Iraqi National journal of Medicine

Background Hydatidiform mole (HM) is a placental pathology, which is a form of gestational trophoblastic disease (GTD). HM is classified into complete hydatidiform mole (CHM) and partial hydatidiform mole (PHM). The incidence of molar pregnancy varies according to the geographical area. It is found to be higher in developing countries. Age is a risk factor for developing HM. In this study, we aim to determine the frequency of hydatidiform mole among cases of early trimester evacuation specimens and its relation to patient's age at Basrah maternity and paediatric hospital and Al- Mosawi private hospital.





Patients and Methods This was a descriptive retrospective study for a four-year period; all cases of early trimester evacuation specimens were from January 1, 2017, to December 31, 2020. All specimens were fixed in 10% formalin and dehydrated in graduated alcohol, (5) micron thickness sections were obtained, stained with hematoxylin and eosin and examined, and cases of CHM, PHM and RPOG were analyzed.





Results A total of 216 evacuation specimens were examined, and the patients age ranged from 14–50 years. Among these, 78.2% of patients were between 20 and 30 years. The percentage of RPOC was 54.2%, while that of CHM was 19.4% and that of PHM was 26.4%. The maximum cases of complete and partial mole were in the 20–30 years age group.





Conclusions The frequency of HM was high compared to many other studies.

Background: Celiac disease (CD) is caused by a reaction to the dietary gluten in genetically predisposed individuals. Measuring of serum IgA antibodies to human tissue transglutaminase (tTGA) can be used alone for the diagnosis of celiac disease. However, it is recommended that individuals with positive tTGA antibodies should have a duodenal biopsy to confirm the diagnosis of CD.


Objectives: This study aims to clarify the extent to which the anti tTGA serological assay can replace the need for performing duodenal biopsy in the diagnosis of CD.


Patients and Methods: This study was conducted in the Basrah University Teaching Hospital laboratory, Jasim Aldiab laboratory, and Al-Moosawi private hospital in the period of 1st January 2019 to 1st October 2021. The cases included in this study are 190 individuals subjected to tTGA serological test and duodenal biopsy. Marsh I and Marsh II categories were not considered diagnostic of CD, while Marsh III category was considered diagnostic of CD. The sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) of the tTGA test were calculated.


Results: The sensitivity of the tTGA was 57.1%, the specificity was 92%, the PPV was 95.2%, and the NPV was 43.4%.


Conclusions: The study concludes that the duodenal biopsy can be omitted in patients with negative serum tTGA antibody because of high specificity but cannot be used as a sole tool for the diagnosis of CD because of low sensitivity. Thus, depending on the serological test could lead to missed diagnosis of some CD cases.

Background: Management disorder of vital signs remains a critical issue worldwide, particularly regarding hypertension in chronic renal disease (CRD), both of which are associated with a higher risk of cardiovascular (CV) and renal events. Physical inactivity resulting in poor exercise capacity is a common consequence of chronic kidney disease and is associated with increased mortality in the general population. Nursing management for patients undergoing hemodialysis requires an experienced nurse who understands the types of complications.


Objective: The present study aimed to evaluate the effectiveness of resistance exercise therapy on patients’ physiological status by utilizing a checklist of physiological parameters and comparing it with a control group.


Patients and Methods: The study was designed as a randomized controlled trial (RCT), using a double-blind technique, and it was conducted on patients divided into two groups (study and control groups). A total of 63 patients were included as follows: 32 patients for the study group and 31 patients in the control group. The patients were diagnosed with chronic kidney disease and were undergoing hemodialysis. The patients were randomly assigned to receive exercise therapy under the supervision of trained therapists during the second hour of the three routine hemodialysis treatments per week and under the supervision of the researcher. The study took place in Al-Najaf Al-Ashraf City/Al-Sadder Medical City and Al-Hakeem Hemodialysis Center.


Results: The study results indicated an improvement in the physiological status of the study group compared to the control group.


Conclusions: Exercise therapy effectively improves the physiological status of patients with chronic kidney disease undergoing hemodialysis.

Background: Osteoporosis is a metabolic bone illness that occurs in males and females and is widely disturbed around the world. Research show that females are more affected after menopause than males due to decreased estrogen secretion. The aim of this research is to evaluate the knowledge, attitude, and practice of family physicians concerning osteoporosis. Patients and Methods: A cross-sectional study started from May to July 2020 in Babylon region. Almost all family physicians work in rural and urban areas in Babylon governorate have been included in the current study. A self-administered questionnaire was collected after taking verbal consent from all participants, with no exclusion criteria. The first part focused on demographic and specialized practice information data, while the second part contained a Knowledge, Attitude, and Practices (KAP) survey.


Results: Out of 97 family physicians, 59% scored moderate, 34% poor, and 6% good in awareness response. Regarding attitude response, 76% were good, 22% moderate, and 2% poor. In practice response, 53% were moderate, 33% good, and 13% poor. There was a significant association between place of work and attitude, source of experience and practice, practice and osteoporosistraining course, practice and use of guidelines, and the years of work and practice.


Conclusions: Most family physicians in Babylon province had moderate awareness, good attitude, and moderate practice towards osteoporosis. Family doctors working in hospitals had poor attitude towards osteoporosis. Therefore, all family doctors can benefit from training courses, especially family doctors who work in a hospital. Further, the current osteoporosis guidelines must be revised for any mistakes.

Background; Calcium is necessary nutrient for normal growth and development. The study aimed to document the normal values of serum calcium levels in healthy Sudanese adults in gezira state and its relation to the body mass index (BMI).


Patients and Methods: A cross-sectional study was conducted during 2018 to 2021 in Gezira state on 534 adults,42.3% (226) were males and 57.7% (308) were females, age ranged from 20 and 60 years. A questionnaire was used for data collection to assess the essential demographic data. Three ml of blood was collected in heparin vacuum tubes and serum calcium was measured by Calcium-O-Cresolphthalein Complex one colorimetric method. Statistical analysis was done using SPSS version (23). BMI was calculated as the weight in kilograms divided by height in meters squared (kg/m2). The participants were further grouped into four groups based on BMI as follows: underweight, normal, overweight and obese.


Results: The mean serum calcium levels of participants with overweight and obese were (9.58± 0.68, 9.75 ± 0.64) respectively, for females (9.42 ± 0.63, 9.47 ± 0.62) respectively, for males as compared to (9.43 ± 0.72,9.52 ± 0.79) for females (9.26 ± 0.67, 9.35 ± 0.72) for males with underweight and normal BMI, respectively. BMI correlated positively and significantly with serum calcium levels in obese individuals (r = 0.72, P = 0.00).


Conclusion: Our study revealed that, serum calcium is positively associated with BMI in both sexes. Micronutrients such as calcium should be considered in the management of obesity/overweight.

Background: Reduction mammoplasty is a technique used for treating women with breast hypertrophy, in addition to improving the appearance of these breasts. Hence, the corrections under this mammoplasty include functional and aesthetic outcomes, while preserving the vascularity and sensibility of the breasts.


Aim : To evaluate superomedial septal-based reduction mammoplasty in patients with breast hypertrophy on Nipple Areola Complex (NAC) vascularity, sensibility and overall complications.


Patients and Methods: A total of 29 patients with bilateral breast hypertrophy underwent reduction mammoplasty with the superomedial pedicle and septal perforated technique. The mean distance of SN-N was 36.9 cm on the right side and 37.4 cm on the left side. The mean distance transfer of nipple–areola was 18.2 cm for the right side and 18 cm for the left side. The mean excised tissue was 1283 g from the right side and 1240 g from the left side.


Results: Postoperatively, the mean of SN-N was 21.5 cm for both the right and left side. A limited wound dehiscence occurred in four patients (13.8%), impaired nipple sensation occurred in three patients (10.1%), while infection was found in one patient (3.4%).


Conclusions: In our study, using the superomedial pedicle and septal perforator provided a safe and reliable technique for treating patients with breast hypertrophy, including macromastia and gigantomastia. It minimized the risk of vascular compromise of the NAC. this technique was found to show minor complications and provide good aesthetic outcomes.

Background: Community-acquired urinary tract infection is a widespread problem encountered in the outpatient clinics of most hospitals. UTI has various clinical presentations; some are simple UTIs that can be managed with outpatient antibiotics. The current treatment of UTI is empirical, based on the limited and predictable spectrum of etiological microorganisms.


Objectives: To collect information on the susceptibility tests of microorganisms in simple urinary tract infections (UTIs) and outline the best empiric antimicrobial prescribed for them.


Methods: A total of 117 patients from 14 to 70 years of age (mean age = 43.61years, standard deviation = + 24.5) received the care of our surgical and urological outpatient clinics in Alnuman Teaching Hospital, Baghdad, Iraq, between March 1, 2019, and September 1, 2020. The patients who were showing symptoms of simple uncomplicated UTI and were prescribed empiric antibacterial treatment and requested for a sample of midstream urine for culture and sensitivity tests were enrolled in this prospective study. The susceptibility test for (ciprofloxacin, trimethoprim, gentamycin, and ceftriaxone) was performed using the Kirby–Bauer disc diffusion method. The data were input into SPSS 22.0 for statistical analysis. Pearson’s chi-squared test was used to compare parameters. The data have been presented as the number of variables (n) and percentages (%). Statistical significance was set at P < 0.05.


Results: The frequencies of isolated uropathogens were as follows: E. coli, n = 65 (77.4%); Klebsiella spp., n = 9 (10.7%), Proteus spp., n = 3 (3.57%), Enterobacter spp., n = 3 (3.57%)., Staphylococcus spp., n = 2 (2.38%)., Pseudomonas spp., n = 1 (1.19%), and Candida spp., n = 1 (1.19%). The resistance rates of the most prevalent microorganisms were E. coli isolates to trimethoprim, ciprofloxacin, gentamycin, and ceftriaxone. The lower resistance rates to ceftriaxone in E. coli isolates (29.7%) was not clinically significant, with p < 0.05. Gentamycin showed significant sensitivity and resistance rates of 58.3% and 33.3% respectively, among the antimicrobials used (p < 0.05). The clinical effectiveness of empirical antimicrobial use in the treatment of simple UTIs showed no statistically significant correlation with P < 0.05.


Conclusions: Trimethoprim and ciprofloxacin should not be used in empirical therapy for UTIs because of their increased resistance rates. A review of the local guidelines should be considered.

Background: Since its emergence in December 2019, SARS-CoV2 infection has been characterized by several signs and symptoms related to the respiratory and other body systems. One of the important symptoms of this infection includes smell disorders that result in the reduction, complete loss, or alteration in smell perception. Although several studies have investigated these disorders from various perspectives, these disorders require further elucidation.


Objective: The objective of this study was to analyze the data pertaining to COVID-19 infected individuals who suffered from smell disorders, and to identify the correlation between different variables.


Materials and Methods: A total of 310 individuals from 5 countries participated in the web-based electronic questionnaire conducted from June 15 to July 15, 2021. Data were collated and analyzed using the IBM SPSS (v. 23) software.


Results: Out of the 310 participants, 228 individuals (73.5%) exhibited a history of COVID-19 infection, with 151 males (66.2%) and 77 females (33.8%). The most common age-group infected by SARS-CoV2 was 41–60 years (44.2%), and 168 patients (73.7%) exhibited smell disorders during infection, with the most common disorder being complete loss of smell. Furthermore, 45.2% patients reported reduced or alterations in smell perception (hyposmia and dysosmia, respectively), while 87.5% patients recovered completely, with most patients recovering within 1–3 weeks. More than one-third of the patients with smell disorders undertook olfactory training at home, and more than half of them benefitted from the training. Moreover, 45.7% of the patients with smell disorders experienced some form of depression during or after the infection. However, no correlation was observed between patients with allergic rhinitis and COVID-19 infection.


Conclusion: Different types of smell disorders were common in individuals infected with COVID-19. Nonetheless, most patients recovered completely and spontaneously. While olfactory training may have benefitted in recovery, few patients suffered from depression and required early psychological intervention to overcome the COVID-19 sequelae.

Background: Diabetes mellitus is a metabolic disease known by chronic hyperglycemia which results from defective insulin action and secretion. Various studies have documented liver disease as a major cause of mortality in patients with type 2 diabetes. It is well known that the liver plays an important role in the maintenance of normal glucose levels during fasting as well as in the postprandial period Aim: To evaluate the levels of liver markers in type 2 diabetes patients in Khartoum state. Materials and Methods: The study was conducted in Alribat University hospital, Sudan during the period from January 2018 to April 2019. Hundred subjects were included in the study, fifty patients previously diagnosed with Type 2 diabetes and similar number of age- andgender-matchedhealthy control subjects. The design of the study was cross-sectional, with a retrospective historical review through apersonal interview of all subjects.Blood was collected in a heparinized tube at room temperature and centrifuged for 10 minutes at 3500rpm, Serum liver markers concentrations were estimated by an enzymatic method in a fully Automated Biochemistry Analyzer (Cobas 3546). The data were analyzed using SPSS version 20.Results: The majority of patients were > 55 years. serum level of AST in type 2 diabetic patients and control group respectively were (31.26±10.34, 20.35±6.48) p value= 0.00), serum levels of ALT in type 2diabetic patients and control group respectively were (33.74±6.48, 19.70±6.23) p value= 0.00, serum level of ALP in Type 2 Diabetes patients and control group respectively were (125.20±49.61, 87.90±24.35) p value= 0.00,Serum level of GGT in Type 2 Diabetes patients and control group respectively were (47.72±9.01, 43.48±8.63) p value= 0.026. The mean BMI in type 2 diabetic patients and the control group respectively were (26.36±5.94,19.19±2.67), p value= 0.00, the correlation between duration of disease and liver enzymes GGT,ALT,AST and ALP respectively were (0.47,0.34,0.57,0.93). The current study showed in significant correlation between serum (GGT and ALT) and BMI of patients among type 2 diabetic patients (p value= 0.83,0.863) but significant correlation between serum (AST, ALT) and BMI of patients ( p value= 0.002,0.032).Conclusion: In the present study, a significant increase in the level of liver enzymes, ALT, AST, GGT ALP was observed in type 2 diabetic patients when compared to the normal group. Hence, we found an association between the level of liver enzymes, ALT, AST, and GGT in type 2 diabetic patients. Thus, these liver enzymes can be used as biomarkers for the assessment of type 2 diabetes, and we found no association between the level of liver enzymes, ALT, AST, and GGT in type 2 diabetic patients and duration of disease.