Thi-Qar Medical Journal

Background: An empyema, or empyema thoracis, is a collection of purulent material in the
pleural space. The management and presentation varies considerably by managing physician,
geographic
location,
and
economic
resources.
Objectives: The aim of this study was to re‐emphasize the importance of open drainage in
the treatment of advanced thoracic empyema and to assess it's effectiveness in patients who
did not respond to more conservative treatment like tube thoracostomy and/ or are not fit for
major surgical interventions like thoracotomy.
Patients and Methods: The current retrospective study was carried out in the Cadiothoracic
and Vascular Unit in Ibn- Al-Nafees Teaching Hospital ( Iraq / Baghdad ) & AL-Hussein
Teaching Hospital ( Iraq / Thi-Qar ) from April 2009 to February 2017. The number of
patients included in the study was (30) patients. Most of our patients were too cachectic to
tolerate thoracotomy for decortication or more aggressive treatment. We treated them by
open drainage with rib resection.Thoracoplasty was added to some of them.

Background: Globally, depression is considered as the first leading cause of disease
burden in women at child bearing age (15-44year). Nationally, scarce information
was published regarding the prevalence of depression in pregnant women with
hyperemesis gravidarum.
Objectives: This study was carried out to measure the prevalence of depression
among pregnant women with hyperemesis gravidarum in Thi-Qar Maternity
hospitals.
Materials and methods: A hospital based cross sectional study was carried out in
two teaching hospitals in Thi-Qar Maternity hospitals from first of Sep 2015 to 31st of
Jul 2016. All pregnant women who were suffering from hyperemesis gravidarum, and
attended the obstetric outpatients in these two hospitals were included. Based on
assumed prevalence of depression among pregnant women in a previous study in Iraq
was (37.2%), so the needed sample size to calculate such prevalence with precision of
5%, confidence level of 95%, and added extra sample of 10%, was almost equal to
322. Women data were collected by using Arabic version of Beck depression
inventory-II and specialized questionnaire which was designed for the purpose of the
study. Depression considered when patients had Beck depression inventory-II score of
> 20.
Results: this study showed that prevalence rate of depression among pregnant women
with hyperemesis gravidarum was 37.1%. This rate was significantly affected by
increased gestational age (P = 0.003), high socioeconomic status (P = 0.009), previous
history of hyperemesis (P = 0.03), unwanted pregnancy (P = 0.03), and increased
gravidity (P = 0.03).
Conclusions: one-third of pregnant women with hyperemesis gravidarum in Thi-Qar
Maternity hospitals had depression. It is recommended to reinforce mental health care
of pregnant women through the antenatal care services at primary health care level,
with strengthening the mental and social rehabilitation method that were used for
diagnosed women with depression.

Psoriasis is a ,chronic inflammatory, and proliferative skin disorder with a not entirely
comprehended etiology. The aim of present study was to investigate the clinical features
and estimate the association between null of GSTM1, GSTT1 genotypes and the
development of psoriasis in Dhi Qar province. This study included 100 psoriasis patients
and 100 healthy (mean age 29.08±16.46 and 31.8±11.2 respectively). Early onset was
predominant (71%) than the late onset (mean of age onset 24.97±15.6). 51% of patients
were males , 49% were females. Among cases 80% were non smoker, 20% were smoker.
No significant between patient and control according to place of residence. Psoriasis
vulgaris found in 65% of cases. Positive family history appear in 13% of patients. More of
patients (56%) were exposure to stress during lifestyle. 5% patients were synchronized
viral and bacterial infections. Analysis of GSTM1 , GSTT1 genotype showed no
statistically significant with psoriasis susceptibility (OR=0.56; 95%, CI=0.32-0.99) and
(OR=0.48; 95%, CI=0.25-0.92). Also the combined effect of GSTM1/GSTT1 null
genotypes were found no increased risk of psoriasis (OR=0.55; 95%, CI=0.20-1.51).

Background : Patients with chronic kidney disease need permanent vascular access
for hemodialysis and the best choice is by surgically created arterio-venous fistula.
Artificial AVF is a challenging surgery because it carries a high failure rate with
increasing morbidity and mortality.
Objectives : to highlight the importance of time factor (the time interval between the
establishment of CKD to the time of creation of AVF) as a predictor factor affecting
the outcome of surgery.
Methodology : a retrospective descriptive analytic study of 216 patients ( 124 male
and 92 female) all with chronic kidney disease underwent surgical creation of AVF
for hemodialysis in the vascular unit at Sader teaching hospital/Basra, south of Iraq
from 1 st of January 2010 to 30 th of June 2012.
Results : the overall success rate was 55.55% and the failure rate was 44.45%, the
causes of failure in sequence were inadequate vein (51%), technical difficulties
(16.6%), fistula thrombosis (11.6%), bleeding (9.4%), false aneurysm (7.3%) and
distal ischemia (4.1%), the patients followed up after 24 hours, 1 week, 1 month and 6
months.
Conclusion : the outcome of the surgery is affected by the time interval between the
establishment of diagnosis of CKD and the time of surgical creation of AVF, the
success rate is decreased with increasing time interval and become abrupt after 6
months, while the failure rate is increasing smoothly with increasing time interval
with peak increase being after 6 months.

Globally, Childhood malnutrition is growing problem and an increasing public health
concern in developed and developing countries. significantly the obesity in children are
have impact on health physical and psychological aspect. Obesity in adulthood lead to
causes chronic diseases like diabetes and cardiovascular diseases at adult age. This
study aimed to estimated the overweight and obesity rate among children.
A descriptive cross sectional study was conduct in AL-dewania teaching hospital, AL
dewania city, Iraq during 2016. the study sample of under 18 years children was selected
randomly from children who attended the nutritional clinic. By using SPSS soft
ware(SPSS version 18. 0) analysis of data was carried out, version 20.0(SPSS-20.0).
Statistical significance will be considered when the P-value was equal or less than 0.05.
A total study sample was 335 children, 97(29%) was male while 238( 71%) was
female. mean ± SD of age ,weight , height and BMI was (10.7 ± 4.5), (46.9 ± 29.9),
(136.5 ± 24.9) and (22.6 ± 9.2) respectively. overweight and obesity was 41.2% most of
them female ( 79%) while underweight was 22.6% , 61.8% was female with statistical
significant (P value 0.0001). The age group 5-10 year was represented 37.6% , then age
group 11-15year was 32.5% with significant association. we concluded that the
overweight and obesity rate was high among children under 18 year, female and age
group 11-15 year had have higher rate.

Background: The sustained effect of poor glycemic control in diabetics results in a wide array
of end-organ damage as a result of small and large vessels pathology. Mortality and morbidity
are related to the progress of this damage but often there are acute metabolic deteriorations “1”.
Autonomic neuropathy (sympathetic or parasympathetic) typically accompanies other chronic
complications of DM and may play a pathogenic role through disturbed regulation of local blood
flow and affecting many systems in the body including the gastrointestinal leading to(hyper
motility or hypo-motility of different organs leading to diarrhea, constipation, gastroparesis and
gall bladder hypo-motility). The gallbladder tone is maintained by the vagal activity, but the
sympathetic activity has little or no effect on the gallbladder “5”. Due to autonomic neuropathy,
the contraction of gallbladder is poor resulting in hypo-motility, impaired gall-bladder emptying
and biliary stasis “13,14” resulting in increased gallbladder volume, which predispose to gallstones
formation“15”. Aim of study: to evaluate the prevalence of asymptomatic gallstones in relation
to of FGBV in type 2 diabetics. Subjects and methods: 47 patient with type 2 DM were
included in this study ( 37 patients were women and 10 patients were men). At first, we studied
the presence of gallstones and then we divided the subjects into two groups, those who have
gallstones and those who haven’t gallstones. Thereafter, we evaluated the fasting gall bladder
volume (FGBV) in each group to study the relation between the presence of gallstones and the
volume of the gallbladder in the fasting state. other parameters were studied in both groups
including ( gender, age, BMI, duration of DM, serum cholesterol and TG, cigarettes smoking,
family history of gallstones and HbA1c). Result and discussion: In this study that studied two
diabetic groups, one of group with gallstones and the other have no gallstones, we found that in
the diabetic group without gallstones,69.7% of the patients were women, while all the diabetics
with gallstones (100%) were women with a significant difference (P-value= 0.020). The study
also shows that diabetics group with gallstones have higher FGBV levels than diabetics without
gallstones as most of the diabetics with gallstones (35.7%) have FGBV in the reference range
of( 21 - 30 mL³), 35.7% have FGBV in the reference range of (31 - 40 mL³), while most of the
diabetics without gall-stones have FGBV levels less than20 mL³ with significant difference
between the two groups (P-value=0.0004). Conclusion: The prevalence of asymptomatic
gallstones is higher in diabetic patients with higher levels of FGBV than in diabetics with
lower FGBV levels especially in women.

The present study was carried out on 50 infertile males whose age range between
(19-49) year and 16 male, who were apparently healthy, as a control group whose age
range between (18-49) year.
The studied males were classified into two groups according to their case health to
infertile male and fertile male.
The parameters measured were seminal fluid levels lead, cadmium, zinc, copper,
chromium, magnesium, iron and cobalt. These parameters were estimated in seminal
fluid of patients and control group.
The results shown a highly significant different in levels of lead element(7.541a,
0.056b ), cadmium element(0.023a, 0.007b), zinc element(1.275a, 0.054b ), chromium
element(0.408a, 0.090b), iron element(2.172a, 0.148b), cobalt element(0.022a, 0.008b),
in primary infertile males when compared with in secondary infertile males(a:
primary, b:secondry).The results shown a highly significant different in levels of lead
element, cadmium element, zinc element, chromium element, iron element, cobalt
element, in infertile men when compared with fertile men.
The results illustrated highest level of concentrations elements in measurements was
lead element levels and cadmium levels in infertile males when compared with
control group.
As well as lower levels of concentration metals was cobalt element levels in
infertile males when compared with control group.

Methicillin resistant Staphylococcus aureus is one of the most dangerous pathogens
in the community and the hospital environment for its high resistance to antibiotics
and the production of a number of virulence agents such as toxins and biofilm. The
study aims to determine the ability of local isolates to produce the biological
membrane and its relationship to resistance to antibiotics. A cross sectional study
include (37) isolates of methicillin-resistant S. aureus from the burn department at Al
Hussein Teaching Hospital in Thi Qar province/Iraq for the period April-October
2015, The capacity of bacteria to produced biofilm was done by micro plate
technique and the antibiotic susceptibility test for vancomycin,
amikacin,
ciprofloxacin, norfloxacin, cefotaxime and amoxicillin-Claviolinate using the
diffusion technique of antibiotic disks. The study showed that 64.9% of the MRSA
isolates were able to form biofilm, while the isolates were fully resistant to the used
beta-lactam antibiotics. But, the 94.6% of the isolates were sensitive to the
vancomycin. There was no significant statistical relationship between the antibiotic
resistance and the ability of bacteria to produce the biofilm except for the
ciprofloxacin. The study showed that the local MRSA isolates have a high ability to
produce the biological membrane and antibiotic resistance with the exception of the
vancomycin with a relationship between the resistance to ciprofloxacin and the
production of the biological membrane by bacteria. Therefore, the study recommends
the use of vancomycin in medical sites to treat the infections caused by MRSA to
prevent the spread and development of these resistant strains.

Aim: To evaluate whether non-contrast Computed Tomogram (CT) parameters (stone
density, localization, size & degree of pelvicalceal system dilatation) predict the
outcome of percutaneous Nephrolithotomy (PCNL).
Method: This study included 68 patients (43 male & 25 female) with renal calculi
scheduled for PCNL. They were examined by non-contrast CT to determine calculus
size, calculus density, calculus location & degree of pelvicalceal system dilatation.
Ultrasound at scheduled PCNL follow-up one and two months later and undertaken
by 2 radiologist at the same unit (HD11XE Philips 2010 unit) checked for residual
stones. Stones equal or more than 4 mm in largest diameter was regarded as
significant.
Result : CT parameters that were associated with more residual stones ( P value
<0.001) included density less than 700 HU, upper calyx location, presence of
preoperative hydronephrosis and large stone size.
Conclusion: pre-operative CT can predict the outcome of PCNL. Stone parameters
that predict the oucome of PCNL included stone density, less than 700 HU, upper
calyceal stone, large size stone & the presence of pre-operative hydronephrosis.

Objective: The study was conducted to determine the effect of acetylsalicylic acidor
commercially called (Aspirin) on the flow rate of patients with benign prostatic
hyperplasia by the use of a self-designed flowmeter.
Materials and Methods: This was a prospective study between May 2007 and
September 2015, evaluating the effect of Aspirin 100 mg in patients with benign
prostatic hyperplasia on prostate symptom score and the maximum flow rate, using a
flowmeter designed and assembled by the author. The total number of patients
completed the study was 1338 patient, they were all assessed and flow rate measured
both before given Aspirin and after one-year time.
Results: The international prostate symptom score had a reduction in its mean
from15.431 ±2.665 SD to14.352±2.455 SD after one year of taking Aspirin, the
maximum flow rate was increased from7.66ml/sec ± 1.63 SD to9.26 ml/sec ± 1.96 SD
in the same period.
Conclusion: Aspirin is effective in reducing the symptom score of patients with
benign prostatic hyperplasia and improve the flowrate in such patients, using the
economical self-designed and assembled flowmeter.

Objective: To assess the immediate-term effectiveness of percutaneous
balloon aortic valvuloplasty (PBAV) for congenital aortic stenosis (AS).
Design: Early clinical and instrumental evaluation of 34 consecutive PBAV
performed from 2001 to 2007.
Setting: A tertiary referral center for heart diseases (Ibn Al-Bitar Cardiac
Center).
Patients: Thirty-four patients with congenital valvular AS, twenty-five males
and nine females.
Interventions: PBAV using Tayshak balloons of different sizes and lengths.
Main outcome measures: Doppler and peak to peak pressure gradient
(PG) across the aortic valve (AV) before and after valvuloplasty, the percent
of PG reduction post dilatation, left ventricular (LV) systolic and diastolic
pressures before and after valvuloplasty, number of the aortic cusps,
degree of aortic regurgitation (AR) before and after valvuloplasty, left
ventricular systolic function before and after valvuloplasty, associated
anomalies, and the need for emergency surgery were the main outcome
measures.

Objective: to assess efficacy and risks of medical treatment of incomplete abortion using
misoprostol versus surgical procedures.
Methods: A prospective comparative study included 208 women with incomplete
abortion with gestational age between 5th and 12th week randomized equally to two groups
Group I received 600 micro gram misoprostol as single oral dose and Group II underwent
surgical dilatation and evacuation. Primary outcome was successful treatment all women
give a written acceptance of being involved in the trial.
Results: There was no statistically significant difference between Misoprostol and
surgical groups regarding endometrial thickness evaluated after treatment (10.5±2.65
versus. 9.3±1.97 respectively, where P value 0.251Non significant , treatment failure (11
versus. 6 respectively, where P value 0.071 Non significant), those with blood loss more
than 500 cc ( 1 versus. 3 respectively, where P value 0.482 Non significant ) and those who
needed recurrettage ((11 versus. 6 respectively, where value 0.064 Non significant). Side
effects of treatment showed no statistically significant difference between the studied
women (fever occurred in 3 versus. 1, IUS in 0 versus. 1 and vomiting occurred in 1
versus. 3 in medical versus. surgical women respectively ,where P value > 0.05) except
diarrhea which was much more common in women under Misoprostol treatment (28
versus.
0
respectively,
where
value
<
0.001).
Conclusion: Medical treatment is effective and acceptable and less costly than surgical
treatment in women with incomplete abortion.

Background : Breast lump is a common presentation in the surgical outpatient
department with increasing awareness of both patient and clinician . The diagnosis of
nature of a breast lump was based on the triple assessment protocol which includes
clinical examination , radiological imaging and histopathologic examination . Despite
that the histopathological diagnosis is a gold standard method for nature of breast lump
diagnosis , fine needle aspiration cytology is easy , rapid , reliable and less expensive
method with high sensitivity , specificity and accuracy rate .
Objective :To assess the diagnostic accuracy of fine needle aspiration cytology in
palpable breast mass.
Methods : A total of 73 female patients with palpable breast mass were included in
this prospective cross sectional study which was performed in Al-Zahraa Teaching
Hospital , College Of Medicine , University Of Wassit from September 2016 to
February 2017 .All female patients were selected randomly irrespective of their age ,
marital status , occupation and social status .All female patients underwent fine needle
aspiration cytology in the department of pathology by expert pathologists, then every
patient underwent a definitive surgical procedure (excisional biopsy )and sent for
histopathology .The results of fine needle aspiration cytology were interpreted as
unsatisfactory , benign ,suspicion of malignancy, and malignant lesion .Then fine
needle aspiration cytology results were correlated with those of histopathology to give
an assessment of diagnostic accuracy of fine needle aspiration cytology .
Results : A total of 73 female patients with palpable breast mass were included in this
study . In 41 patients ,the breast lumps were malignant while in 32 patients the breast
lumps were diagnosed as benign .No patient had false positive results but,4 patients had
false negative results .
The sensitivity and specificity of fine needle aspiration cytology for detecting
malignancy were 90.24 % and 100 % respectively. The positive predictive value (PPV )
and negative predictive value (NPV) of fine needle aspiration cytology for malignancy
were 100 % and 88.88 % respectively .The accuracy of fine needle aspiration cytology
was 94.52 % .
Conclusion : FNAC has high accuracy for the diagnosis of the pathologic nature of
breast lump . Thus , we conclude that FNAC is an ideal method of investigation of
palpable breast lump if being performed by expert hands and the results show high
degree of correlation with the histopathologic results.

The roles of inflammatory cytokines and local placental thrombosis in patient with
unexplained intrauterine growth restriction ( IUGR ) accompanied by early onset
oligohydramnios have been shown. Since low molecular weight heparin ( LMWH )
and aspirin have both anti-inflammatory and anti-coagulant effect, we evaluated
their efficacy in patient with unexplained IUGR accompanied by early onset
oligohydramnios.
Methods: A prospective comparative study that conduct at the department of
obstetrics and gynecology at bint AL huda teaching hospital in Thiqar city between
the 1st of march 2012 to the 1st of march 2013 in which ( 80 ) patients aged between
( 20 – 37 ) years old with unexplained IUGR and oligohydramnios referring to
participated in our study, patients were divided into two groups, the
thromboprophylaxis group ( n=40 ) who received aspirin ( 80 mg PO daily ) and
LMWH enoxaparin ( 40 mg SQ once daily ), the other group ( n=40 ) was the control
group who received no treatment apart from the usual protocol that are used for
management of IUGR and oligohydramnios which involve frequent follow up. Live
birth rate, obstetrical complications, prenatal complications and hemorrhagic side
effect were recorded.
Result: There was no significance difference regarding the age, parity, BMI,
gestational age at time of involvement in both groups. The rate of successful
pregnancy was ( 75% ) and ( 37.5% ) in the treatment and control group respectively.
So the thromboprophylaxis group had a higher rate of live birth than control group (
P < 0.05 ). In thromboprophylaxis group ( 12.5% ) patients and in the control group (
37.5% ) patients had intrauterine fetal death during the period of follow up. There
were no significant difference in the number of preterm deliveries between the two
groups, no maternal or fetal side effect was seen.
Conclusion: Aspirin and LMWH are successful in treatment of IUGR accompanied by
early onset oligohydramnios by increasing the rate of live birth with few side effects
for both the mother and fetus.