Iraqi National journal of Medicine

Background and objectives: SARS-CoV-2 may affect the hemodialysis population as well as be possibly associated with their higher mortality rate. The objectives of the study were to describe the clinical presentations, assess laboratory markers, and risk factors for mortality.


Methods: This was an observational single-center retrospective study of two hemodialysis units in Basra from May 1, 2020 to June 1, 2020.


Results: Among the 11 patients, four (36.4%) died. Compared to the survivors, non-survivors had significantly longer dialysis vintage (16 ± 14.7 vs 9 ± 5.2; P = 0.048) and lower day 10 lymphocyte count (3.75 ± 0.96 vs 9.4 ± 5.6; P = 0.036). Age and laboratory parameters were not associated with the increased hazard risk for death.


Conclusions: The SARS-CoV-2 infection in hemodialysis units was linked with a high mortality rate.

Background: Diabetic foot disorders (DFD) involve several pathologies affecting the foot of patients suffering with diabetes, such as diabetic peripheral neuropathy, peripheral arterial disease, foot deformity, diabetic foot ulcer and amputation.


Objectives: To measure the prevalence and associated risk factors of DFD in a cohort of patients in Basrah, Iraq.


Methods: This is a cross sectional study that was performed in Basrah Province, Iraq, from 1/1/2019 to 1/8/2019. Patients with diabetes attending Faiha Specialized Diabetes Endocrine and Metabolism Center were screened for DFD. The participants were divided into four groups according to the International Working Group on the Diabetic Foot Classification. Data were analyzed using SPSS version 25 software.


Results: A total of 121 participants (69 females (57%)) were included. Their mean age was 53.7 ± 12.3 years. The mean duration of diabetes was 8 ± 0.6 years and the mean HbA1c was 9.6 ± 2.3%. Those with type 2 diabetes represented 115 (95%) of the total number and 63 (52%) were on insulin-based regimes. Twenty-six (21.5%) patients had callosity. The patients were classified as having no DFD, neuropathy, neuropathy with peripheral artery disease and/or foot deformity and neuropathy with a history of ulcer or amputation at frequencies of 29.8%, 52.1%, 9.1% and 9.1%, respectively. Females and patients with longer diabetes durations were identified as predictors of DFD; the p values were 0.008 and 0.019, respectively. Additionally, no significant association was detected between DFD and the type of diabetes, age and glycemic control.


Conclusions: Approximately two-thirds of the patients with diabetes have DFD in Iraq. DFD were strongly associated with long duration of diabetes and the female gender. It is crucial to conduct a proper and thorough foot examination and screen all patients with diabetes for DFD at their visit to the clinic. Such an examination may prevent the development of active disease, ulcers and, consequently, amputation.

Objectives: This study aimed to compare the surgical outcomes of rectus muscle plication with those of standard rectus muscle resection in combination with recession in patients with horizontal ocular deviations.


Methods: This comparative prospective case-control study was conducted in the Department of Ophthalmology of Basra Teaching Hospital in Iraq from March 2017 to August 2019. Fifty-eight patients (25 male, 33 female; mean age = 3.86 years), including 32 with esotropia and 26 with exotropia, were divided randomly into two treatment groups after a comprehensive preoperative assessment and selection process. They underwent the indicated rectus muscle tightening procedures. During a postoperative follow-up, a surgical success was defined as an alignment of ≤5 prism diopter (PD). Patients with different characteristics were compared statistically, and differences with P-values of ≤0.05 were considered statistically significant.


Results: Thirty cases (51.7%; 95% confidence interval [CI]: 37.9–65.5%) underwent rectus muscle resection and 28 (48.3%; 95% CI: 34.5–62.1%) underwent rectus muscle plication. Surgical success was achieved in 55 of 58 patients (94.8%; 95% CI: 89.7–100.0%), and there was no statistically significant difference in the achievement of postoperative alignment (≤5 PD) between the groups.


Conclusions: Both surgical procedures for the treatment of esotropia and exotropia coupled with rectus muscle recession yielded equivalent postoperative surgical alignment results. Plication provided advantages such as a reduced surgical trauma, fewer bloody fields, no slipped muscles, and a reversible outcome.

Background: Hypertension It is one of major public health problems in developing counties like Sudan, and increases the risk of mortality. Biochemical renal parameters are necessarily routinely tested to check for renal efficiency of patients when hypertension is a chronic disease and has many complications for long time such as renal failure.


Objective: The aim of present study was to assess serum urea, creatinine and uric acid in Sudanese patients with hypertension.


Patients and Methods: This study was analytical case control hospital based study, carried out in Wad Madani city, Gezira state from December 2019 to February 2020. Hundred subjects were enrolled in the study, 50 hypertensive patients as case groups and other 50 subjects as a control groups, the age and sex were matched in the study population. The serum urea, creatinine and uric acid were measured using biosystem (310) spectrophotometer . The data were analyzed by SPSS version (21).


Results: The (Mean±SD) of serum urea, creatinine and uric acid in case group respectively were (17. 42±6. 54mg/dl, 0. 83±0. 23mg/dl, 6. 02±1. 39mg/dl). The (Mean±SD) of serum urea, creatinine and uric acid in control group respectively were (17. 44±6. 44mg/dl, 0. 87±0. 26mg/dl, 5. 14±1. 70mg/dl). Was no significant difference between patients and control group. The serum creatinine was significantly (p-value= 0. 004) higher in males than females. Was a negative correlation between age and diastolic pressure (r=-0. 417**p=0. 003), and also was positive correlation between systolic and diastolic pressure (r=0. 292, p= 0. 039). The serum urea was negatively and positively associated with diastolic pressure and age respectively, r=0. 323, p=0. 022, r=0. 393, p=0. 005 ).


Conclusion: The study observed that, the age was positive association with serum urea and serum uric acid and also negatively with diastolic pressure. Diastolic pressure had positive correlation with systolic pressure and also positive correlation with serum urea. No significant differences between serum parameters in the study population were found. The serum creatinine was significantly increased in males than females.

Introduction: Antenatal care (ANC) includes preventive and curative care services delivered during pregnancy. The World Health Organization (WHO) suggests that pregnant women should receive at least four ANC visits. ANC is provided in Iraq in the public sector mainly in primary health care (PHC) centers with referral to higher care if required. Private sector contributes to ANC, both private clinics and private hospitals have outpatient services as well.


Objectives: This study aims to describe the ANC use among women attending PHC centers in Basrah, determine associations of ANC utilization rate with sociodemographic characteristics, and ascertain barriers to the utilization of ANC services at the PHC centers in Basrah.


Methods: This is a descriptive cross-sectional study carried out among 322 mothers (with children aged below two years) attending four PHC facilities in rural areas of Basrah. Data was collected through direct interview of the mothers by the investigator.


Results: The study found that 15.8% of the mothers in rural areas of Basrah made no ANC visits to the PHC centers, 44.8% had between one to three visits, and just over one third received the recommended four or more ANC visits (39.4%). The study found significant association of ANC services utilization in PHC centers with number of children, mother’s occupation, family income and woman’s desire for pregnancy (p < 0.05). The most reported barriers by mothers to availing ANC services included: preference of private medical care, difficult to leave elder children, no one accompany, laziness, ignorance, forgetfulness, lack of authorization by husband, distance to health center, health-related barrier and transportation barrier.


Conclusion: This study found that ANC services in PHC centers were underutilized. Intervention aimed at raising women’s awareness of the significance of ANC services and improving utilization, especially in rural areas, is necessary.

Background: Cranioplasty refers to the surgical repair of a defect or deformity of skull that may result from trauma, growing skull fracture, congenital encephalocele, neoplasm.


Objectives: To evaluate the efficacy of monomeric acrylic implant material in cranioplasty


Patients and methods: Retrospective analyses of (64) patients undergoing cranioplasty over five years from January 2010 to December 2015 were performed in AL- Kadhimiya teaching hospital Baghdad, Iraq. Monomeric Acrylic was used in all patients and cranioplasty were performed under general anesthesia. 26 RTA, 19 bullet injuries, 7 FFH, 5 fan injuries, 4 congenital encephalocele, 3 brain tumors.


Results: A total of 64 cranial defect patients, 48 males and 16 females, were studied. Surgery had been conducted on all using monomeric acrylic designed in the hospital. Wound infection occurred in one patient, postoperative seizure in two cases, and dizziness post operatively in one case.


Discussion: The monomeric acrylic implant is considered the most compatible material as it can be easily used and prepared in a dental laboratory, is cheap, light weight, radiolucent, requires no thermal production, is malleable, sterilizable, and non-magnetic.


Conclusion: The monomeric acrylic implant designed in a dental laboratory is a new material used in cranioplasty which is malleable, sterilizable, nonmagnetic, radiolucent, light weight, inexpensive with easy and short surgical procedure and less post-operative complications.


Recommendation: Monomeric acrylic is the ideal synthetic material for cranioplasty; it is relatively safe, provides an acceptable aesthetic reconstructive option and contributes to neurological improvement in the treatment of cranial defect.

Background: Renal stone is one of the most common renal diseases worldwide. There are several modalities for treatment of renal stone disease, one of these modalities is the use of percutaneous nephrolithatomy (PCNL) surgery which can be done either under fluoroscopic or ultrasonic or even combined fluoroscopic and ultrasonic gaudiness. The purpose of this study is to compare the outcome of combined ultrasonic and fluoroscopic versus fluoroscopic guided PCNL.
Materials and Method: This is a prospective study done in AL Basrah teaching hospital from May 2015 to December 2019, 200 patients with the diagnosis of renal stone indicated for PCNL surgery and operated on in standard prone position. One hundred forty-eight patients were operated on using fluoroscopic guidance. The other 52 patients were operated on using combined ultrasonic and fluoroscopic guided PCNL. Statistical analysis for the results regarding the outcome and complication was done using SPSS 22 program.
Results: The mean BMI of the two groups was 28 in fluoroscopic group and 27.3 in the combined ultrasonic and fluoroscopic group (p=0.30). The mean stone burden was 21.5 and 24.4 in fluoroscopic and combined group, respectively (p=0.20). The stone free rate was 85.5% in fluoroscopic group and 88.5% in combined group, that was of no significance (p = 0.16). Overall 17 patients (11.4%) in fluoroscopic group and 5 patients (9.6%) of combined group had complications (p=0.11). Mean operative time in fluoroscopic group was 85 minutes, and in the combined group it was 78 minutes (p=0.39). Mean hospital stay was two days for both groups. There were no reported cases of visceral injury in both groups.
Conclusions: This study showed that patients treated by combined ultrasonic and fluoroscopic guided PCNL had the same outcomes of fluoroscopically guided PCNL with the advantage of lower time of radiation exposure in the combined group.




Abbreviations: PCS: Pelvi Calyceal System, US: Ultra Sound, CT: Computed Tomography, BMI: Body Mass Index, URS : Uretroscopy.

Background: A low-dose X-ray mammogram is considered the most useful tool for detecting early-stage breast cancer among women. Both mortality and morbidity prove to be reduced when cancer is detected early, before any signs and symptoms appear. This study aims to determine the knowledge level, attitude, and practice of women at general hospitals/consulting clinics in Baghdad city in 2017.
Methods: This cross-sectional study was conducted on a sample of 657 women in general hospitals/consulting clinics in Baghdad. The women were selected as an improbability sample. Their average age was between 20 and 59 years. Data collection extended from 1st April to the end of July 2017. A pre-tested questionnaire was adopted and filled through a face-to-face interview. Data were analyzed using descriptive and analytical statistics.
Results: The sociodemographic features of the participant women showed a mean age of 37.6 ± 11.3 years with a majority of them (71.1%) having no education and 34.6% being of high social class. More than half of the women (61.2%) had heard of mammography, and this is significantly related to age and social class (< 0.001). Only 7.6% had adequate knowledge on mammography according to the American Cancer Society (ACS) recommendations, and the women with adequate practice of mammography had higher knowledge scores than those with inadequate practice.
Conclusion: The study results suggested that the practice of breast cancer screening or mammography was inadequate in a majority of the participants and needs to be improved.

Background: The family members of schizophrenic patients frequently report that caring for the patient imposes a great burden on them and hampers the typical structure and functioning of the family to the detriment of its members.
Objectives: To assess the level of the burden of care (objective and subjective) shouldered by the primary caregivers of schizophrenic patients and to determine the relationship between the objective and subjective level of such burdens.
Method: A descriptive analytical study was conducted on a purposive sample of 50 primary caregivers of schizophrenic patients who were hospitalized in Ibn-Rushd Psychiatric Teaching Hospital in Baghdad. The data were gathered utilizing self-administered questionnaires, namely, the objective burden questionnaire (OBQ), the subjective distress questionnaire (SDQ), and the self-reporting questionnaire (SRQ 20).
Results: It was revealed that the primary caregivers of schizophrenic patients experienced high levels of objective and subjective burdens. Significant differences were observed in the relationships between the objective and subjective burdens and between objective burdens and the SRQ 20 at p≤0.05 and p≤0.01, respectively.
Conclusions: Schizophrenia affects the interactions and routine among family members much more substantially than their income and leisure.

A 49 years nullipara lady with history of primary infertility for fifteen years, she had heavy menstrual bleeding over the last years causing anaemia. the patient presented with severe lower abdominal pain start in the sub-umbilical area and radiated to the genitalia ,with no response to analgesia.


On examination the patient was normotensive but there was tachycardia, on abdominal examination there was lower abdominal tenderness; no guarding with hard irregular mass of 22 weeks size. bimanual pelvic examination revealed severe vaginal bleeding associated with clot, bulky tender irregular shaped uterus of approximately 20–22 weeks in size with bilateral fullness in the adnexa.


Blood investigations revealed leucocytosis with a white blood cell (WBC) count of 12 x 109/l, bHCG titre was less than 2 µ/l with normal hepatic and renal function test. MRI and ultrasonography revealed multiple uterine fibroids, the largest being the subserous of 8 * 8.5 cm project from the posterior fundal wall with distorted uterine axis with possible uterine ischemia, as well as a cervical fibroid of 4.4 * 3cm and minimal amount of free fluid in the pouch of Douglas.


Urgent laparotomy was done under spinal anesthesia the abdominal wall was opened through Pfannenstiel incision. There was hemoperitoneum of approximately 500 ml with large, deformed uterus containing multiple subserosal fibroids. one of them was congested, and its feeding vessel was ruptured. the uterus was twisted about 360° at the level of the isthmus.


the uterus had re-twisted and total hysterectomy and bilateral salpingo-oophorectomy was performed.


Histopathological examination revealed a uterine size of 20 x 16 x 6 cm with multiple intramural and subserosal myoma, the largest of which measured 5 x 5 cm with foci of adenomyosis; there was no significant pathology in the ovaries and fallopian tubes.


the postoperative period passed smoothly, and the patient was discharged after two days