Thi-Qar Medical Journal

Background: Obesity associated with high risk of cardiovascular disease and diabetes due
to impairment in glucose and lipid metabolism as well as low grade inflammatory response.
Hypothalamic hypodopaminergic state is observed in obese subject. Accordingly, treatment
with Bromocriptine, a centrally acting dopamine D2-receptor agonist, was reported to
regulate food intake and improve insulin sensitive and glucose tolerance in obese subject.
Aim: The objective of this study is to investigate the potential effect of bromocriptine on
body weight and metabolic parameter as well as the inflammatory response in obese women.
Method: Out of 46 women enrolled in the study, 12 women did not complete study. The
remaining 34 patients divided into two groups Group I: Control group (N=16), this group
advised only for dietary therapy plus life style modifications. Group II: Bromocriptine group
(N=18); The women of this group given 2.5mg bromocriptine at morning once daily for 12
weeks in addition dietary therapy plus life style modifications as in group I.Body weight
(WT) and body mass index (BMI) and Fasting blood glucose level (FBG) , Lipid profile
[total cholesterol (TC), triglyceride (TG), high-density lipoprotein (HDL-C), low-density
lipoprotein (LDL-C)] and inflammatory markers high sensitive C-reactive protein (hsCRP)
and tumor necrosis factor alpha (TNF-α) were measured before and after 12 weeks of the
treatment.

Objective: In order to assess the some factors related with the admission of the neonates to
neonatal intensive care unit, moreover to find out the relationship between these factors and
outcome of the neonates.
Methodology: A retrospective review of record / cross sectional study was conducted in Al
Kut hospital at Wassit governorate among a sample of women under 34 years of age during
the period from 1st of January 2015 to end of February 2015. Data collection was done by
using a hospital records that includes all the information.
Results: The results showed that the mean(±SD) values of age for Neonates was (26.62 ±0
.093weeks), and the mean(±SD) values of weight for Neonates was (2.9809± 0.03616 kg).
The majority of neonates admission to the NICU because of respiratory distress syndrome,
they have accounted more than half . Correlation analysis of results, showed that there was
significantly positive correlation between birth type and other risk factors for the neonates.
Also, it was observed from the results that there was significantly positive correlation between
birth type with causes of admission and causes of death in NICU.
Recommendations: One of the main recommendations of the study are improvement the
health and nutrition of mothers and provision of reproductive health services especially
obstetric care and postpartum care at the right time for both mothers and newborns. In
addition to enhancing the links between the different levels of care in health facilities.

Background:
Rheumatoid arthritis (RA) is the most common form of inflammatory arthritis, which is an
autoimmune disease characterized by chronic inflammation of synovial joints, ultimately
leading to joint destructions and permanent disability.
In RA oxidative stress are impaired (which caused by free radicals) might have an essential
role in the etiology of RA.
Objectives:
The objective of this study was to determine oxidative stress by measuring malondialdehyde
and enzymatic status by estimating superoxide dismutase, catalase and glutathione peroxidase
in patients of RA and then comparing with healthy individuals.
Setting and design:
A total 42 patients with Rheumatoid Arthritis (20 females, 22 males) in the age of 30-50 years
were included, as a control, 50 matched healthy volunteers (20 females and 30 males) were
involve, non of the subjects smokes nor receiving any form of drugs. Subjects with any acute
infections or with coexisting system disease such as coronary artery disease, hypertension or
chronic renal failure were excluded.
Methods:
Antioxidant enzymes in erythrocyte , superoxide dismutase (SOD), glutathione peroxidase
(Gpx) and Cayalase (CAT) was measured.
Malondialdehyde (MDA) along with Copper, Zink and Iron are measured by using the serum
of the patients and control group.
Results:
The serum level of MDL was higher in RA patients compared with the control group, the
differences among both groups was statistically significant (P < 0.001)
Conclusion
There is oxidative stress in RA patients evidenced by increased serum MDA and decreased
antioxidant enzymes activity.

Background: The most common site for salivary gland tumors is the parotid gland;
accounting for (64% - 80%) of all cases .The pleomorphic adenoma is the most common
tumor (53% to 77%) of all cases in the parotid gland. The treatment of choice for most parotid
tumors is surgical excision. One of the main aims of superficial parotidectomy is to minimize
injury to the facial nerve and maximize the rate at which it recovers. Two techniques are used
for dissection of the facial nerve in parotid surgery: antegrade technique and retrograde
technique.
Objectives: The aim of this prospective study is to compare between the two techniques to
know the best method of dissection to preserve the facial nerve integrity.
Patients and Methods: This study presents the surgical excision of benign parotid tumors in
60 patients who complained from a mass in the parotid region. These cases were collected
from maxillofacial surgery unit in AL-Shaheed Gazi AL-Hariri Hospital / Medical
city/Baghdad from May 2009 to July 2011 and in AL-Hussain hospital in Thi-Qar from 2013
2016 .The age of those patients ranged from (19 – 60) years with a mean of 40.9 years. The
patients divided into two groups, the 1st group (30 patients) underwent antegrade superficial
parotidectomy and the 2nd group (30 patients) were underwent retrograde superficial
parotidectomy. The assessment of facial nerve function is categorized into 6 grades according
to House- Brackmann grading system. This assessment was started in 1 week, 1 month, 3
months and 6 months postoperatively.

Objectives: To assess the effectiveness of single calculated dose of dexamethasone
per-operatively in reducing pain in pediatric adenotonsillectomy.
Materials and Methods: its retrospective study of One hundred fifty patients
underwent adenotonsillectomy with age range of 6-12 years old divided into two
equal groups , the 1st group (treatment) receive single dose (0.5mg/Kg)
dexamethasone intravenously at induction of general anesthesia , the 2nd (control)
receive nothing , pain assessed postoperatively at 2, 8 and 16 hours using Visual
Analogue Score (Mild "1-4" , Moderate "5-7" and Severe "8-10") .
Results : The difference at 2 hours postoperatively was statistically insignificant , but
at 8 and 16 hours it was statistically significant (P-value <0.05) .
Conclusion : single dose dexamethasone at induction of adenotonsillectomy general
anesthesia significantly reduce pain in the postoperative period .

Study was done Over the past one year, starting from January 2016 to the end of October 2017,
an observational, analytical –cross-sectional study had been conducted in Al-Hussein Teaching
Hospital in Al-Nasiriya city to study the estimate the incidence, severity, and mode of splenic
injuries in blunt abdominal trauma, other objectives were to detect sensitivity investigations, and
modalities of management in this injuries.
A representative sample of 67 individual aged (6-77) years through multistage sampling had been
included in the study . The diagnosis of the cases was clearly depending on the history, physical
examination and investigations (ultra-sonography and CT scanning)
The overall 67 patients with blunt splenic injury were identified (47 males, 20 females). The
mean age of patients with splenic injury was 24.7 years .The most common cause of injury was RTA
(88.2%). The most common grades of splenic injury were grade I, II. Majority of patients arrived to
emergency unit after 2 hours .The most patients with RTA were managed as splenectomy (60.0%).
The abdominal pain and abdominal tenderness were the most common clinical finding in splenic
injury patients arrived to emergency unit. More than half of patients were stable at time of arrival to
emergency unit (62.6% s ) .Splenectomy was the most common type of management (50.7%), while
the conservative management was 19 patients (28.3%) most of them at age under 20 years.
The study will help in establishing the priorities to act on according to the problems and their
impact. Also to design the strategies for control and treatment of patients with blunt splenic injury in
emergency unit.

Background: Measurement of population health is important means to identify a given health
status indicators and indicators of the effects of health programmes.
Objectives: To measure selected health indicators of the catchment population of two primary
health care centres and to support data base for the purpose of better care provision and to
compare pattern between urban and rural communities.
Methods: A cross-sectional survey involving 557 families (3785 individuals) from two primary
health care centres catchment population, namely: Al-Zuwain Village in northern part of Basrah
governorate and Hay Al-Muhandisin in Basrah city centre.
Results: The main findings were the similarity of age pattern in both populations and the very
sharp decline in population share as age advanced. The percent of married persons was high in
Al-Zuwain compared to Al-Muhandisin population. Acute illness episodes were equally
reported in both population with some variation in some individual disease entities. The use of
preventive care was very acceptable and comparable in both populations. The local primary
health centre was the main source of curative care in Al-Zuwain but not in Al-Muhandisin
population.
Conclusions: Household surveys represent a good source of additional information on various
aspect of population, they are feasible and of multipurpose approaches to data acquisition. In
this study, The overall pattern of services utilization is similar in rural and urban population with
few exceptions. However the pattern of morbidity and use of curative care is different.

Background: Sepsis during neonatal life is one of main leading attributer of the
neonatal mortality, it consider as a major morbidity constituents, especially in the 3rd
word and developing countries.
Identification, diagnosis and treatment delays of this main problem consider as the main
cause of mortality for this group of population.
Aims of the study: to determine the main risk factors for neonatal sepsis in Al-Nasiriya
public hospitals at 2017
Methods:A case control - hospital based study was done in Al-Nasiriya public hospitals –Southern of Iraq, extended over a period of 2017, neonates who had sepsis were the
Cases, while with their index of pediatrician diagnosis while neonates who hadn’t
sepsis consider as controls. clinical and proper laboratory investigations was done for to
prove the inclusion and diagnostic criteria for both Cases and controls. Control and cases
had been selected by using systematic random sampling. Spss version 23 had been
used for statistical analysis . graph Bad had been used for epidemiological analysis. P
value < 0.05 consider as significant. dependent and independent association had been
tested by using binary logistic regression model, while identification of the associated
risk factors to neonatal sepsis was tested by multivariable logistic regression.
Results: A total of 150 neonate had been studied allover 2017, sixty cases and ninety
control, with mean gestational age (37.5467± 2.36753), . near three quarters(72%) of
NS were with EOS(<7 days), while the remainder were with LOS. The only Maternal
age (21-35), CS as a mode of deliver, presence of( bleeding, PROM, maternal fever),
and low birth weight of the of the neonate were strong risk factors for neonatal sepsis ,
APGAR <7, MSAFA<7 and Not crying immediately might be consider as neonatal
sepsis predictors that might give hint for early initiation proper antibiotic
Conclusion: Both neonatal and maternal factors had contributed to the risk of NS. The
crucial things are improvement of institutional delivery practices as well as
Strengthening of the existing risk based prevention strategies.

Context: Thyroidectomy is a major as well as common surgery usually performed by
endocrine or general surgeon. The postoperative complications, although rare in
experienced hands, have severe implications on the patients.
Aim: - this study issued in Iraqi hospitals aimed to assess the effects and outcomes
that result following ligation of the inferior thyroid artery during the procedure of
thyroidectomy versus those which may follow thy roidectomy without ligation of this
artery especially in the immediate postoperative period.
Patients & Methods: in this study 30 patients presented with goiter underwent
different operations done by different surgeons from Jan. 2016 to Jan. 2017. The
evaluation included the intraoperative maneuvers concerning ligation of the inferior
thyroid artery during thyroidectomy whether ligation is done in continuity or by
ligation-division or as temporary ligation & the effect and outcome of this step was
studied in relation to the immediate postoperative complications in comparison to
those without ligation of the inferior thyroid artery .
Results: the immediate postoperative complications and outcome following
thyroidectomy with or without ligation of the inferior thyroid artery are relatively
similar and show no significant difference.
Conclusion: the study results showed that no statistically significant difference was
reported following thyroidectomy with ligation of the inferior thyroid artery versus
those without ligation of this artery. Actually ligation of this artery has no effect on
the outcome and subsequent postoperative complications .

Background: Long standing metabolic derangement in diabetes mellitus(DM) is associated
with functional and structural changes in many organs particularly the vascular system,
where hyperglycaemia represents an independent risk factor for both small and large blood
vessels diseases which lead to the clinical complications of diabetes”1”. Poorly controlled
type 2 DM is associated with microvascular, macrovascular, and neuropathic complications.
Microvascular complications of DM include retinal, renal, and possibly neuropathic disease.
Macrovascular complications include coronary artery and peripheral vascular disease”4”.
Blood pressure should be measured in both arms either in rapid succession or simultaneous-
ly ; normally the blood pressure measurement should differ by less than 10 mmHg,
independent of handedness. However, as many as 20% of healthy individuals have a blood
pressure difference greater than 10 mmHg in the absence of symptoms or other examination
findings. Blood pressure difference of >10mmHg can be associated with subclavian artery
disease(atherosclerosis or inflammatory), supravalvular aortic stenosis, aortic coarctation, or
aortic dissection”6”.
Aim of study: To explore the association of type 2 diabetes mellitus and inter-arm
difference of blood pressure.

Background: Patients with cardiovascular diseases might be poorly educated
regarding the rational use of their drug treatment, such as dealing with missing doses,
relationship to food, and potential side effects. In addition, many poor quality
medications are available in our drug market that might differ in their efficacy and
safety profiles.
Aim: Metoprolol, a commonly used drug in our local medical practice, is to be
investigated through measuring its blood concentration at one point of time after
achieving the steady state, and to correlate blood concentration with compliance, side
effects and the quality of brand products they are using.
Methods: Measurement of levels of metoprolol (by scanning spectrometry) in blood
samples taken from patients at their visits to the consultation clinics in Thi-Qar during
the period October 2014 to April 2015 was made. Their blood concentrations was
correlated with compliance, side effects and the quality of the drugs they were using.
A questionnaire containing patient demographic information, type disease, type of
drugs, trade names, and a check-list of potential side effects, was used.
Results: Out of the 56 patients who were treated with different preparations and
dosage regimens of metoprolol, 53 patients were within the reported therapeutic range
of metoprolol plasma concentration (0.035-0.5µg/ml). The two brand metoprolol
products used were found interchangeable with no significant difference in their
achieved plasma concentration. The most frequent adverse effects associated with the
use of metoprolol were tiredness followed by dyspnea and bradycardia. There is no
difference between the two brand products of metoprolol in relation to the frequency
of side effects. Around 90% of patients using metoprolol were not aware of the proper
action to be taken when they miss a dose. 23.2% of patients who reported missing one
or more doses did not take any action till the next dose.
Conclusion: Availability of more than one brand product of metoprolol and other
drugs need to be investigated in terms of their blood levels and occurrence of adverse
effects especially when these drugs are used for long duration to test their
interchangeability. Patient awareness of the proper use of drugs is necessary in order
to increase effectiveness of their treatment and decrease potential side effects.

Staphylococcus aureus is an important bacterial pathogen associated with a wide
range of infections due to its ability to produced several types of virulence factors. The study
aimed to determine the prevalence of serine-aspartate dipeptide-repeat region (sdr C and E)
genes among S. aureus isolates from different sources. A total of 37 isolates was conducted in
this study divided into 17 isolates from tonsils infections and a 20 isolates from nasal carriage,
the prevalence of sdrC and sdrE genes was detected by polymerase chain reaction technique.
The results showed high prevalence of sdrC and sdrE genes among bacteria from tonsils
infections in compared with isolates of nasal carriage with high significant differences. Also,
sdrC gene was high prevalent than sdrE in tonsils isolates than in nasal carriage. In brief, the
sdr genes highly prevalent in S. aureus isolates from invasive infections when compared with
nasal carriage isolates with predominant of sdrC gene.

A descriptive study was performed on 82 patients diagnosed as colonic polyps out of
1538 colonoscopy done at AL-Hussain Teaching Hospital between 2007-201. The
incidence of colonic polyps is (5.3%). Among 82 studied patients ( 67 % ) were males
and (33 %) were females. Average age was 42.5 years (range 4-81 years). Non
neoplatic polyps were more prevalent under age of 20 years while above 20 years most
polyps were neoplastic. Bleeding per rectum (50 %) was the most frequent symptom
followed by abdominal pain (25.6 %).Neoplastic polyps were (80.5 % ) out of the total
while the non-neoplatic represent only (19.5 %.). Most non-neoplatic polyps had been
encountered in the rectum while polyps in the sigmoid were mostly neoplastic. Among
adenomatous polyps, tubular adenoma (71.2 %) were the most frequent type, villous
adenoma (27.3%) while serrated adenoma is the least common type (1.5%).
Low grade dysplasia was found in (68.2% ) of adenomatous polyps while (28.8 %) and
(3%) were of moderate and high grade dysplasia respectively.

Background: epispadias is an unusual congenital malformation of the penis and is often part of
the condition termed epispadias exstrophy complex. There are different surgical techniques for
repair of epispadias.
Objective: evaluation of our experience in male epispadias repair by modified Cantwell - Ransley
technique.
Patients and Methods: Twenty-four male patients with epispadias (eighteen cases with isolated
epispadias and six cases associated with bladder Exstrophy) had undergone repair by modified
Cantwell-Ransley technique in Al-Sader Medical City, Najaf. The patients age range from 1 year
to 26 years with mean age 8.6 years. Primary repair was achieved in 20 patients and secondary
repair was accomplished after prior unsuccessful closure in four patients.
Results: The patients were followed up at 3, 6 and 12 months postoperatively. No patient
develops major complication like urethrocutaneous fistula or urethral stricture. One patient
develops minor skin dehiscence.
Conclusion: Epispadias repair by modified Cantwell-Ransley technique have excellent functional
and cosmetic result.

Background:
The effect of the site of perforation of tympanic membrane and amplitude of hearing
difficulty is discussed in many authors with different results we try to estimate these
relationships in our study.
Method:
A cross sectional analytic study off 55 patients with chronic suppurative otitis media.
The tympanic membrane was divided into four segments according to the relation of each
to handle of malleus, antero-superior, antero-inferior, postero-superior and postero
inferior.
Hearing level of each patient was assessed in decibel with audiometer at frequencies from
250Hz to 8kHz in acoustically treated sound proof room.
Results: in our study we found that the highest incidence of csom at age group (15-34)
year and highest number and percentage of perforation were in anter-inferior segment of
tympanic membrane (34),(66.6%) followed by postero-superior segment (7),(13.7%) then
postero inferior (6),(11.7%) and antero-superior one (4),(7.8%).No significant sex
difference.
The conclusion was the clear effect of the site of perforation in relation to degree of
hearing difficulty.

Background;
Psoriasis is a one of the common dermatological diseases with no curative topical or
systemic treatment, Curcumin is a naturally occurring phytochemical present in
turmeric; it was traditionally used for the treatment of many skin diseases. This study
was designed to evaluate the anti-psoriatic effect of curcumin preparations.
Objectives; this study aimed to examine the probability of anti-psoriatic activity of
topical curcumin by using mouse tail model.
Methods; The extracted curcumin was assessed for antipsoriatic activity using a
mouse tail model of psoriasis. 18 animals were divided into three groups (6 animals
each).
Group A: control group (cream base treated group)
Group B: (treated with curcumin cream 1%)
Group C: (treated with curcumin cream 2 %)
Granular layer formation, epidermal thickness and drug activity were taken as an
evaluating parameter to detect the efficacy of the new preparation.
Results; The local application of curcumin 1%, 2% on the mouse tail skin produced a
significant differentiation in the epidermis, as seen from its degree of orthokeratosis (
43.4± 0.75) and ( 44.4 ±0.98 ) respectively when compared with the negative control
(17.06±2.5 ).
Conclusion;
Topical curcumin have anti-psoriatic activity and seems to be well tolerated on skin
since the incidence of side effects was limited except staining of skin by an orange
color.

Background: Staphylococcus aureus is an imperative cause of community acquired infections
and nosocomial infections,The formation of biofilm on host surfaces and adherence is
painstaking to be significant virulence factor in S. aureus.

Objective:The main objective of this study is to detect and describe the distribution of S.
aureus and icaB gene in wound infection samples taken from patients at Al-Hussein Teaching
Hospital in Thi-Qar province, Iraq, during the period extended from February to September
2007.
Materials and Methods:A total number of bacterial isolatesincluded 130 sample recovered
from different woundsof patients in burn unit. All isolates of the targeted bacteria were
subjected for screening the biofilm allied gene (icaB) by Polymerase Chain Reaction (PCR)
technique.
Results: The recent data indicated that 72 (55.3%) identified as S. aureus, and the females were
likely more affected with S. aureus infection than males (47 > 25). The results of PCR recorded
that icaB gene was expressedonly in 61% of all isolates.

Conclusion: The recent results recorded a high percentage of icaB gene
which related with biofilm production may be increased the pathogenicity of
this pathogen which caused different human diseases.

Objective: A gallstone (also called cholelithiasis) is a crystalline concretion formed within
the gallbladder by accretion of bile components. These calculi are formed in the gallbladder
but may distally pass into other parts of the biliary tract such as the cystic duct, common bile
duct, pancreatic duct or the ampulla of Vater. Rarely, in cases of severe inflammation,
gallstones may erode through the gallbladder into adherent bowel potentially causing an
obstruction termed gallstone ileus..The study was designed to determine and compare the
levels of lipid profile, and MDA in gallstones diseases and healthy individuals. Material and
Methods: Blood lipid profile and malondialdehyde levels were determined in 50 gallstones
Disease and 40 healthy subjects . Results:The levels of serum malondialdehyde and
biochemical markers of body lipid profile (serum TCH,TG,LDL,VLDL) were showing
significant increase in gallstones disease patients as compared to control group whereas the
levels of HDL showed a significant decrease in gallstones disease patients in comparison to
control subjects( P ≤ 0.01 ).. However we compared all measurement parameters for all
groups according to type of disease.
Conclusion: In gallstones Disease, we finding a significant elevation in the levels of
cholesterol and triglyceride during gallstones disease. -Gallstones disease can effect on lipoproteins levels (high LDL, low HDL, and high VLDL.
The increase in lipid peroxidation in gallstones disease, the increase in cholesterol, TG,
LDL,VLDL . In gallstones disease lipid peroxidation can clearly occur.