were included in this study if they had at least 2 times
pneumonia per year or three ever in life proved by radiographic confirmation during hospital
admission. Children were classified according to underlying diseases associated with Pneumonia.
Based on the clinical features and the results of the investigations, the underlying disease could be
identified in 92/107 (86%) children. Aspiration pneumonia was diagnosed in 25 (23.4%) children,
followed by congenital heart disease (CHD) in 22(20.6%) children, Asthma in 21 (19.6%), these three
diseases were the most frequent with a relatively small difference between them. TB was reported in
9 (9.3%) children, Cystic fibrosis (CF) in 9(8.3%), Fibrosing alveolitis and immune deficiency were
found in 2 (1.9%) children for each and the least frequent disease was congenital cystic adenomatoid
malformation (CCAM) in one (0.9%) child. On the other hand, 15 (14%) children were reported with
unknown diagnosis at the time of data collection.
Most children with RP had an underlying disease for each, which was demonstrated. Aspiration
syndrome, CHD, and asthma were the most common underlying diseases that result in RP in children.
Early diagnosis is essential to ensure optimal treatment and to minimize irreversible lung damage.