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Arthroscopic Fixation of Isolated Type II Superior Labrum Anterior to Posterior (Slap) Lesions, Short-Term Results

Iraqi Postgratuate Medical Journal, 2019, Volume 18, Issue 4, Pages 291-298

ABSTRACT:
BACKGROUND:
SLAP defined as separation of superior labrum from anterior to posterior, with or without the involvement of the attachment of the biceps tendon.
OBJECTIVE:
To assess the results of arthroscopic management of type II isolated SLAP tear using suture anchors in patients below forty years of age according to the University of California Los Angeles (UCLA) rating scale.
PAT IENTS AND METHODS:
This is a prospective study conducted in the medical city directorate in Baghdad starting in October 2015 till October 2017, it included fourteen patients having dominant side type II SLAP tear, twelve males and two females, mean age was 31.8. All the tears fixed by arthroscopic suture anchor using the 2-ports technique. All patients evaluated by the (UCLA) scale preoperatively and one year after surgery.
RESULTS:
The UCLA shoulder rating scale regarding the pain relief, function and patient satisfaction showed significant improvement from 14.0±2.8 preoperatively to 31.9±1.9 one year postoperatively in all the patients with a P value < 0.0001.One patient had post-operative anterior stitch infection treated by daily dressing and antibiotic.
CONCLUSION:
Arthroscopic repair of isolated type II SALP lesions by using suture anchors fixation and by two ports technique show favorable outcomes in term of function, pain relief and satisfaction of patients below 40 years in one year follow up.
KEYWORDS SLAP lesion, shoulder arthroscopy

Frequency of Skin Cancer among Iraqi Patients Attending Dermatology Center/Medical City in Baghdad between January 2013 and December 2018

Iraqi Postgratuate Medical Journal, 2019, Volume 18, Issue 4, Pages 299-304

ABSTRACT:

BACKGROUND:
Nonmelanoma skin cancer is the most common cancer in humans especially with lighter skinned individuals and ultraviolet exposure which are the major predisposing risk factors. There are many reports of increased frequency of skin cancer among Iraqi individuals.
OBJECTIVE:
To study the frequency of skin cancer in Iraqi patients.
PATIENTS AND METHODS:
This is a retrospective study, conducted in the outpatient clinic of dermatology center at Baghdad Teaching Hospital from the beginning of January 2013 to the end of December 2018. A total of 365 biopsies proved histopathologically as malignant skin cancer were included in the study. RESULTS:
Basal cell carcinoma accounted for 37.3% (n=136), mean age was 63±13 years. Squamous cell carcinoma represented 16.2% (n=59), mean age was 61±15 years. Mycosis fungoid frequency was 15% (n=55) with a mean age of 47±16 years. Kaposi sarcoma was 10.1% (n=37), mean age 64±15 years. Cutaneous metastasis represented 7.8% (n=29) with mean age of 64±5 years. Patients with malignant melanoma were 4.3% (n=16), mean age was 50±19 years. Other less commonly skin malignancies represented 9.3% (n=33).
CONCLUSION:
The most frequent primary skin cancer is nonmelanoma skin cancer followed by mycosis fungoides, Kaposi Sarcoma and malignant melanoma, respectively. The most common origin of skin metastasis is breast carcinoma.
KEYWORDS: Skin cancer, Iraq, Metastasis

Role of Dixon MRI in Quantification of Liver Fat in Non-Alcoholic Fatty Liver Disease

Iraqi Postgratuate Medical Journal, 2019, Volume 18, Issue 4, Pages 305-312

ABSTRACT:
BACKGROUND:
Hepatic steatosis is a broad term; nonalcoholic fatty liver disease (NAFLD) is the most common type. Magnetic resonance imaging (MRI) can provide a quantitative, accessible and accurate evaluation of diffuse liver disease.
OBJECTIVE:
Study the role of MRI Dixon in quantification of hepatic fat in patients with NAFLD in correlation with (computed tomography) CT attenuation, serum alanine aminotransferase (ALT), serum aspartate aminotransferase (AST) and body mass index (BMI)
PATIENTS AND METHODS:
This cross sectional analytic prospective study was conducted from November 2016 to December 2017 at radiology department of Al-Imamein Al Kadhimein Medical City, Baghdad/ Iraq. Fifty patients were included in this study (28 females and 22 males), the study included patients with clinical and laboratory suspicion of NAFL and CT evidence of fatty liver (in unenhanced CT the liver parenchyma were less than 40 Hounsfield unit (HU), or if CT attenuation of the liver were 10 HU less than that of spleen). All patients were examined with T1 vibe Dixon sequence with breath hold. Hepatic fat fraction (HFF) was calculated from mean ROIs of water and fat images using following formula: % of HFF=F/F+W, where W and F are the signal contribution from water and fat respectively.
RESULTS:
The cases were divided into 3 groups according to the results of MRI Dixon fat fraction % as following: group A MRI Dixon fat was less than 15% (21 patients), group B between 15 -30% (13 patients) and group C more than 30% (16 patients). There was statistically significant relationship between Dixon fat fraction with CT attenuation in group A and C while no statistically significant relationship was seen in group B. There was no statistically significant relationship between Dixon fat fraction and serum ALT and AST in group A and B while statistically significant relationship between Dixon fat fraction and serum ALT was found in group C. there was statistically significant relationship between Dixon fat fraction and body mass index in all 3 groups.
CONCLUSION:
Dixon MRI was noninvasive, reliable technique in quantification of fat fraction in NAFL, Dixon MRI was more sensitive sequence for early detection of fatty liver diseases infiltration.
KEYWORDS: Dixon Magnetic resonance imaging, liver fat, fatty liver disease

Relation between Human Papilloma Virus Infection and Spontaneous Miscarriage

Iraqi Postgratuate Medical Journal, 2019, Volume 18, Issue 4, Pages 313-321

ABSTRACT:
BACKGROUND:
Approximately one in four women will have an early pregnancy failure during her lifetime. In pregnant women or in their partners, human papillomavirus infection can be considered as a risk of preterm birth, miscarriages and virus transmission to the newborn.
OBJECTIVE:
To disclose the prevalence of high risk human papillomavirus infection in women suffering from spontaneous miscarriage .
PATIENTS AND METHODS:
A case - control study included 100 pregnant women ,age (20-42 years old) ,50 full term pregnant )Gestation age 37-40 week) delivered viable full term pregnancy, and 50 pregnant women experienced spontaneous miscarriage (Gestation age 8-24week), cervical swab was done in the labor ward of Al-Yarmouk Teaching Hospital from all participants, and the samples were taken to a private lab for high risk human parvovirus detection. The study period was from 1st of March to 30th of November 2017.
RESULTS:
The overall prevalence of high risk human papillomavirus is 7%, the highest proportion of study patients with high risk human papillomavirus infection ended with miscarriage (71.4%), while in those with viable full term pregnancy were (28.6%). A number of risk factors which increased prevalence of high risk human papillomavirus hrHPV infection were detected as previous history of miscarriage, smoking, and history of oral contraceptives use.
CONCLUSIONS:
High risk human papillomavirus prevalence was higher in pregnancy with spontaneous miscarriage compared to women experience a normal full term pregnancy.
KEYWORDS: Miscarriage, high risk human papillomavirus (hrHPV), Pregnancy.

Knowledge, Attitude and Practice of Female Physicians, Dentists, and Pharmacists Regarding Complementary Feeding of Their Infants: An Online Study

Iraqi Postgratuate Medical Journal, 2019, Volume 18, Issue 4, Pages 322-328

ABSTRACT:
BACKGROUND:
The transitional period from exclusive breastfeeding to family foods, is known as complementary feeding, and it is a very vulnerable period. WHO has developed and updated the guide "Complementary feeding: Family Foods for breastfed children" that gives a clear guidance for health care workers on how to promote complementary feeding.
OBJECTIVE:
To assess the knowledge, attitude and practice of mothers from the medical staff concerning complementary feeding, and pattern of their infants feeding
SUBJECTS AND METHODS:
A cross sectional study with analytic components was carried out online through Facebook, targeting members of close group of mothers from the medical staff. The study was done in 2018.
RESULTS:
The age of mothers ranged between (23- 44) years, (45.6%) were physicians, (54.2%) of them were prim gravida. 73.2% of mothers introduce the complementary food between the age of four to six months. The total knowledge score of mothers was (68.4 ± 23.03. The total attitude score was (44.1 ± 22.8). The total practice score of mothers was (51.25 ± 18.2). (59%) received their information from the internet.
CONCLUSION:
Almost half of the participants had a good knowledge, majority of them had poor attitude and almost half had a poor practice toward their infants feeding. Internet is the major source of their information.
KEYWORDS: complementary feeding, medical professions, online(facebook) group.a

Distribution of Hematological Neoplasia Diagnosed by Bone Marrow Morphology in Adult Patients Attending Medical City Teaching Hospital

Iraqi Postgratuate Medical Journal, 2019, Volume 18, Issue 4, Pages 329-334

ABSTRACT:
BACKGROUND:
The hematological malignancies are clonal diseases that derive from a single cell in the marrow or peripheral lymphoid tissue that has undergone genetic alteration; they represent approximately 7% of all malignant diseases.
OBJECTIVE:
Assessment for the frequency of the hematological neoplasia diagnosed by bone marrow morphology in adults patients attending Medical City-Baghdad.
PAT IENTS AND METHODS:
This is a retrospective cross sectional study carried out in Teaching Laboratories of Medical City-Baghdad during the period from 1/1/2017 to 1/1/2018. All the cases of hematological neoplasia were diagnosed by the morphology of peripheral blood, bone marrow aspirate and /or biopsy were included in the study.
RESULTS:
Out of 2266 bone marrow examinations carried out in 2017 year, 570 patients (25%) were diagnosed as Hematological Neoplasia and included in the study; The frequency of HN was as follow: Acute Myeloid Leukemia:19.3% , Non-Hodgkins Lymphoma: 15.7 %, Acute Leukemia (unclassified morphologically):15.6%, Multiple Myeloma: 14%, Chronic Myeloid Leukemia:10.3%, Chronic Lymphocytic Leukemia:4.5%, Acute Lymphoblastic Leukemia: 4.4%, Myeloproliferative Neoplasia: 4.2%, Lymphoproliferative Disorders:3.3%, Primary Myelofibrosis: 2.6%, Essential Thrombocythemia: 1.9%, Hairy Cell Leukemia:1.7% ,Myelodysplastic Syndrome:1.2%, Chronic Myelomonocytic Leukemia: 0.5%, Plasma Cell Leukemia: 0.4%; 489 (86%) patients were diagnosed by bone marrow aspirates while 81(14%) patients were diagnosed by bone marrow biopsy.
CONCLUSION:
The most common hematological neoplasia was Acute Myeloid Leukemia followed by Non-Hodgkins Lymphoma while the least was Plasma Cell Leukemia. Patients with Acute Myeloid Leukemia, Acute Lymphoblastic Leukemia and Chronic Myeloid Leukemia presented at lower age than other hematological neoplasias. The majority of hematological malignancies were diagnosed by bone marrow aspirates.
KEYWORDS: Acute Myeloid Leukemia, Acute Lymphoblastic Leukemia, Chronic Lymphocytic Leukemia

Ultrasonographic Guidance versus Fluoroscopic Guidance for Renal Access in Percutaneous Nephrolithotomy (PCNL): A Comparative Study

Iraqi Postgratuate Medical Journal, 2019, Volume 18, Issue 4, Pages 335-343

ABSTRACT:
BACKGROUND:
Guiding access of percutaneous nephrolithotomy is essential in acquiring better surgical outcomes and preventing serious postoperative complications.
OBJECTIVE:
To assess the safety and efficacy of ultrasonographic guidance vs. fluoroscopic guidance for renal access in percutaneous nephrolithotomy (PCNL) focusing on the success rate of renal access, stone-free rate, operating time, duration of hospitalization, and major complications after the procedure.
PATIENTS AND METHODS:
A Prospective comparative study conducted in Shahid-Ghazi Hariri Surgical Specialties Hospital and Nursing Home Hospital in Baghdad Medical city. The duration of study was through the period from 1st of October, 2016 to 1st of October, 2018 on convenient sample of 70 patients with renal stones underwent percutaneous nephrolithotomy. The selected patients were categorized into two groups were undergoing percutaneous nephrolithotomy ;(35 patients guided with ultrasound) and (35 patients guided with fluoroscopy), they compared mainly by stone free rate, and secondarily by access time, operative time and post operative complication. S. T. O. N. E. score use to determine the charecter of the stone.
RESULTS:
For patients with low S.T.O.N.E score no difference was found regarding stone free rate between ultrasonographic guidance and fluoroscopic guidance percutaneous nephrolithotomy (p value 0.1). For patients with high S.T.O.N.E score fluoroscopic guidance percutaneous nephrolithotomy achieve higher stone free rate ( p value 0.04) . No significant difference was found between the two groups regarding hemoglobin decline, blood transfusion, operative time and hospitalization.
CONCLUSION:
Percutaneous nephrolithotomy under ultrasound guide is safe and effective as fluoroscopic guidance for patients with low S. T. O. N. E. score. Fluoroscopic guidance is more effective for patients with high S. T. O. N. E score.
KEYWORDS: Percutaneous nephrolithotomy, Ultrasonography guidance, Fluoroscopy guidance

Comparative Study between Simplified Modified Ripping, Coagulation and Pluck ( RCP Technique) of Mural Part of Ureter and Open Resection of Mural Part in Radical Nephroureteroectomy

Iraqi Postgratuate Medical Journal, 2019, Volume 18, Issue 4, Pages 344-350

ABSTRACT:
BACKGROUND:
In radical nephroureterectomy for high risk upper tract urothelial cancer UTUC, mural part of the ureter need to be removed otherwise recurrence will occur in up to 75% .
OBJECTIVE:
To compare results of modified transurethral ripping, coagulation and pluck technique with the traditional open resection of the mural part of the ureter in the radical nephroureterectomy for upper TUC.
PATIENTS AND METHODS:
Seventeen patients with high risk upper tract urothelial cancer were managed by radical nephroureteroctomy ,7 of them the mural part was removed by open resection while for 10 patients the mural part was managed by transurethral ripping by Collins knife then the meatus was closed by ball electrode coagulation before plucking of the ureter during nephroureteroctomy which was done by open method in 8 patients and by laparoscopic way in two patients.
RESULTS:
There is a statistically significant difference in the outcomes of endoscopic procedure (ripping, coagulation and plucking of mural ureter) in comparison to the results of open resection for mural part of ureter ,where the mean operative time for bladder cuff excision reduced from 75+6 to 10.5+ 2 minute ,mean total operative time reduced from 190+2 to 100 + 7 minutes ,hospital stay from 7 + 0,6 days to 4.5 + 0.6 days, and bowel recovery period reduced from 3.5 + 1 to 1.5 + 0.4 days
CONCLUSION:
Retrograde modified ripping-coagulation and pluck of mural part of the ureter in radical nephroureterectomy for high risk UTUC is rapid ,safe ,simple and applicable with all type of radical nephroureterectomy procedures, whether open or by minimal invasive procedures and it applies all means for oncological safety.
KEYWORDS: Urothelial cancer

The Association of Fibromyalgia with Adult Ankylosing Spondylitis Patients

Iraqi Postgratuate Medical Journal, 2019, Volume 18, Issue 4, Pages 351-355

ABSTRACT:

BACKGROUND:
Ankylosing Spondylitis is a chronic systemic inflammatory disorder affecting the spine and other areas of the body(joints and entheses). Fibromyalgia is a syndrome characterized by chronic( more than three months) wide spread musculoskeletal pain. Detection of fibromyalgia in patients with ankylosing spondylitis is an important aspect in the treatment of ankylosing spondylitis.
OBJECTIVE:
To determine the association of fibromyalgia with adult ankylosing spondylitis, and to evaluate the effect of coexisting fibromyalgia on the scores of disease activity and functional status.
PATIENTS AND METHODS:
A case-control study with 100 ankylosing spondylitis patients and 100 controls enrolled in the study. Ankylosing spondylitis was diagnosed with modified New York criteria. Fibromyalgia assessed by using modified 2010/ 2011 American Collage of Rheumatology criteria for the diagnosis of fibromyalgia.
RESULTS:
Fibromyalgia was found in 25% of patients with ankylosing spondylitis with female: male ratio(5.2:1), while seen in 6% of controls with female to male ratio(5.9:1). Fibromyalgia was significantly associated with increase in the disease activity index. The function index in fibromyalgia patients was significantly higher than in non-fibromyalgia patients.
CONCLUSION:
Fibromyalgia is more common in ankylosing spondylitis patients than in controls. The coexistence of fibromyalgia with ankylosing spondylitis negatively impacts the scores of ankylosing spondylitis disease activity and functional status.
KEYWORDS: Fibromyalgia, Ankylosing spondylitis.

Difficult Laparoscopic Cholecystectomy Prediction by the Use of Clinical Parameters

Iraqi Postgratuate Medical Journal, 2019, Volume 18, Issue 4, Pages 356-362

ABSTRACT:
BACKGROUND:
Laparoscopic cholecystectomy has now replaced open cholecystectomy for the treatment of gallbladder pathologies (stones, polyps) , However, Laparoscopic cholecystectomy may be considered ‘difficult’ by various problems encountered during surgery, such as difficulties in accessing the peritoneal cavity, creating a pneumoperitoneum, dissecting the calot’s triangle, extracting the gall bladder from the liver bed, or the excised gall bladder removal from the port.
OBJECTIVE:
This study was cond ucted to identify and evaluate whether preoperative clinical parameters in patient undergoing laparoscopic cholecystectomy for cholelithiasis can predict the levels of intra- operative difficulties.
PATIENTS AND METHODS:
100 patients who underwent laparoscopic cholecystectomy. All the patients were with symptomatic gallstone disease. Detailed clinical history, examination and Investigations were taken. Prospective analyses of different preoperative (patient-related) clinical parameters contributing to difficult laparoscopic cholecystectomy were performed. The study was performed in Al-Imamain Al-Kadhimain Medical City between October 2015 to October 2016.
RESULTS:
OF 100 patients with laparoscopic cholecystectomy, 33 patients (33%) developed difficulties during operation. Factors associating difficult laparoscopic cholecystectomy included; male gender, wall thickness more than 4 mm, previous upper abdominal surgery and BMI more than 35 and the most common (specific) type of intraoperative difficulties was bile leak due to gall bladder perforation and liver bed affecting 10 patients out of the 33 difficult cases (10%) from the total cases and the least difficulty was conversion to open cholecystectomy occurred in 2 patients (2%).
CONCLUSION:
The prediction of difficult laparoscopic cholecystectomy by the use of clinical parameters showed that male gender, wall thickness above 4mm, and history of previous upper abdominal surgery are statistically significant predictive factors.
Knowledge of these predictive factors preoperatively may help in improving patient safety with
involvement of experienced laparoscopic surgeon who could better anticipate intraoperative risk & technical difficulty encountered while operating on these patients.
KEYWORDS: prediction, difficult laparoscopic cholecystectomy, clinical parameters

An Observational Case Control Study of Nailfold Capillary Dermoscopy in a Sample of Iraqi Patients with Connective Tissue Diseases: A Single Center Study

Iraqi Postgratuate Medical Journal, 2019, Volume 18, Issue 4, Pages 363-369

ABSTRACT:

BACKGROUND:
Connective tissue diseases show certain characteristic morphological changes in their nailfold capillaries. Studies are limited on nailfold capilloroscopic findings using dermoscopy.
OBJECTIVE:
To describe nailfold capillary findings and patterns in patients with connective tissue diseases using dermoscopy.
PAT IENTS AND METHODS:
Demographic variables, nailfold capillary findings and patterns were examined and described using a handheld dermoscope in 40 healthy control subjects and 85 patients with connective tissue diseases including 37 scleroderma patients, 36 systemic lupus erythematosus and 12 dermatomyositis patients.
RESULTS:
Capillary disorganization, giant capillaries, capillary hemorrhage, avascular areas and ramified capillaries were significantly higher in patients than control subjects (p<0.001). Giant capillaries, hemorrhages, avascular areas, disorganized and ramified capillaries were observed significantly more in scleroderma and dermatomyositis patients than systemic lupus erythematosus patients, but no single finding differentiated scleroderma from dermatomyositis. The presence of tortuous capillaries was significantly more in systemic lupus erythematosus patients than scleroderma and dermatomyositis (p<0.001). The scleroderma-dermatomyositis pattern is observed significantly higher in patients than controls (p<0.001). The scleroderma-dermatomyositis pattern was seen significantly more in dermatomyositis and scleroderma than in patients with systemic lupus (100% and 86.5% respectively vs. 11.1%, p<0.001). The normal pattern was significantly more seen in systemic lupus than scleroderma and dermatomyosits (66.7% vs 5.4% and 0% respectively, p<0.001).
CONCLUSION:
The dermoscope is a very useful tool in detecting scleroderma- dermatomyositis pattern, allowing a confident differentiation among normal subjects and those with underlying connective tissue diseases. The scleroderma-dermatomyositis pattern is seen in scleroderma as well as in dermatomyositis but to a much lesser extent in systemic lupus erythematosus patients. Detecting a normal pattern in a patient with underlying connective tissue disease is more likely to be seen in systemic lupus erythematosus patients rather than other diagnoses.
KEYWORDS Nailfold capillaroscopy, connective tissue diseases, Raynaud’s, scleroderma, dermatomyositis, and systemic lupus erythematosus.

Troponin Positive Acute Coronary Syndrome with and without Significant Stenosis on Coronary Angiography

Mohammed Hilal AL-Ali; Hassan A. Farhan

Iraqi Postgratuate Medical Journal, 2015, Volume 14, Issue 2, Pages 237-243

ABSTRACT:
BACKGROUND:
Occasionally, coronary arteries without significant stenosis are observed during invasive treatment of acute coronary syndrome (ACS).
OBJECTIVE:
The aim was to study the frequency and to determine the most predictive factors of Troponin positive ACS without significant Stenosis on angiography.
METHODS:
The study involved one hundred twenty four patients admitted with Troponin positive ACS who underwent cardiac catheterization during hospitalization. The primary end-point was the estimation of coronary arteries without significant stenosis, and the secondary end-point was analysis of the most predisposing factors. In evaluating the primary end-point, the patients were divided into two groups according to the presence of ST elevation myocardial infarction (STEMI) or not. Also the patient who has no significant coronary artery Stenosis (< 50%) was subdivided to two groups:
a- Myocardial Infarction with No critical lesion in Coronary angiogram (MINC)
b- Normal coronary angiogram
RESULTS:
Overall, 20 patients (16%) had coronary arteries without significant lesions, from which 8 patients (6.4%) had MINC and 12 patients (9.6%) had normal coronary angiogram. The predictors were: female sex (P=0.008), age <45 years (P=0.001), and the absence of: diabetes (P=<0.001), hypertension (P=0.005) and absence of ST-segment elevation (P=0.001). Furthermore absence of regional wall motion abnormality (RWMA) is considered as another predictors for non-significant coronary artery lesion (P=0.008). Also the angiographic analysis of all lesions revealed that single vessels CAD are the commonest finding in Group I patients (P= 0.02). We further analyzed a suspicious angiographic lesions by using QCA {18 lesions (14.5%)} and FFR {6 lesions (4.8%)} technique.
CONCLUSION:
Overall, patients with Troponin positive ACS had non- significant coronary artery Stenosis on angiography, and female sex, age <45 years and the absence of diabetes, hypertension, ST- segment elevation or RWMA were all associated with coronary angiography showing no significant stenosis.

Prevalence of Pressure Ulcers in Orthopaedic Patients

Ali M. Al-Shadedi

Iraqi Postgratuate Medical Journal, 2012, Volume 11, Issue 4, Pages 529-535

ABSTRACT:
BACKGROUND:
Pressure sore in orthopedic patients is a common problem with high expectation of occurrence on the ward, it should be watched for in any admitted patient having high liability for its development like, old age particularly those patients with dementia, patient with malnutrition or anemia and long stay in bed or complicated multiple surgeries.
Orthopedic staff should be familiar with measures required to prevent and reduce its occurrence.
OBJECTIVE:
To highlight the prevalence, onset, types and number and the most common sites of pressure sores, length of stay in hospital with various types of treatment delivered to these patients in orthopedic wards.
PATIENT AND METHODS:
215 patients were admitted with orthopedic problem for treatment and observed for the possibility of occurrence of pressure ulcer in orthopedic ward. The data collection period was over five years; these patients were treated for trauma to proximal femur, hip joint, pelvis and elective surgery at Al-Sader teaching Hospital of Kufa College of Medicine in Najaf City and Al-Yarmouk teaching Hospitals of Al-Mustanseria College of medicine in Baghdad city. Braden scale was used for predicting pressure ulcer and for assessing these patients.
RESULTS:
215 patients were assessed for being at risk of developing pressure sores by using Braden scale for predicting pressure ulcer. 60 patients with various levels of risk factors with prevalence of 27.90% developed the pressure sores. The age range of patients with pressure ulcer was 42-77 years, with mean age of 63.2 years. Female patients were 40 and male patients were Pressure sores developed in 42 [70%] patient with trauma out of 60 patient under study, 10 patient 16.6% with elective surgery patients, two patients 3.32% conservatively treated patients, and 6 patients 9.96% treated for removal of old implants.13 patients developed ulcer at the first week and 10 patients developed pressure ulcer at the second week of their stay in orthopaedic ward and the rest 37 patients developed it after the second week of their stay in the ward. .
CONCLUSION:
Prevention of pressure ulcer requires the collaboration of all the nursing and surgical staff from different specialty like orthopaedic surgery. Development of pressure sore is the cause behind delay of patient discharge after successful surgery. Expectation of the development of bed sore is significantly high in elderly or bed ridden and hemiplegic patients

The Role of Repaglinide in the Management of Type 2 Diabetes Mellitus

Abbas M Rahmah; Majid R Al-Zaidee; Roaa abbas

Iraqi Postgratuate Medical Journal, 2013, Volume 12, Issue 1, Pages 51-56

ABSTRACT:
BACKGROUND :
Repaglinide belongs to the meglitinide class of blood glucose-lowering drugs.
Repaglinide lowers blood glucose by stimulating the release of insulin from the pancreas.
It achieves this by closing ATP-dependent potassium channels in the membrane of the
beta cells. This depolarizes the beta cells, opening the cells' calcium channels, and the
resulting calcium influx induces insulin secretion.
OBJECTIVE:
To evaluate the effect of repaglinide as a monotherapy or in combination with metformin on
controlling the fasting plasma glucose, postprandial plasma glucose, HBA1C, and body weight in
61 patients with type 2 diabetes mellitus, (DM).
PATEINTS & METHODS:
During the period between February 2005 and October 2005, the effects of repaglinide
has been reviewed in 61 patients with uncontrolled Type 2 diabetes mellitus (T2DM),
they are divided into two groups depending on their previous treatment , the 1st group
included 43 of them were on metformin while the remaining 18 patients were on diet
only. Weight, HBA1c, FPG and PPG were checked after 3 and 6 months.
RESULTS:
It has been found that six months after using Repaglinide in combination with metformin or as a
monotherapy cause significant reduction in HBA1c, from 9.8 to 8.1% (P < 0.01) in 1st group, and
from 7.9 to 6.7%, (P < 0.01) in 2nd group and a significant reduction of FPG from 214.0 mg/dl to
148.5 mg/dl (P < 0.01) in 1st group and from 170.7 mg/dl to 130 mg/dl (P < 0.01) in 2nd group.
While the PPG shows a decrement from 255.6 mg/dl to 178.8 mg/dl, (P < 0.01) in 1st group and
from 248.3 mg/dl to166.1 mg/dl (P < 0.01) in 2nd group. There’s no significant weight gain thus
mean weight rose from 84.4 Kg to 84.6 Kg, (P > 0.2) in 1st group and from 75.1 kg to 76.1 kg (P >
0.2) in 2nd group .
CONCLUSION:
Repaglinide when used as monotherapy or in combination with metformin improve
overall glycemic control and significantly reduced HBA1c but have no significant
change in body weight

Focal Dermal Hypoplasia )Goltz Syndrome(

Luay Abdulla Al-Nouri

Iraqi Postgratuate Medical Journal, 2010, Volume 9, Issue 1, Pages 110-112

ABSTRACT:
BACKGROUND:
Focal Dermal Hypoplasia (FDH) is a condition of multiple features . It is important to recognize on clinical grounds , as it may show life threatening complications that need to be dealt with by properly timed interventions

“Cytomegalovirus Seroprevelance in Iraqi Pregnant Women”

Sajed Nader; Mohammed Ayad

Iraqi Postgratuate Medical Journal, 2012, Volume 11, Issue 3, Pages 303-307

ABSTRACT:
BACKGROUND:
Cytomegalovirus is the commonest cause of congenital viral infection in the developed and developing countries. It is a symptomatic in 90% of infected females. Forty percent of pregnant females transmit the virus to their fetus. Ten percent of born infants whom gain the virus will get the clinical signs plus its neurological sequelae.
OBJECTIVE:
To outline the relationship between Cytomegalovirus infection among pregnant women and its influence upon their pregnancy outcome.
PATIENTS AND METHODS:
A case-control study was carried out was carried out in the teaching laboratories – medical city, Baghdad through a period from June 2010 till March 2011; upon 165 pregnant women whom taken as a patient group. Blood samples were taken from them and Cytomegalovirus-IgM antibodies plus Cytomegalovirus-IgG antibodies levels were measured via Elisa technique in both to evaluate the viral infection if present or not.
RESULTS:
The usual age whom attended the gynea-obestetric clinics were the age group from 11-19 years old 73 cases (44.24%); Next came the age group from 20-29 years old 66 cases (40.00%), thirdly was the age group from 30-39 years old 20 cases (12.12%), Lastly was the age group from 40-49 years old 6 cases (3.64%). The concentration of CMV-IgG among females whom attended clinics were seropositive in nearly half the included cases 66/165 (40.0%); while the CMV-IgM concentration was within the seronegative limits. Secondly came another group of patients with seronegative limits regarding both the CMV-IgM and CMV-IgG antibodies 56/165 cases (33.94%), next 30/165 cases (18.18%) were seropositive in their results pointing to both CMV-IgM and IgG limits; and this might be a middle point distance between the previous group and the last group were the CMV-IgM was positive and the CMV-IgG concentration was negative 13/165 cases (7.88%).
CONCLUSION:
Cytomegalovirus-IgG antibodies got important role as a protective agent against gestation abortion, if Cytomegalovirus-IgM antibodies are seropositive alone this is a risky factor to the pregnancy outcome

Pregnancy with Stroke

Abathar Qahtan

Iraqi Postgratuate Medical Journal, 2012, Volume 11, Issue 4, Pages 490-495

ABSTRACT:
BACKGROUND:
Although stroke in pregnancy is uncommon, the risk of stroke is increased during pregnancy and puerperium, and considered a major contributor to the serious morbidity and mortality of pregnancy
OBJECTIVE:
This study had been designed to find the frequency of stroke in relation to different periods of pregnancy and puerperium, to assess the effect of variable risk factors and their association with stroke and to verify which type of stroke is more frequent among pregnant ladies
METHODS :
This is a cross sectional study that enrolled 30 pregnant patients who had stroke either during pregnancy or puerperium and being admitted to the Neurology words of Al-Yarmouk, Baghdad and Al-kadhemia teaching hospitals during the period from the 1st of January, 2001, to the 31st of December, 2002. All of the patients, who had been included in this study, had been subjected to detailed history, physical and neurological examinations and investigations.
RESULTS:
19 patients (63.3%) of the sample included in this study acquired stroke during pregnancy while 11 patients (36.3%) had developed stroke during puerperium. 2/3rd of the sample had ischemic stroke. Impaired consciousness was the commonest presenting symptom with a frequency of 50% of the sample, cerebellar signs were the least observed signs, in the other hand; all of the patient included in this study had motor dysfunction during the disease course. 53.3% of the sample was hypertensive 6.7 % was diabetic, while 36.7% of them had no significant past medical history. Oral contraceptive pills had been used by 50% of the sample, 2/3rd of those using oral contraceptive pills had ischemic stroke. 63.3% of the sample had cesarean delivery, 50% of the sample had history of abortion, 60% of whom had positive history of recurrent abortion.
CONCLUSION:
This study revealed that most of stroke happened during the 3rd trimester and early weeks of puerperium. Being hypertensive, whether pregnant related or not, is the most important risk factor, in addition, other recognized risk factors included diabetes mellitus and use of oral contraceptive pills.

The Outcome of Two Modes of Treatments in Patients with Posterior Urethral Valve

Saad Dakhil Farhan Daraji

Iraqi Postgratuate Medical Journal, 2015, Volume 14, Issue 2, Pages 203-208

ABSTRACT:
BACKGROUND:
The obstructive effect of the posterior urethral valve (PUV) can manifest along a spectrum of severity, ranging from disease incompatible with postnatal life to conditions that have such minimal impact that they may not manifest until later in life.
OBJECTIVE::
To compare the outcome of patients with PUV underwent both techniques of PUV incision and primary urinary diversion (with a delayed PUV incision).
PATIENTS AND METHODS:
A prospective and retrospective study of twenty-eight children with posterior urethral valve was conducted. Details of age, presenting symptoms, serum creatinine, ultrasound and Voiding cystographic (VCUG) findings, the presence or absence of vesicoureteric reflux and the type of surgical interventions done were recorded. On the follow-up between 1- 2 year period, the patients were assessed by progression of the clinical state, biochemical analysis and ultrasound of the abdomen. Outcomes of surgery and further surgical intervention also assessed in addition to the assessment of the bladder function for older children.
RESULT:
The primary treatment of the PUV was with incision of the PUV in 13 cases (46.4%) while the primary treatment with urinary diversion and delayed incision of the PUV was performed in 15 cases (53.3%). A posterior urethral valve incision was cured in 46% of patients, while the primary diversion and the delayed incision operation was cured in 26.6%; Most of the patients (60.7%) still needed further urological intervention. There was no statistical significance between the results of both surgical procedures. Renal impairment and poor bladder function were more common with diversion operation.
CONCLUSION:
There is no convincing evidence to support any procedure as a way of improving long-term renal function or long-term bladder function. Therefore, urinary diversion is to be considered in selected cases with clear goals and endpoints in mind as it has an important place in the management of boys with PUV.

Pulmonary Function Test in Cement Workers in Iraq

Haider Noori Dawood; Abdul Razak Makki Abd Lrazak; Adnan Majeed Muhasen

Iraqi Postgratuate Medical Journal, 2013, Volume 12, Issue 1, Pages 85-89

ABSTRACT:
BACKGROUND:
Exposure to cement dust has long been associated with the prevalence of respiratory symptoms and decline in pulmonary function.
OBJECTIVE:
This study assessed the effect of exposure to cement dust on lung function in cement factory workers in Iraq , by measuring Forced Vital Capacity (FVC), Forced Expiratory Volume in the first second (FEV1), FEV1/FVC ratio and Forced Expiratory Flow 50% (FEF50%).
PATIENTS AND METHODS
180 workers enrolled in the study , 171 , are male (93.44%) and only 12 are female(6.56%). and 100 workers controls (non exposed) were selected.The age of the subjects ranged between 20-50 years. Both groups were smokers and non smokers, had no chronic pulmonary diseases or symptoms during the time of study. Spirometeric study was used to measure FEV1, FVC, FEV1/FVC ratio and FEF50% .
RESULTS:
Statistically, significant reduction in FEV1 and the FEV1/FVC ratio were found in exposed workers when compared to control. Lung
function indices were found to be not affected with increasing duration ofexposure to cement dust nor with smoking.
CONCLUSION:
Exposure to Portland cement dust may result in reduction in the pulmonary function and may lead to respiratory diseases.Implementing measures to control dust and providing adequate personal respiratory protective equipment for the production workers are highly recommended

Primary Repair of Unilateral Cleft Lip Nasal Deformity

Zakaria Y.Arajy; Ahmed A.M.Nawres

Iraqi Postgratuate Medical Journal, 2009, Volume 8, Issue 3, Pages 212-219

ABSTRACT:
BACKGROUND:
There is a growing attitude towards correcting the nasal deformity in conjunction with primary repair of cleft lip. Many studies had concluded that this repair will not affect the nasal cartilages growth; it usually reorients the deformed nasal cartilages into a near normal position, and will allow a better growth pattern.
OBJECTIVE:
This study was conducted to document the pattern of primary unilateral cleft lip nasal repair and to evaluate the medium term outcome.
METHODS:
A total of 33 babies with unilateral cleft lip deformities underwent simultaneous nasal correction with their lip closure, between March of 2004 and April of 2008.Through short nostril rim incision, alar suspension to the dorsal skin at the nasion and interdomal sutures were performed primarily. Alar transfixion stitches were used to maintain the new position of the suspended cartilages.
RESULTS:
The average follow up periods were 3 years (ranging from 1 – 5 years).The results were assessed by 4 parameters: Nostril asymmetry, nasal dome projection, alar buckling deformity, and flaring deformity of the alar base. Eleven patients had good results, 16 patients had acceptable results, and 6 patients had poor results.
CONCLUSION:
Alar suspension is a relatively simple effective procedure for the primary correction of cleft lip nasal deformity. Short nostril rim incision can be relied on to access the alar dome and facilitate insertion of suspension sutures. Weather it interferes with nasal growth or not, it is necessary to have a long period of follow up to answer this question.

“Cytomegalovirus Seroprevelance in Iraqi Pregnant Women”

Sajed Nader; Mohammed Ayad

Iraqi Postgratuate Medical Journal, 2012, Volume 11, Issue 3, Pages 303-307

ABSTRACT:
BACKGROUND:
Cytomegalovirus is the commonest cause of congenital viral infection in the developed and developing countries. It is a symptomatic in 90% of infected females. Forty percent of pregnant females transmit the virus to their fetus. Ten percent of born infants whom gain the virus will get the clinical signs plus its neurological sequelae.
OBJECTIVE:
To outline the relationship between Cytomegalovirus infection among pregnant women and its influence upon their pregnancy outcome.
PATIENTS AND METHODS:
A case-control study was carried out was carried out in the teaching laboratories – medical city, Baghdad through a period from June 2010 till March 2011; upon 165 pregnant women whom taken as a patient group. Blood samples were taken from them and Cytomegalovirus-IgM antibodies plus Cytomegalovirus-IgG antibodies levels were measured via Elisa technique in both to evaluate the viral infection if present or not.
RESULTS:
The usual age whom attended the gynea-obestetric clinics were the age group from 11-19 years old 73 cases (44.24%); Next came the age group from 20-29 years old 66 cases (40.00%), thirdly was the age group from 30-39 years old 20 cases (12.12%), Lastly was the age group from 40-49 years old 6 cases (3.64%). The concentration of CMV-IgG among females whom attended clinics were seropositive in nearly half the included cases 66/165 (40.0%); while the CMV-IgM concentration was within the seronegative limits. Secondly came another group of patients with seronegative limits regarding both the CMV-IgM and CMV-IgG antibodies 56/165 cases (33.94%), next 30/165 cases (18.18%) were seropositive in their results pointing to both CMV-IgM and IgG limits; and this might be a middle point distance between the previous group and the last group were the CMV-IgM was positive and the CMV-IgG concentration was negative 13/165 cases (7.88%).
CONCLUSION:
Cytomegalovirus-IgG antibodies got important role as a protective agent against gestation abortion, if Cytomegalovirus-IgM antibodies are seropositive alone this is a risky factor to the pregnancy outcome

Publisher: The Iraqi Borad for Medical Specialization

Email:  IPMJ2000@yahoo.com

Editor-in-chief: Professor Dr. Zakaria Y. Arajy

ISSN: 1608-8360

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