Table of content

Iraqi Academic Scientific Journal

المجلة العراقية للاختصاصات الطبية

ISSN: 16088360
Publisher: The Iraqi Borad for Medical Specialization
Faculty:
Language: English

This journal is Open Access

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Table of content: 2016 volume:15 issue:3

Article
Prevalence of CT Scan Findings in Patient with Traumatic Brain Injury with Respect to Glasgow Coma Scale

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ABSTRACT: BACKGROUND: Traumatic brain injury (TBI) contribute to a significant mortality and substantial morbidity. CT is essential for identifying lesions requiring urgent intervention & those that require observation and non surgical management . OBJECTIVE: To assess the prevalence of CT findings with respect to the severity of TBI & to find out the relation between the age of the patient & the severity of TBI. PATIENTS AND METHODS: 100 patients with TBI evaluated by brain CT. All age groups with Glasgow coma scale (GCS) of less than 15 were included.The abnormal CT findings were evaluated & recorded. The findings were further correlated with the patient`s age & the GCS score RESULTS: Eighty percent of the cases had mild TBI, 6% had moderate TBI and 14% had severe TBI. Ninety three percent had closed type of injury . Twenty four percent of the patients had normal CT scan , all of them had mild TBI . The most common CT findings in mild TBI cases were subgalial haematoma(SGH) & calvarial skull fracture, with minority of cases had cerebral contusion , fracture base of skull , diffuse cerebral oedema & intracranial haemorrhage . Two third of patients with moderate TBI had subarachnoid haemorrhage(SAH) & cerebral contusion, 50% had diffuse cerebral oedema, calvarial skull fracture,& 1/3 had Subdural haematoma & fracture base of skull. More than half of patients with severe TBI had calvarial skull fracture, fracture base of skull, cerebral contusion, SAH, with lower prevalence of diffuse cerebral oedema,and intracranial haemorrhage. CONCLUSION: The lower the GCS score, the more significant CT findings,predominantly fracture base of skull, subarachnoid haemorrhage and diffuse cerebral oedema. KEY WORDS: traumatic brain injury, computed tomography, glasgow coma scale.


Article
The Value of Diffusion Weighted Magnetic Resonance Imaging 3 Tesla in Detection and Staging of Bladder Carcinoma

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ABSTRACT: BACK GROUND: To evaluate the value of diffusion weighted magnetic resonance imaging (DWMRI) in detection and T- staging of bladder carcinoma and correlation with histopathological staging. PATIENTS AND METHODS: An analytic prospective study was conducted at the MRI units of Al-yarmook teaching hospital in the period from January of 2015 to December 2015, 42patients (36male and 6 female) presented with hematuria (40 patients ) and 2 patients presented with pelvic pain were enrolled prospectively ,they underwent conventional magnetic imaging(MRI) and diffusion weighted MRI using 3 tesla MR units (Achieva ; Philips medical systems, the Netherlands). Diffusion weighted images were obtained using a single shot echo planar imaging sequence EPI with b value 0,500sec/mm2.ADC value map was reconstructed and mean ADC value were measured in 42 patients .and histological examination was done to all patients. RESULTS: Correlation between standard MR staging of bladder carcinoma and histopathological results revealed that 17 patients (40%) had the same T -staging while 17 patients(40%) over staged. DWI and ADC values were able to declare the cause of overstating by discrimination between tumoral tissue and peritumoral inflammation. Statistically significant difference is found between ADC value of bladder tumor and those of urine. CONCLUSION: Diffusion weighted MR imaging at 3 tesla is new and good imaging modalities for detection and staging of bladder carcinoma, , without using contrast media, so can used in patient with renal impairment or contrast media allergy


Article
The Value of Diffusion Weighted Magnetic Resonance Imaging in Differentiating Atypical Vertebral Haemangiomas from Metastatic Lesions

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ABSTRACT: BACKGROUND: Atypical vertebral hemangioma and metastatic spinal lesions share many MRI signal intensity and appearance in common ,thats why differentiation between them is crucial. For two decades, diffusion-weighted imaging (DWI) has been applied to the evaluation of intracranial diseases, but DWI technical advancement make it possible to apply for assessment of extra cranial sites, including vertebral column. OBJECTIVE: The goal of our study is to assess the value of diffusion weighted MRI imaging in differentiating vertebral atypical hemangiomas from metastatic lesions. PATIENTS AND METHODS: A prospective cross-sectional study was employed at AL-Imammain AL-Khadymain Medical city in Baghdad health directorate, (43)patients with total (65) vertebral lesions grouped into three groups Group(A) 10 patients (23.2%)with total (15) lesions of vertebral typical hemangiomas, Group(B) 13 patients (30.3%) with total ( 13) lesions of vertebral atypical hemangiomas and Group (C) 20 patients(46.5%) with total ( 37) lesions of spinal vertebral metastases . MRI was done for all patients (including T1, T2, T1 fat suppression with IV contrast administration (when needed) and DWI). Complementary non contrast CT was also done. RESULTS: Total study sample were (43) patients with total (65) lesions, with (29/43) females and (14/43) males with male to female ratio of (1:2), their age range from (28-75 years) and their mean age was (54.2+ 10.1 years). Atypical hemangioma and malignant lesions were generally low signal in T1 and high or intermediate signal in T2 WI. Restricted diffusion and low ADC values were seen in atypical hemangioma compared with metastasis with mean ADC value were (1.426+0.231.6x10 -3mm2/s and 0.6182+ 0.137x10-3mm2/s respectively). Complementary CT confirmed the lytic or sclerotic nature of malignant lesions while in haemangiomas, it showed their characteristic striated (polka dot) appearance. CONCLUSION: Diffusion weighted Magnetic Resonance Imaging is a valuable tool in differentiation of atypical hemangioma and metastasis of spine with high sensitivity and specificity with the aid of ADC values calculated from the maps obtained by DWI. KEYWORDS: diffusion weighted magnetic resonance imaging, atypical haemangiomas, metastasis.


Article
Magnetic Resonance Urography Plus, Abdominal Radiograph in Acute Calculus Ureteric Obstruction

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ABSTRACT: BACKGROUND: About 2-3% of the population experiences an attack of acute ureteric colic during their lifetime, and 67%-95% caused by ureteric calculi. Magnetic Resonance Imaging (MRI) can rapidly demonstrate both the presence and the level of ureteric obstruction.] OBJECTIVE: To study the diagnostic accuracy of MRI (alone and in combination with plain abdominal radiograph) in detecting acute ureteric calculus obstruction compared to unenhanced Computed Tomography (CT). PATIENTS AND METHODS: A cross sectional comparative study was conducted on a total of 48 patients suspected to have acute ureteric calculus obstruction, at the radiology department in AL-Imamain AL-Kadhemain Medical city, during the period from March to November 2015. Patients underwent MRU then unenhanced abdominal CT, and plain abdominal radiograph. The sensitivity, specificity, positive predictive value, negative predictive value and overall accuracy of MRU findings were obtained in comparison to CT findings regarding ureteric dilatation and its level, stone detection and perirenal fluid and fat stranding. RESULTS: Of the 48 patients imaged with both CT and MRU, 4 of them showed no evidence of obstruction on any imaging modality, and 44 of them had a final diagnosis of acute calculus ureteric obstruction. Regarding the detection of ureteric dilatation in MRU, in comparison to CT, the sensitivity = 100%, specificity = 80%, the positive predictive value (97.72%), the negative predicative value (100%), and overall accuracy (97.9%). The detection of ureteric stone by MRU (when combined with plain abdominal radiograph) in comparison to CT, the sensitivity = 95.45%, specificity = 100%, the positive predictive value (100%), the negative predicative value (66.66%), and over all accuracy (95.8%). The detection of peri-renal fluid by MRU in comparison to CT, the sensitivity = 96.66%, specificity = 72.22%, positive predictive value (85.29%), the negative predicative value (92.85%), and overall accuracy (87.5%). CONCLUSION: MRI when combined with plain abdominal radiograph was nearly as accurate as unenhanced spiral CT in acute calculus ureteric obstruction. Also the MRI was more sensitive than unenhanced CT in detecting the secondary signs of upper urinary tract obstruction, as perirenal fluid.


Article
Acromioclavicular Joint Dislocation Clinical , Radiological and Therapeutic Study

Authors: Basim Sabah Abdullah
Pages: 288-295
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ABSTRACT: BACKGROUND: The ACJ is the most peripheral joint component of the upper extremity appendicular linkage . All significant mechanical forces applied directly to or through the upper extremity are ultimately transmitted across that linkage . OBJECTIVE: We try to see the outcome of both conservative and operative treatment on dislocated acromioclavicular joint {ACJ} METHODS: From September 2005 – June 2008, 14 patients with ACJ dislocation were seen at AL-Hay hospital wasset , the patient age, sex , occupation, injured side and manner of injury were recorded. The patients were chosen randomly to operative or conservative treatment according to type of injury and will of patients and studied in form of indication tactile approaches to treatment and results were described and discussed in some details. RESULTS: Conservatively treated patient regained movement significantly more quickly and fully returned to work earlier and had fewer unsatisfactory results than having early operation. however for severe dislocation with coracolavicullar displacement of 2cm and more, early surgery produced better results. CONCLUSION: Conservative management is best for most acute dislocation but younger patients with severe displacement may benefit from early reduction and stabilization. .


Article
The Validity of Pulse Wave Tissue Doppler Imaging in Predicting Elevated left Ventricular end Diastolic Pressure in Patients with Coronary Artery Disease

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ABSTRACT: BACKGROUND: Elevated left ventricular filling pressures are the main physiological consequence of diastolic dysfunction and carry a prognostic significance in different cardiovascular diseases including coronary artery diseases, and cardiomyopathies. Filling pressures are considered elevated when the mean pulmonary capillary wedge pressure is >12mmHg or when the left ventricular end diastolic pressure is ≥ 16 mm Hg. a reliable noninvasive method for the estimation of LVEDP is needed. OBJECTIVE: The aim of this study was to evaluate the correlation between the Tissue Doppler Imaging derived E/é ratio, and Left Ventricular End Diastolic Pressure (measured during left ventricular catheterization) in patients with significant Coronary artery Disease, and to identify the optimal cutoff value of the E/é ratio to predict elevated LVEDP. PATIENTS AND METHODS: This study included 87 patients scheduled for elective coronary angiography at Ibn-Albitar Hospital catheterization laboratory between December 2012 and April 2013.Transthoracic echocardiography was performed to all patients within 2 hours before left heart catheterization, using Philips echocardiography system & S5-1 probe. Mitral valve inflow velocities were assessed by Pulsed-wave Doppler performed in the apical 4-chamber view. Ejection fraction (EF) was measured with biplane Simpson's method from the apical 4-chamber view. PW TDI was performed in the apical 4-chamber view to measure mitral annular velocities from the medial and lateral mitral annuli. RESULTS: The mitral inflow velocities (E, and A) were not correlated to LVEDP while the E/A ratio had a weak positive and the DT of the E wave had a weak negative correlations with LVEDP. E/é ratio showed intermediate to good positive correlation with LVEDP especially those derived from the medial mitral annulus. The correlation between E/é ratio and LVEDP was similar in the patients with or without significant CAD. The ROC curve showed that the cutoff point of E/ é ratio for predicting LVEDP higher than 15mm Hg was from medial mitral annulus > 15 (sensitivity 77.5 % , specificity 84.6%; P<0.001) and from lateral mitral annulus >10 (sensitivity 79 %, specificity 80.3 %; P < 0.001). On subgroup classification according to EFs, the E/é medial showed significant but weaker correlation with LVEDP in patients with EF ≥ 50%, as compared to patients with EF < 50 %. E/é lateral and E/é average had poor correlation with LVEDP in patients with EF ≥ 50 %, while they have intermediately significant correlation in patients with EF < 50%. CONCLUSION: The TDI derived E/é ratio is better than mitral inflow doppler velocities and intervals for predicting elevated LVEDP in patients with or without significant CAD, especially in patients with reduced EF. The E/é medial > 15 and E/é lateral > 10, predict LVEDP > 15 mm Hg with good sensitivity and specificity.

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Article
Ministernotomy in Off-Pump Coronary Artery Bypass Surgery

Authors: Jabbar Jasim AL-Tai
Pages: 303-307
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ABSTRACT: BACKGROUND: Ministernotomy is a new suergical producer which is decrease invasiveness of suergical treatment coronary arteries insuffecince and there are several advantages over standard poceduer. OBJECTIVE: Patients with isolated lesions of the proximal left anterior descending artery (LAD) have been demonstrated to benefit more from surgical treatment than percutaneous coronary interventions (PCI). However, with the less invasiveness of PCI, the majority of the patients have been referred for this latter procedure. We report here on the inferior ministernotomy approach for the treatment of patients with single LAD lesions, with off-pump anastomosis of the left internal thoracic artery graft. METHOD: Fourteen patients, consecutively operated on using this technique with the LITA graft anastomosed to the LAD, were examined. The mean age of the patients was 56.7 ± 10.1 years. The length of the skin incision varied from 8 to 10 cm and only the distal sternum was split lengthwise. The anastomosis was facilitated with the use of an Octopus-3 stabilizer . RESULTS: All patients had satisfactory postoperative outcomes, the length of postoperative hospital stay ranged from 2 to 6 days (median 3 days). No ECG changes or enzymatic rises were seen in this series. One patient was re-admitted for wound infection. CONCLUSION: The ministernotomy approach allows safe accomplishment of off-pump LAD grafting, providing the long-term benefits of using the LITA. KEY WORDS: ministernatomy,left internal thoracic artery(LITA),off-pump.


Article
Hypomagnesemia During Early Post Renal Transplantation Period

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ABSTRACT: BACKGROUND: In renal transplantation, hypomagnesemia is a frequent disturbance associated with the use of calcineurin inhibitors (Cyclosporine and Tacrolimus) and sirolimus. They may cause obligatory renal loss and decrease transcriptional expression of the Mg transporter in the distal collecting tubule. OBJECTIVE: Evaluation of serum Magnesium in patients during the first four days post renal transplantation and to find any correlation with different variables. PATIENTS AND METHOD: A cross sectional descriptive study was performed at Nephrology and Kidney Transplantation Center- Medical City-Baghdad, Iraq from first of January, 2012 to first of December, 2012. Serum Magnesium was followed in forty patients underwent renal transplantation during the first four days post transplantation. Other variables also was studied to find any correlation with serum Magnesium, include (age, sex, duration dialysis of , calcineurin inhibitors (types and dose) , diabetes mellitus, loop diuretics, urine volume . electrolytes (serum Potassium and s. Calcium) and s.creatinine . RESULT: The mean serum Magnesium was (2.87 ± 0.5 mg/dl ) pre transplantation, on 1st day it was (2.3±0.49) and 4thday (2.31±0.67). The mean Post transplantation serum Magnesium was significantly lower than pre transplantation, (P<0.01). Serum Magnesium had statistically significant direct correlation with serum Potassium and s.creatinine and statistically significant inverse correlation with s. Calcium and urine volume. It was significantly lower in those using loop diuretics at 1st day post-transplant (P=0.039). Tacrolimus was associated with lower serum Magnesium level than cyclosporine. CONCLUSION: Serum Mg post transplantation was significantly lower than pre transplantation level, and sometime may reach to significant hypomagnesemia. This was significantly correlated with S.K , S.Ca, and S Creatinine,


Article
A New Assessment Tool to Predict Stone Free Rates in Ureteroscopic Laser Lithotripsy

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ABSTRACT: BACKGROUND: Holmium: YAG laser lithotripsy shows a high successful rate in fragmentation of ureteric stones , The S.T.O.N.E. Score is a novel assessment tool to predict stone free rate (SFR )in patients undergoing Ureteroscopic Lithotripsy( URS). OBJECTIVE: To develop a user friendly system (S.T.O.N.E. Score) to quantify and describe stone characteristics provided by computed axial tomography scan to predict ureteroscopic lithotripsy outcomes and to evaluate the characteristics that are thought to affect stone free rate. PATIENTS AND METHODS: The S.T.O.N.E. score consists of 5 stone characteristics: (S)ize, (T)opography (location of stone), (O)bstruction, (N)umber of stones present, and (E)valuation of Hounsfield Units. Each component is scored on a 1-3 point scale. The S.T.O.N.E. Score was applied to 50 ureteroscopic procedures performed , patients with anatomical abnormalities such as duplicated ureters, horseshoe kidney, ureteral strictures and renal failure were excluded from the study, postoperatively patient were evaluated by KUB,U/S and CT scan to assess stone free status. RESULTS: The mean patient age was( 37.3± 12.5 )year. 58% were male patients and 42% were female patients. mean stone size was13±3.9. Stones locations: 20(40%)stones were located in the lower ureter,13(26%) in the mid ureter ,17(34%) in the upper ureter. Mean operative time was 26.9±18.3 minutes. The overall SFR was 84%. Results of stone size on percent of stone destruction was very significant (p-value=0.001). Also the results of stone location on percent of stone destruction was very significant (p-value =0.002). whereas hydronephrosis, stone number, stone HU unite were not significant(p-value 0.8, 0.54, 0.61. respectively ). Results of stone score with SFR was significant (p-value 0.003). CONCLUSION: The S.T.O.N.E. Score is a new assessment tool to predict SFR in patients who require URS for the surgical therapy of ureteral disease. The features of S.T.O.N.E. are relevant in predicting SFR with URS. Stone size, location were statistically significant factors in multivariate analysis. The S.T.O.N.E. Score establishes the framework for future analysis of the treatment of urolithiasis .


Article
Prevalence of Latent Tuberculosis in End Stage Renal Disease Patients at Baghdad Teaching Hospital

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ABSTRACT: BACKGROUND: Tuberculosis (TB) is one of the oldest diseases known to affect humans, it caused by infection with Mycobacterium Tuberculosis (MTB). MTB is most commonly transmitted from a patient with infectious pulmonary TB to other person by droplet nuclei. End Stage Renal Disease (ESRD) patients are exposed to a variety of infections, including TB. The standard test for detecting Latent TB infection (LTBI) is tuberculin skin test (TST). OBJECTIVE: Determination the prevalence of latent tuberculosis among end stage renal disease patients in hemodialysis unit in Baghdad teaching hospital, and assessing its correlations with various conditions. METHODS: A stratified random sampling technique was used to select a sample of 71 patients of ESRD in hemodiaylsis unit in Baghdad teaching hospital. The selected patients were interviewed using a structured pretested questionnaire. Two units of PPD (0.1mL) had been injected intradermally to the volar surface of forearm to be seen within 48-72 hours. The test was considered positive if (>=10mm induration) developed. RESULTS: The study showed the rate of tuberculin reactivity among End Stage Renal Disease (ESRD) patients is 28.57%. About 57.14% of patients were male; mean age of patient was 54.34 ± 15.25 years. The major cause of renal impairment were diabetes mellitus (DM) 52.86%, followed by hypertension 15.71%, duration of dialysis more than 6 months was 46.67% . History of contact with active tuberculosis patient was 62.5%. CONCLUSION: Significant relationship between history of contact with active TB patients, duration of dialysis, and age of patients with TST positivity. .


Article
Evaluation of Significance of Prolonged Liquefaction Time of Semen in Hypofertile Men

Authors: Siddeek B Mar'ie
Pages: 328-333
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ABSTRACT: BACKGROUND: Until now most of the references adopt a sixty-minute liquefaction time as a guideline for normality in general semen analysis. During the last twenty years of interest in these patients, we found that there is a correlation between primary hypofertility, prolonged liquefaction time and therefore delayed conception worthy for this study. This study represent a clinical biometric case series on (284) patients consulting an outpatient urology clinic with primary hypofertility during the last ten years in Mosul. OBJECTIVE: To signify the impact of prolonged liquefaction time of semen on fertility potential of primary hypofertile men, including its relation with the delay of conception and other semen parameters. PATIENTS AND METHODS: Married males who are sexually healthy supposed to have healthy partners with no pregnancy who were not using any method of contraception. Patients should give their semen for analysis in the laboratory by masturbation. All patients should have at least two separate samples to be analyzed, with not less than 7 days apart. Collected data included age in years and duration of delayed conception in months. Semen parameters collected were: volume in milliliters (ml), liquefaction time in minutes, concentration (density) in millions/milliliters, motility in percentage, and morphology in percentage. RESULTS: The mean age of people in our sample was 29.7 years, mean volume of semen was 2.9 ml, mean liquefaction time was 26 minutes, the mean sperm density was 32.9 millions/ml, while the mean activity percentage was 31.2%, the mean percentage of the normal sperms was 61.9% and the mean duration of delay in conception was 33.7 months. There was a very highly significant correlation of prolonged liquefaction time with impaired motility, and morphology, and a significant correlation with sperm concentration. Also there was a linear positive relationship between prolonged LT in minutes and delayed conception in months, but it was more prominent in those hypofertile men who failed to conceive for ≥ 36 months. CONCLUSION: The prolonged liquefaction time has a possible role as a cause of delay in conception in hypofertile men, and has a significant relationship to defects in other semen parameters.


Article
Feasibility and Efficacy of Percutaneous Nephrolithotomy, Initial Experience

Authors: Ammar Fadil Abid
Pages: 334-337
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ABSTRACT: BACKGROUND: Renal stone disease is common in Iraqi population and percutaneous nephrolithoyomy present a minimal access for large stone a substitute for traditional open surgery OBJECTIVE: We are presenting our first experience in percutaneous nephrolithotomy )PCNL( in terms of renal access, stone free and to evaluate the other aspects such as the need of auxiliary procedures in a center without prior experience in this field. MATERIALS AND METHODS: We evaluate all the PCNL performed in period of two year. A series of perioperative and post-operative details were recorded. All PCNL were performed in prone position. RESULTS: The first 55 PCNL cases were included in the study. Out of 55 patients, 16 were women and 39 men. Their mean age was 35.5 years (range 11-65) and means stone diameter were 23.5 mm ± 8.9. A successful renal access achieved in 87.3 % (48) cases with stone fragmentation. Procedures were performed over two year Dec.2013-Dec. 2015. Of fifty five patients 4 cases with single functioning kidney, and eleven cases with PCNL on same side of previous scar of pyelolithotomy. Stone free rate was 82%. Co morbidities included 8 hypertensive, 3 diabetics, one systemic lupus erythematosus and two with elevated blood urea. Morbidity and complications following PCNL are dominated by access failure in 12.7 % (n= 7); intraoperative bleeding in 3.6 % (n=2), urinary leakage in one patient, ureteric colic in 5.4 % (n=3) hydrothorax 1.8 % (n=1). None of these patients experienced post-operative bleeding, No mortality CONCLUSION: PCNL can be learned by urologists who do not have the support of an experienced colleague without endangering patient safety.


Article
Clinicopathological Findings of IgA Nephropathy in Children and Adolescents; (Multicentn Study)

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ABSTRACT: BACKGROUND: IgA nephropathy (IgAN) is the most common lesion found to cause primary glomerulonephritis throughout most developed countries of the world. Patients may present at any age, but there is a peak incidence in the second and third decades of life. OBJECTIVE: To study the demographic, clinical and laboratory findings of IgAN patients including children and adolescents. METHODS: The medical records of 30 patients with IgAN were retrospectively reviewed and assessed. Patients enrolled in this study were between 1-18 years old diagnosed as IgAN in the period from January 2010 to the end of December 2012 being treated and followed in the main three centers of treating cases of pediatric nephrology in Baghdad (Al-karama teaching hospital, Central Child Teaching Hospital and Baghdad Medical City) that receive referral cases from all Iraqi governorates. RESULTS: The total number of cases enrolled in this study was 30 patients, with males being 19 and females being 11. The male to female ratio was 1.72:1. Family history of chronic renal disease was found in 10 patients (33%). History of pharyngitis was found in 16 patients (53.3%). Macroscopic hematuria was found in 24 patients (80%), followed by edema in 18 patients (60%), and followed by hypertension in 15 patients (50%). The most common laboratory findings among study group was microscopic hematuria (29 patients, 96.7%), followed by proteinuria in 22 patients (73.3%). Renal biopsy was done for all patients for the diagnosis of IgAN. The distribution of histopathology staging system was: Stage (1) 14 patients, Stage (2) 8 patients, Stage (3) 5 patients, Stage (4) 2 patients and Stage (5) 1 patient (46.7%, 26.7%, 16.7%, 6.7% and 3.3% respectively). The study showed that 24 patients were found to have IgA deposited solely (80%). Out of the total 12 patients presented with hematuria, nine of them (75%) showed stage 1 disease on histopathology study. Two patients were noticed to have other associated autoimmune diseases, one with hepatitis and another with ulcerative colitis. CONCLUSION: Further studies in large number of patients are needed in order to confirm the findings in this study and to establish the best therapeutic choice for IgAN. The need for immunofluorescence examination of the renal biopsies in suspected cases is recommended.


Article
Evaluation of Holmium YAG laser Lithotripsy in Ad-Diwaniyah Teaching Hospital

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ABSTRACT: BACKGROUND: In this study we evaluate the efficacy and safety of ho:yag laser lithotripsy via rigid ureteroscopy as primary treatment modality of ureteric ston in our institute stones parameters,stone free rates and complications rates were evaluated OBJECTIVE: To evaluate holmium YAG (yttrium aluminum garnet) laser lithotripsy via semi rigid ureteroscope in management of ureteric calculi in Ad-Diwaniyah teaching hospital. METHODS: From October 2013 to October 2014, 100 patients with ureteric calculi were included in this study. Calculi were approached with 9.5 Fr. Semi rigid ureteroscope and fragmented with holmium YAG laser system (Stone light AMS). The following parameters were assessed: success, failure, and complications rates in addition to patient’s age, sex, stone size and site. Cases of failure of introduction of the ureteroscope or those with small stones retrieved by grasper only were excluded from the study. Termination of the procedures because of perforation or retropulsion were considered as failure. RESULTS: Sixty five males and 35 females were included with a mean age of (39±3) years (range 20-60). Fifty eight patients (58%) had lower ureteric stone, 25 patients (25%) had mid ureteric stone and 17 patients (17%) had upper ureteric stone. Mean stone size was 10.61 mm (range 7-20mm). Overall success rate was 96% which was more for the lower than upper ureteric stone. Failure occurred in 4 patients (4%), 2 of them due to retropulsion and the other 2 patients due to ureteric perforation. Apart from ureteric perforation and retropulsion, complications were minor and were amenable to conservative treatment. CONCLUSION: Holmium YAG laser lithotripsy is a minimally invasive, highly effective safe method for treatment of ureteral calculi.


Article
Preliminary Experience of Sleeve Gastrectomy

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ABSTRACT: BACKGROUND: Laparoscopic Sleeve gastrectomy (LSG) is the most common restrictive procedure performed worldwide for treatment of morbid obesity. OBJECTIVE: To assess the safety, effectiveness and complications of LSG performed for Iraqi patients and shows early experience of LSG. METHODS: Prospective clinical case series study conducted in Al-Jumhoori Teaching Hospital and involved 70 patients (57 females and 13 males);their age (19-59 average 37 years) underwent LSG(6 open ,64 laparoscopically with one conversion);51 patients finish 1 year follow up . RESULTS: The initial body weight 70-195(122Kg); BMI 31.8-65.9 (50.16Kg/m2); two patients with diabetes mellitus and BMI less than 35Kg/m2 involved. The average weight loss assessed and found to be (13.85, 32.8, 40.8 and 48.3 Kg) in 1st, 3rd, 6th and 12th month interval; The BMI reduced from 50.16 to 35.43 and 29.52 at 6th and 12th months. We recorded 1 mortality after 10 days (massive pulmonary embolism), 1 case converted to open and minigastric bypass due to narrowing of the sleeve part. The associated comorbidities improved after weight loss, and the quality of life improved in 88% of patients depending on bariatric analysis and reporting outcome systems (BAROS). CONCLUSION: Sleeve gastrectomy is relatively safe and effective procedure to decrease weight for morbid obesity and it improves the quality of life, but all bariatric procedures needs good health resources and settled countries which were not present in Iraq for the time being.


Article
Mycoplasma Pneumonia in Hospitalized Patients in Baghdad Teaching Hospital :Clinical, Radiological and Cold Agglutinin Assessment

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ABSTRACT: BACKGROUND: Mycoplasmapneumonia is a cause of community-acquired pneumonia. The disease usually is of a gradual onset, with almost equal gender distribution between male & female. OBJECTIVE: Assessment of the clinical, radiological & laboratory characteristics of mycoplasma pneumonia in Baghdad teaching hospital. MATERIALS AND METHODS: 30 patients were collected from Baghdad teaching hospital between 1st of November 2003 till 30th of October 2004 having pneumonia with positive cold agglutinin titer. They were studied regarding their clinical presentation & features including seasonal incidence, radiological assessment, & testing blood for cold agglutinin titer. RESULTS: The study showed almost equal gender distribution (14 patients were male & 16 patients were female), with ratio of male: female equal to 1:1.1. The most common symptoms were dry cough76.7%, headache (6.77%) &fever(70%). Other symptoms are less frequent. Seasonal variation showing more incidence during spring time. Radiological finding showed patchy infiltration in 18 patient (60%), lobar consolidation in 7 patient (23.3%), & pleural effusion in 4patient (13.3%). CONCLUSION: There is almost equal gender distribution between male & female. The most common symptom was dry cough, headache, while fever is more common in old age groups than other age groups.


Article
The Association between Maternal Ghrelin Hormone Levels and Hyperemesis Gravidarum

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ABSTRACT: BACKGROUND: Ghrelin hormone (Hunger hormone) is one of the appetite hormones that either secreted from adipose tissue (leptin, adiponectin and resistin), or mainly secreted from GI tract (ghrelin, obestatin, cholecystokinin, peptide YY and glucagon—like peptide –1). These hormones may be responsible for hyperemesis gravidarum. OBJECTIVE: To evaluate the role of ghrelin hormone in the etiopathogenesis of hyperemesis gravidarum PATIENTS AND METHODS: A case control study was performed in Gynecology and Obstetrics Department/ Baghdad teaching hospital(medical city complex) from the 1st of Sep. 2014 to the end of August 2015 including 100 women 50 women were the cases and 50 women were the control group. RESULTS: Mean age of cases was 24±8 years; prevalent age group was 20-29 years (48%).there was no significant difference in both groups regarding to the age, gestational age, gravidity and BMI between cases and controls (p>0.05). no significant differences were observed in TSH between cases and controls (p>0.05). But a significant association was observed between cases and low ghrelin level (p<0.001). CONCLUSION: there is a relation between the low level of ghrelin and hyperemesis gravidarum.


Article
Efficacy and Safety of Yellow Light Diode Laser 577nm for Treatment of Melasma Patients in Sulaymaniyah City.

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ABSTRACT: BACKGROUND: Recent evidence suggests that angiogenetic factor involved in the pathogenesis of melasma. Yellow light laser which emits 577 nm may has effect on dermal vasculature and may be of benefit in the treatment of melasma. OBJECTIVE: To evaluate the efficacy and safety of yellow light laser 577 nm for the treatment of melasma in Fitzpatrick skin types II-IV in both male and female patients. METHODS: Thirty three patients with melasma were enrolled, from which 30 patients completed the study (5 males, 25 females), age range of (20-40) years, duration of melasma between (2-10) years. They all are either dermal or mixed according to Wood's light examination, Each patient received 2 sessions of yellow light laser 577 nm treatments to the face at 4 weeks interval. The treatment fluency ranged from 10-15 J/cm2, with the pulse duration of 100 ms for skin type II, III, and 120 ms for skin type IV. Clinical parameters included patient self assessment of changes in the pigmentations after each treatment session and 8 weeks after the last session and two investigators independently evaluated Melasma Area and Severity Index (MASI) score before each session and 8 weeks after the last session. RESULT: Mean MASI score decreased dramatically after treatment from 18.6 ± 7.5 before treatment to 7.6 ± 4.5; eight weeks after the last treatment, with a P-value < 0.001 which is statistically significant. Patient´s self assessment revealed that 14 of the patients were experienced excellent improved, 10 of the patients moderately improved, 4 of the patients mildly improved, no patients had no changes and 2 of the patients develop post inflammatory hyperpigmentation. CONCLUSION: The use of yellow light diode laser 577nm is an effective and safe treatment option for the demal and mixed type of melasma in both males and female patients with Fitzpatrick skin types II-IV..


Article
Clinical Evaluation of Overnight Oximetry Monitoring of High Risk Patients for Obstructive Sleep Apnea

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Abstract

ABSTRACT: BACKGROUND: Obstructive sleep apnea (OSA) is a condition of sleep related pharyngeal collapse, in which recurrent episodes of upper airway occlusion occur during sleep causing diminution (hypopnea) or cessation of airflow (apnea) in the pharynx provoking arousals and sleep fragmentation, resulting in daytime sleepiness. Oximetry alone is very valuable tool in the diagnosis and management of OSA, it can identify most cases allowing referral for continuous positive airway pressure (CPAP) treatment. OBJECTIVE: To evaluate the overnight oximetry monitoring as a swift and accessible PATIENTS AND METHOD: Cross sectional study of 20 patients, 12 males and 8 females with high probability of OSA, attended to respiratory clinic in Baghdad teaching hospital suffering from excessive daytime sleepiness, they were clinically evaluated plus using overnight oximetry as an objective testing method. RESULTS: The study sample was 20 patients, 12 males (60%), 8 females (40%), mean age 48 years, mean BMI 45.6 Kg/m2, female mean BMI 53.1 Kg/m2, male mean BMI 37 Kg/m2, and mean basal Po2 saturation 89.6 %. Desaturation index (DI) show significant correlation with AHI, BMI, and gender, while no significant correlation with age. AHI show significant correlation with baseline SPO 2 and gender, and no correlation with BMI and age. CONCLUSION: Desaturation index assessed by nocturnal pulse oximetry maintain its utility as a screening method in the recognition of obstructive sleep apnea in obese patients with high clinical pretest suspicion. DI when combined with appropriate clinical evaluation could be used as an initial diagnostic test for OSA. .


Article
Epidermal Growth Factor Receptor (egfr) Immunohistochemical Expression in Gastric Carcinoma

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Abstract

ABSTRACT: BACKGROUND : Gastric cancer is the the fourth most common cancer and the second leading cause of cancer-related deaths. Gastric cancer is a major cause of cancer morbidity and mortality worldwide. OBJECTIVE: To estimate the immunohistochemical expression of epidermal growth factor receptor(EGFR) in the gastric cancer in relation to other parameters like grade and stage. METHODS: Formaline fixed ,paraffin-embedded blocks from 51 patients (29 male and 22 female) with gastric carcinoma were included in this study. Ten biopsies of normal gastric tissue were selected as a control group. Envision (DAKO) technique was applied to study the immunohistochem- ical expression of EGFR in paraffin embedded sections of gastric cancer. RESULTS: Positive immunohistochemical expression of EGFR was seen in 41.2% of cases as both membranous and cytoplasmic brown staining while there was negative staining in the normal control group (p<0.05). EGFR immunoexpression was correlated with the histological type( more in the intestinal variant than the diffuse type) (p<0.0.5). CONCLUSION: These findings provides further evidence for the role of EGFR in the tumorgenensis of gastric cancer. However, EGFR could not be well correlated with stage of tumor and hence may be poor prognostic parameters of the state of malignancy.

Table of content: volume:15 issue:3