Volume 18, Issue 2, Spring 2019, Page 76-187


Prevalence of Viral Hepatitis B, C, and Human Immunodeficiency Virus among End Stage Renal Disease Patients on Hemodialysis

Iraqi Postgraduate Medical Journal, 2019, Volume 18, Issue 2, Pages 76-86

ABSTRACT:
BACKGROUND:
Viral hepatitis infections are an important cause of morbidity and mortality in patients with end-stage renal disease (ESRD) on hemodialysis (HD), and its prevalence varies considerably among different areas of the world.
OBJECTIVE:
The aim was to investigate the prevalence of the HBV, HCV, and HIV among patients with ESRD on HD in a Hemodialysis Center in Baghdad, and to identify the factors associated with their transmission.
PATIENTS AND METHODS:
A cross-sectional study was carried out in the HD Center in Al-Kindy Teaching Hospital in Baghdad, Iraq. A total of 302 patients with ESRD on HD were enrolled in the period from February to May 2017. They were tested for the presence of hepatitis B surface antigen (HBs Ag), antibodies for hepatitis C virus (anti-HCV), and antibodies for human immunodeficiency virus (Anti-HIV).
RESULTS:
From the 302 patients; the mean age patients was 51.06± 15.15 SD years, 176 (58.27%) were males, and 126 (41.72%) females. Four (1.3%) patients had positive HBs Ag. One (0.3%) male had anti-HIV Ab, and 140 (46.36%) had anti-HCV-Antibodies positive. Male gender, age between 41-60 years, been married, and unemployed patients scored a higher prevalence of anti-HCV positivity. The causes of renal failure in HCV patients were; hypertension in 44 (31.4%), diabetes mellitus in 34 (24.3%), renal diseases (like UTI, AGN, Renal stones) in 21 (15%), congenital renal diseases in 15 (10.7%), and unknown cause in 26 (18.6%). There were highly significant differences in the mean number of blood transfusions and the mean HD duration between HCV and non-HCV groups. There was a significant association between HCV infection and renal failure duration, and a history of surgery. Significant differences were also reported in the mean serum creatinine and hemoglobin levels between HCV and non-HCV groups.
CONCLUSION AND RECOMMENDATIONS:
The prevalence of HBV and HIV infections were low and the prevalence of HCV was high. HCV infection was related to the higher number of blood transfusions, longer duration of renal failure, longer duration of HD, a history of surgery, creatinine and Hemoglobin levels. The study recommends local guidelines emphasizing on blood safety strategies, implementation of infection control practices with regular monitoring.

The Immediate and Intermediate Term Follow Up of Patients with Critical Pulmonary Valve Stenosis after Balloon Valvuloplasty

Iraqi Postgraduate Medical Journal, 2019, Volume 18, Issue 2, Pages 87-95

ABSTRACT:
BACKGROUND:
Balloon pulmonary valvuloplasty (BPV) represents the standard of management for all patients with severe pulmonary valve stenosis (PS) irrespective of their age. Nevertheless , neonates and infants with critical PS represent an emergency and a high risk group that needs to be studied.
OBJECTIVE:
To evaluate results ,complications and follow up of BPV in neonates and infants with critical PS.
PATIENTS AND METHODS:
During the period extending from February 2010 to February 2011, 25 neonates and infant patients with critical PS were subjected to detailed history taking, full clinical examination, resting 12-lead ECG, chest x-ray and transthorasic echocardiography.BPV was attempted in all patients .Full echocardiographic evaluation was done 24 hour after the procedure as well as 3 and 6 months later.
RESULTS:
Twenty five patients with critical PS with a mean age of 32.7 ± 21.9 days were subjected to BPV .Immediately after the procedure , patients had a significant reduction of the right ventricular systolic pressure (RVSP) from a mean of 103.96 ± 24.98 mmHg to a mean of 43.6 ± 13 mmHg . The immediate success rate(defined as the drop in the RVSP to less than or equal to 50% of the baseline measurement) was achieved in 76% of cases . Throughout a follow up period of six months, there was a progressive decline in the pressure gradient (PG) across the PV by Doppler echocardiogram from a mean of 93.3 ± 18.2 mmHg to a mean of 17.4 ± 10.42 mmHg. The oxygen saturation increased from 80 ± 8% to 96 ± 2% . There was a significant increase in the mean PV annulus diameter after balloon dilatation from a mean value of 7.1 ± 1.9 mm to a mean value of 9.3 ± 1.1 mm. The incidence of pulmonary incompetence (PI) significantly increased immediately after BPV to 66.6% followed by a progressive decline over a 6 months period of follow up to 19% . Over the same period of follow up , there was a significant decrease in the incidence of tricuspid regurgitation (TR) from 32% to 9.5% . There were complications including three deaths (12%).One patient was referred to surgery (4%) and two had developed significant re stenosis (8%) .
CONCLUSION:
BPV is safe and effective procedure to relieve critical PS in neonates and infants that should be done as early as possible .

Preoperative Predictors of Outcome Post Lumbar Discectomy

Iraqi Postgraduate Medical Journal, 2019, Volume 18, Issue 2, Pages 96-106

ABSTRACT:
BACKGROUND:
Deciding the prognostic factors that influence the surgical result would be useful for judgment planning. Other than that, recognizing the prognostic factors that foresee the clinical course of remaining dissensions may be essential for assist advancement of viable strategies for treatment, particularly when these prognostic components can be changed.
OBJECTIVE:
The aim of the study was to determine the positive, negative and unrelated predictors of surgical outcome for patients undergo lumbar discectomy.
PATIENTS AND METHODS:
A prospective cohort study including consecutive series of 102 patients, who had undergone surgical management for herniated lumbar discs at the private nursing home hospital in Baghdad, Iraq, between March 2017 and March 2018, were included in this study. The patient population consisted of 45 females and 57 males, ranging in age from 22 years to 65 years at the time of initial diagnosis with a mean age of 44.7 ± 7.9 years. A full available investigation had done including X-rays and M.R.I.
RESULTS:
Male: female ratio equals 1.3:1, 69.6% are employed, 58% with no or basic educational level and 70% of patients were smokers. Average duration of low back pain and radicular pain were 8 and 4 months respectively. In 89% there was disc space height loss, the level lumbar disc herniation was at L4-L5 in 45% while at L5-S1 in 41%. Mean Oswestry disability index (ODI) was 63 and 27.7 respectively both pre and postoperatively. Mean Visual Analogue Score (VAS) for low back pain for pre (4.8) and postoperative period (1.8) while mean VAS for radicular pain preoperatively was 4.3 and postoperatively 1.4. The mean MCID – TUG test was 4.3 seconds.
DISCUSSION:
Comparisons have been made with other studies regarding preoperative predictor factors and the lumbar discectomy surgical outcome.
CONCLUSION:
- The good surgical outcome can be predicted with MCID ~ TUG test ≥ 3.4 seconds, TUG < 14 seconds, L5 - S1 disc level, annular defects, employed status, higher education, preserve disc height, BMI < 25, short duration of < 3 months of preoperative radicular pain. Lower VAS low back pain preoperatively of < 4 will have better postoperative results regarding back pain.
- Worse outcome predictors include male gender, tall patients >180 cm, low level of education, unemployment, higher preoperative ODI ≥ 40%, positive tension root signs, > 50 % disc height loss, preoperative motor deficits, prolonged duration of preoperative low back pain (> 3 months) and higher preoperative VAS score radicular pain (≥ 4). Also to mention that higher preoperative VAS low back pain (≥ 4) will be translated to more postoperative radicular pain.
- Factors that have no effect on outcome include age and smoking.
KEYWORDS: Outcome, predictor factors, lumbar discectomy.

Effect of Gamma Knife Radiosurgery in Meningioma

Iraqi Postgraduate Medical Journal, 2019, Volume 18, Issue 2, Pages 107-114

ABSTRACT:
BACKGROUND:
Meningioma is a common disease affects middle age patients especially females. Surgery is the first choice of treatment, gamma knife usually is a treatment for residual tumor or sometimes initially when surgery is risky.
OBJECTIVE:
To evaluate the short time effectiveness of gamma knife in treatment of meningioma with associated complications including necrosis and edema and assessing factors that favor success PATIENTS AND METHODS:
A retrospective study from April 2017 to October 2017 in Neurosciences hospital of 35 patients, 25 female and 10 male, age range 36-70 years, brain MRI done before and 6 months after gamma knife, patients evaluated regarding type of meningioma, number of shots, edema and radiation dose
RESULTS:
The most common types were parasagittal and convexity meningioma, size of tumors ranged from 10mm to 57mm most tumors were 20-29mm, post-gamma necrosis was higher in non-basal meningioma (76.5%) than basal meningioma (44.4%). Necrosis appeared 100% when using > 18 Grey. The necrosis decreased when using doses 14-16 Grey and 10-12 Grey. Non-basal meningioma showed high edema (47.1%) while basal showed less edema (38.9%), higher doses of radiation associated with more edema. Headache improved post-gamma.
CONCLUSIONS:
Gamma knife is effective and safe option to treat meningioma when surgery is risky, the tumor necrosis is highest in non-basal meningioma and when the dose above 14 grey and the peritumoral edema was highest also in non-basal meningioma and when the dose of radiation above 18 grey.
KEYWORDS: Meningioma, Gamma knife surgery, Stereotactic radiosurgery

The Knowledge of Elderly Clients Attending Geriatric Clinic at Baghdad Teaching Hospital towards the Prevention of Fall

Iraqi Postgraduate Medical Journal, 2019, Volume 18, Issue 2, Pages 115-122

ABSTRACT:
BACKGROUND:
Falls among the geriatric population, cause frequent morbidity and mortality
OBJECTIVE:
To evaluate the Knowledge of elderly clients toward the prevention of fall.
PATIENTS AND METHODS:
A cross sectional study was carried out on a total of 403 elderly ,aged≥60 years attending geriatric clinic at Baghdad teaching hospital during the period from 6th of February to 26th of June 2017,collection of data by direct interview.
RESULTS:
This study included 403 elderly with mean age (68.5±5.4SD) years, (95%)of them had chronic diseases and (94%) currently on medications,(73.2%) had fall attack previously and (39.3%) of them with ≥5 times attacks of fall. About (52.6%), (60.3%) and (30.8%) had correct knowledge towards risk factors, cause of fall and fall prevention respectively,(56.3%) do not know the intervention to preventfall in elderly while (25.8%) believed that the fall prevention health educationis the best intervention. About two third (65.5%) believed that no action could protect them.
CONCLUSION:
The study concluded that the participants had low level of knowledge and practice about fall prevention in elderly.

Pattern of Serum Irisin Hormone in Patients with Thyroid Dysfunction

Iraqi Postgraduate Medical Journal, 2019, Volume 18, Issue 2, Pages 123-132

ABSTRACT:
BACKGROUND:
The protein irisin is one of the most recent hormone-like adipo-myokine, which have an important role in controlling energy metabolism in humans. Both thyroid hormones & irisin have some similarities in regulation of body metabolism, such as thermogenesis & energy balance.
OBJECTIVE:
To assess the association & correlation between serum irisin & thyroid hormones in hypothyroid & hyperthyroid patients as compared to normal individuals.
PATIENTS AND METHODS:
This work is a cross-sectional case-control study, involving 150 participants (50 with primary hypothyroidism, 50 with primary hyperthyroidism, & 50 healthy controls). Withdrawal of serum samples were done to estimate irisin level, triiodothyronine(T3), tetraiodothyronine (T4), thyroid stimulating hormone(TSH), glucose, lipid profile, urea, & creatinine.
RESULTS:
In hypothyroid group the mean irisin concentration was higher than hyperthyroid & normal controls (P=0.05). A significant positive correlation between irisin & TSH levels was identified (r: 0.201, p = 0.014). The correlation of irisin with T3 was negative (r : -0.180, p = 0.027) while with T4 was highly negative (r : -0.212, p= 0.009).
CONCLUSIONS:
The mean serum level of irisin was higher in hypothyroid patients than healthy controls, while the hyperthyroid patients had the lowest levels. Serum irisin was correlated positively with TSH & negatively with T3 & T4.
KEYWORDS: Adipokines; Endocrine; Hypothyroidism; Hyperthyroidism

Correlation of Optic Nerve Sheath Diameter and Optic Sheath to Optic Nerve Diameter Ratio with Lumbar puncture opening Pressure in Pseudotumor Cerebri Syndrome

Iraqi Postgraduate Medical Journal, 2019, Volume 18, Issue 2, Pages 133-140

ABSTRACT:
BACKGROUND:
In cases of Pseudotumor Cerebri Syndrome, increased intracranial pressure is transmitted to the subarachnoid space surrounding the optic nerve, causing increase in the optic nerve sheath diameter and Optic nerve sheath to optic nerve diameter ratio. Magnetic Resonance Imaging is the image of choice in Pseudotumor Cerebri Syndrome and it can be used to measure precisely the diameter of optic nerve and its surrounding sheath.
OBJECTIVE:
To evaluate the diagnostic value of optic nerve sheath diameter, Optic nerve sheath to optic nerve diameter ratio, and their correlation with lumbar puncture opening pressure in Pseudotumor Cerebri Syndrome
PATIENTS AND METHODS:
In a prospective blinded correlational diagnostic yield study, a 3 tesla Magnetic Resonance Imaging data of 34 patients with Pseudotumor Cerebri Syndrome, and 34 normal control were collected and analyzed, optic nerve sheath diameter and optic nerve diameter were measured in an axis perpendicular to the optic nerve, 3 mm behind the globe.
RESULTS:
Both optic nerve sheath diameter and Optic nerve sheath to optic nerve diameter ratio were found to be significantly larger in patient's group compared to control. Lumbar puncture opening pressure in patient was measured and found to be correlated significantly with both optic nerve sheath diameter and optic nerve sheath to optic nerve diameter (r 0.79-p 0.000, r 0.45-p 0.007 respectively). The optic nerve sheath diameter in patients were 5.75 ±0.6 mm, cut-off value for diagnoses of Pseudotumor Cerebri Syndrome was 4.9 mm with a sensitivity of 91% and specificity of 88%. The cut-off value of optic nerve sheath to optic nerve diameter ratio was 2.39 with a sensitivity of 100% and specificity of 97%.
CONCLUSION:
Magnetic Resonance Imaging -determined (optic nerve sheath diameter & optic nerve sheath to optic nerve diameter ratio) have excellent diagnostic value in Pseudotumor Cerebri Syndrome, and they were correlated significantly with LP opening pressure.
KEYWORDS: MRI, Optic nerve, Pseudotumor Cerebri Syndrome

Pediatric Consultations to the Center of Dermatology and Venereology, Medical City Teaching Hospital During the Period from February 2017 till April 2018

Iraqi Postgraduate Medical Journal, 2019, Volume 18, Issue 2, Pages 141-147

ABSTRACT:
BACKGROUND:
Skin Problems are very common in children attending pediatric hospitals, there are few studies of pediatric consultations to dermatological clinics and none from Iraq.
OBJECTIVE:
to describe the pediatric consultations attending the Center of Dermatology, Medical City Teaching Hospital.
PATIENTS AND METHODS:
This is a descriptive cross-sectional study. It was conducted at the Center of Dermatology and Venereology, Medical City Teaching Hospital between February 2017 and April 2018. All consultations from Children Welfare Teaching Hospital were included. Consultations were made for either inpatients or patients consulting the outpatient clinic of that hospital. Detailed information including gender, age, site of lesion, duration, symptoms, past medical history, drug history, family history, vaccination and developmental history were recorded. The requesting department for inpatient consultations was also recorded. Any diagnostic procedure performed at the dermatology center was also recorded.
RESULTS:
A total of 207 pediatric consultations were referred to the Center of Dermatology during the study period of 14 months. One hundred twenty seven consultations were outpatient consultations, and 80 were for hospitalized children. Male to female ratio was (1.3:1) in outpatient consultations and (1.2:1) for inpatient consultations. The largest number of outpatients consultations 48 patients (37.8%) were children aged (6-12 years), and 29 patients (36.3%) of hospitalized patients were in preschool age (1-5years). Referred children with pure dermatological compliant constituted the majority of the outpatient consultations (77.2%) while they constituted (26.3%) of the inpatient consultations. The other reason for referral was dermatological manifestations that were related to the general illness, this constituted (15%) of the outpatient consultations and (30%) of the inpatient consultations. About (7.9%) of outpatient consultations and (43.%) inpatient consultations were referred for skin diseases unrelated to their systemic illness. The largest number of consultations came from the general pediatric department (30%), followed by hematology and oncology department(21.25%). Biopsy was performed in (3.9%) of the outpatient consultations and (10%) of the inpatient consultations. Infectious skin diseases were the most frequent established diagnosis in both outpatient and inpatient consultations (37% and 38.75% respectively), Drug eruptions were the second most common established diagnosis in the inpatient consultations (8.75%), while papulosquamus eruptions were the second common diagnosis in the outpatient consultations (16.5%). Genetic diseases were seen in (6.3%) of outpatient consultations and (8.75%) of inpatient consultations.
CONCLUSION AND RECOMMENDATIONS:
Pediatric consultations constituted an important part of the dermatologist work. This is the first study of pediatric consultations to a department of dermatology in Iraq. Dermatological training is recommended for pediatricians so that they can deal with simple dermatological problems. Pediatric dermatology is a emergent and important subspecialty in dermatology.
KEYWORDS: Pediatric, consultation, Dermatology, Center

Assessment of Tubal Patency by Sonohystrography in Infertile Women

Iraqi Postgraduate Medical Journal, 2019, Volume 18, Issue 2, Pages 154-160

ABSTRACT:
BACKGROUND:
Tubal problem is one of the causes of infertility in infertile couples. For that, evaluation of fallopian tubes forms an important part of evaluation in infertile woman.
OBJECTIVE:
To assess the diagnostic accuracy of Sonohysterography (SHG) in comparison with hysterosalpingography (HSG) in infertile women.
PATIENTS AND METHODS:
this cross sectional study included 50 women, 37women with primary infertility and 13women with secondary infertility. The study was conducted in Al-Imamian Al-Kadhimian medical city/Baghdad/Iraq from 1st of October 2017 to 30th of July 2018. All underwent clinical and physical examination. This was followed by Sonohysterography on day 7th or 8th of menstrual cycle and Hysterosalpingography on the same day.
RESULTS:
Fifty infertile women were included in this study with mean age of 27.9±5.9 years. Mean infertility duration of studied women was 3.6±2.4 years; 68% (N=34) of infertile women had duration of less than 5 years and 32% (N=16) of them had duration of 5 years and more. The history of previous surgical operation was detected in 28% (N=14) of infertile women. The final diagnosis of hysterosalpingography (SHG) revealed that 89% (N=89) patent fallopian tubes and 11% (N=11) obstructed tubes. The final hysterosalpingography (HSG) revealed that 85% (N=85) patent fallopian tubes and 15% (N=15) obstructed tubes. No significant difference between women with patent and obstructed fallopian tube by SHG regarding history of parity (p=0.6), abortion (p=0.7), type of infertility (p=0.1), infertility duration (p=0.6), history of previous operation (p=0.5) and history of previous diagnostic intervention (p=0.6). Sonohysterography (SSG) has 100 % sensitivity and 60 % specificity in comparison to hysterosalpingography (HSG). Analysis of the raw data gave positive predictive value of 95.7% and negative predictive value of 100 %. From the results of this study it clear that there is no statistically significant difference (p = 0.001) between the results of the two methods (SSG and HSG) with an accuracy of 96%.
CONCLUSION:
Sonohysterography has higher sensitivity and good specificity and is lesser invasive. It can be used primarily to assess tubal condition in infertile women.
KEYWORDS: Sonohysterography (SHG), infertile women

Immunohistochemical Expression of Cyclin D1 in Urothelial Carcinoma of Urinary Bladder

Iraqi Postgraduate Medical Journal, 2019, Volume 18, Issue 2, Pages 161-168

ABSTRACT:
BACKGROUND:
Transitional cell carcinoma is the most common cancer in urinary bladder. Bladder carcinoma is the 5th from the most common ten cancersin Iraq, It is the 2nd in males and the 10th in females according to Iraqi Cancer Registry. It is the 4th most common cancer in inmales, 8thin females in the USA.
OBJECTIVE:
To evaluate the immunohistochemical expression of cyclin D1 in transitional cell carcinoma of urinary bladder and its role in predicting type, grade, stage, progression and prognosis of the tumor.
MATERIALS AND METHODS:
This is retrospective study of 40 bladder biopsy (formalin fixed ,paraffin embedded). Two sections of 5 μmthickness were taken from each block, the first was stained with H&E, the 2nd was stained immunohistochemically for cyclin D1.
RESULTS:
The majority of cases were high grade papillary urothelial carcinoma stage T1 .Nine of cases were score 0 of 4 , six of cases were score 1, three of cases were score 2 ,eleven of cases were score 3,eleven of cases were score 4.
CONCLUSION:
There was no statistical significant correlation between cyclinD1 immunohistochemical expression and tumor stage, grade and type.
KEYWORDS: cyclinD1 expression, Transitional cell carcinoma

Evaluation of serum Predictive Markers for Placental Inflammatory Response in Preterm delivery

Iraqi Postgraduate Medical Journal, 2019, Volume 18, Issue 2, Pages 161-168

ABSTRACT:
BACKGROUND:
Placental inflammation represents a crucial pathogenic process responsible for preterm labor& neonatal complications for example low birth weight, premature delivery, cerebral palsy ,sepsis , and neonatal death. Being able to predict preterm labor with histological chorioamnionitis is important. However, there may be an urgent requirement for sensitive and noninvasive markers to predict inflammatory response of Placenta
OBJECTIVE:
To assess the usefulness of inflammatory markers in maternal serum to predict placental inflammation in patients with threatening premature Labor.
PATIENTS AND METHODS:
A prospective study conducted in the department of Obstetrics and Gynecology of Al-Yermook Teaching Hospital for a period of one year from 1st of May 2015 to the 30th of April 2016 The study included 74 pregnant women presented with preterm labour or preterm prelabour rupture of membrane. Measurement of differential counts of leukocyte, C-reactive protein in maternal serum and histological examination of placenta post delivery done to identify placental inflammatory status. Comparison of neutrophil to lymphocyte ratio is done in patients with no inflammation of placenta and those with placental inflammatory response
RESULTS:
The level of neutrophil to lymphocyte ratio in patients with inflammatory response in the mother and/ or the fetus (8.3±5.4), (11.8±9.2) respectively were significantly higher than those with no placental inflammation (5.2±3.1). It showed higher Predictive accuracy; with 77.9% specificity, 71.4% sensitivity 81.5% positive predictive value, and 65.8% negative predictive value for prediction of PIR. Regarding CRP the results show significant relationships among women with no PIR and those with MIR alone or MIR with FIR (P values = 0.011, 0.005, 0.003) respectively. Also revealed that women with inflammatory response in the mother or both mother and fetus who had high levels of neutrophil to lymphocyte ratio had a shorter admission to delivery interval (mean=2.6 days, 3.2±7.5) than those with no placental inflammation (mean=4.1days).
CONCLUSION:
A placental inflammatory change may be simply and quickly verified at low expense by measuring the NLR .The Maternal blood NLR can be considered a useful, quick, noninvasive prenatal method to predict placental inflammatory response and for diagnosis of HCA in pregnant women presented with preterm labor.
KEYWORDS: preterm delivery, serum inflammatory markers, placental inflammatory response

The Prevalence of Gall Bladder Diseases during Pregnancy in Baghdad Teaching Hospital

Iraqi Postgraduate Medical Journal, 2019, Volume 18, Issue 2, Pages 169-174

ABSTRACT:
BACKGROUND:
Gallbladder disease,defined as biliary sludge and stones, is a significant cause of maternal morbidity during pregnancy. Gallbladder disease has a higher incidence in women than in men and is particularly high in multigravida women. Pregnancy is considered to be one of the major risk factor for cholesterol cholelithiasis.
OBJECTIVE:
To estimate the prevalence and determinants of gallbladder diseases in women during pregnancy in Baghdad Teaching Hospital.
PATIENTS AND METHODS:
Cross sectional study was carried out on total 500 pregnant women attending Obstetrical and Gynecological outpatient clinic in Baghdad Teaching Hospital using a convenient sampling technique, during the period from 7th of January to 18th of April 2016. A designed questionnaire was prepared for this study and information was taken by direct interview with pregnant women. Ultrasound was done and women with cholecystectomy were excluded.
RESULTS:
Out of 500 pregnant studied the overall prevalence of gallbladder disease was 10.8%. older age (>35 years) (27.5%), higher parity (39.3%), advancing gestational age (third trimester 16.6%), previous use of contraceptive pills (29.9%), diabetic (30%) and a positive family history (90.9%) were factors significantly associated with gallbladder disease. Most of pregnant with gallbladder disease were asymptomatic (66.7%).
CONCLUSION:
There is a risk of GBD in pregnancy, mostly asymptomatic. This risk might be increased with advanced maternal age, increased parity and gestational age, OCP use, DM, previous history of GBD and positive family history.
KEYWORDS: Pregnancy, gallbladder diseases, cholelithiasis

Mothers’ Thoughts, Beliefs, and Habits in Breastfeeding in Baghdad

Iraqi Postgraduate Medical Journal, 2019, Volume 18, Issue 2, Pages 175-181

ABSTRACT:
BACKGROUND:
Mothers should breastfeed their children exclusively for the first six months of their children's life, if they really want to protect their children from malnutrition, diseases, obesity and its complications
OBJECTIVE:
is to assess breastfeeding knowledge, attitude and practice (KAP) among mothers attending outpatient clinic in Fatema Alzahra baby friendly hospital.
METHODS:
A cross-sectional study from 1st of January 2018 to 15th of November 2018, among mothers attending outpatient clinic in Fatema Alzahra hospital. Mothers who had one child aged two years or older at the time of the study was evaluated for their KAP in breastfeeding using direct questionnaire, which contained socio-demographic characteristics of mothers like age, educational level, number of children, mode of delivery, and employment. The questionnaire also contained questions regarding their knowledge, attitude and practices of lactation based on their customs of breastfeeding in the last child.
RESULTS:
Three hundred mothers enrolled in the study, 135 (45%) of them were 20 -30 years of age, 162(54%) finish the primary school, 60(20%) of them finish the high school, 237 (79%) were unemployed, 186(62%) of mothers had normal vaginal delivery, 288(96%) of mothers know that breastfeeding has benefit for children. Only seventy two (24%) of the mothers know about the exclusive breastfeeding (EBF), All of the mothers know that breastfeeding is better for their children, but 180(60%) of them know that breastfeeding prevent disease in children. And 42(14%) mothers know that breast milk is easy to digestion.
CONCLUSION:
Breastfeeding initiation rate was high but the EBF rate at 6th month of life was low. We found that there was a deficiency in mother`s knowledge about exclusive breastfeeding, and in dealing with breast engorgement and nipple crack during early days of breastfeeding. There was a gap in mother’s practice of breast milk extraction.
KEYWORDS: breastfeeding, exclusive breastfeeding, baby friendly hospital

Outcome of Hemolytic Uremic Syndrome in Iraqi Children a Single Centre Experience in Baghdad

Iraqi Postgraduate Medical Journal, 2019, Volume 18, Issue 2, Pages 182-187

ABSTRACT:
BACKGROUND:
Hemolytic uremic syndrome (HUS) is important cause of acute kidney injury (AKI) and chronic kidney disease (CKD) in children. Proposed prognostic features are controversial.
OBJECTIVE:
Our objective was to study the characteristics of HUS and determine short-term outcome and risk factors for prognosis in children followed in a single center in Baghdad city.
PATIENTS AND METHODS:
We reviewed, retrospectively, the records of children with HUS seen at child welfare Teaching hospital, Baghdad( April2015- April 2017and studied outcome and some prognostic risk factors.
RESULTS:
Thirty-three children with HUS were recorded; 40% had diarrhoea positive (D+) and 60% diarrhoea negative (D−) HUS. The mean age was 47.8 40.4 months and males were 63.6%. At the acute phase seizures and hypertension were present in 33.5%, and 66.7% respectively. Severe anaemia, thrombocytopenia, and leukocytosis were present in 87.9%, 96.6%, and 27.2% respectively. Clinical and laboratory features were not significantly different in D+ and D− cases (P > 0.05 for all parameters). Dialysis was undertaken forall patients. Demographic, clinical and laboratory features were not significant risk factors for adverseoutcome. At short-term follow up (mean period ± SD of 18.54 ± 13.21 months), 42.2% had complete renal recovery, 35.4chronic kidney disease, and 24.2% died.
CONCLUSION:
In spite of institution of dialysisand supportive therapy for all patients, our data showed less favorable outcome of HUS.
KEYWORDS: Children, Hemolytic uremic syndrome, Outcome