Thi-Qar Medical Journal

BACKGROUND
Transobtorator tape (TOT) is a minimally invasive procedure that gained increased
popularity in the surgical field for management of patients with stress urinary incontinence .
The use of TOT had significantly simplified the surgical procedure and made it safer.

OBJECTIVES
To evaluate the safety and efficacy of the TOT procedure in women with SUI.

PATIENTS AND METHOD
Thirty female patient are complaining of urinary incontinence presented at urology
department of Ghazi Al-Hariri surgical specialties hospital from January 2012-Oct. 2013
were enrolled in this study. All of our patients are with pure SUI. The procedure was done
under spinal anesthesia. TOT require placement of macroporous polypropylene tape at the
mid urethra through the obturator membrane with minimal vaginal incision. The patients
were followed up before discharge, 1 month and six month using cough test.

Background:Triazoles are the mainstay of treatment for aspergillosis. However, azole resistance
is an emerging problem reported worldwide in Aspergillus infection mainly caused by
A.fumigatus. Increase azole resistance in A.fumigatus has reported with treatment failure and
become a significant challenge in effective management of aspergillosis.
Aim: The aim of this study is to investigate the triazole-resistant of A. fumigatus and underlying
MDR pump genes in viable clinical isolates which obtained from patients suffering pulmonary
infections in Thi-Qar province.
Methods:The conventional Polymerase Chain Reaction (PCR) was used to confirm antifungal
resistance by detecting the presence of MDR pump genes (MDR3 and MDR4).
Results:The results of using this technique showed that A. fumigatusisolates were positive to
MDR pump genes with 90% and 96% for MDR3 and MDR4 genes, respectively.
Conclusions: Our study revealed that the MDR pump genes are predominant in azole resistance
isolates. Furthermore, PCR was proven to be highly effective method for identifying these genes.

Infection with Strongyloides stercoralis is associated with asymptomatic chronic disease
involving the gut and respiratory systems and can persist for long period undetected leading to
development of fatal hyperinfection syndrome. The severity is even more in
immunocompromised individuals or patients undergoing immune suppressive therapy.
Unfortunately the disease is difficult to diagnose due to low parasite load and the irregular larval
output. Development of efficient diagnostic techniques requires large supply of infective larvae
and this can be achieved through in vivo maintenance of the parasite. In this regard, S. ratti is
being used as a model instead of S. stercoralis due to difficulty and risk of infection. In this
study, a significant amount of previously characterized filariform (iL3) larvae of S. ratti was
collected. Chronic infection was successfully established and maintained by experimentally
induced immunosuppression of Wistar rats following oral administration of prednisolone. This
model can serve as a good source of infective larvae for production of monoclonal antibodies
and development of diagnostic assays for prevention of the disease. It can also provide room for
further research in diagnostics of human strongyloidiasis.

Objectives : this study to identify the clinical and laboratory factors associated with
the risk factors of major amputation in diabetic foot patients.
Patents, materials and method: this is cross sectional study carried out in Basra
general hospital between November 2013 to June 2016. 100 diabetic foot patients
evaluated for duration of the illness, type of diabetes, socioeconomic state, smoking
history, previous amputation, retinopathy, nephropathy, neuropathy, cardiac
disease, foot deformities. The foot ulcers were classified according to Wagner
classification, foot ischemia was assessed by Doppler study, baseline laboratory
investigations done include Hb%, WBC, ESR, Fasting blood sugar, Hb A1c, blood
urea, serum creatinine, serum albumin, ECG, Chest x-ray.
Results: number of risk factors found to be associated with risk of major
amputation in diabetic foot patient include male sex, age>60 years, nephropathy,
retinopathy, neuropathy, foot deformity, previous amputation, duration of diabetes
>15 years, low socioeconomic state, Hb<10gm/dl, ESR>80, Hb A1c>8%, serum
albumin<2.5gm/dl, Doppler score>6, high Wagner score.

Objectives:To evaluate the antimicrobial activity of the aqueous methanolic extract was given by
the leaves of Eucalyptus sp.growing in Thi-Qar Province, south of Iraq. Additionally, to detect the
compounds within the extract by using the technique of gas chromatography-mass spectrometry
(GC-MS).
Methodology: The healthy leaves of Eucalyptus sp. were collected, washed with tap water then by
distilled water, dried, and pulverized through using a small mill to make the dried leaves as a
powder. The leaves powder was extracted by absolute petroleum ether then aqueous methanol
(80%) for obtaining a sticky crude extract of the aqueous methanol filtrate. The crude extract was
tested against some microbial pathogens as well as analysis of the extract using the technique of
GC-MS and phytochemical tests.
Results:The current study showed the antimicrobial activity of the crude aqueous methanolic
extract obtained from Leaves ofEucalyptus sp. by which 40000 µg∕ml of the extract exhibited
inhibition zones around Staphylococcus aureus, Streptococcus mutans, Escherichia coli, and
Klebsiella sp. besides Candida albicans that the inhibition zones were measured to be 30, 27, 26,
30, and 38 mm respectively. The chemical tests appeared the crude extract containsalkaloids,
glycosides, flavonoids, tannins, andsaponin glycosides. GC-MS analysis detected constituents of
the extract are dimethylsulfoxoniumformylmethylide, diethyl phthalate, benzene,1,1'-(1,2
cyclobutanediyl)bis-trans-,diisoctyladipate, and 2-methyl-7-phenylindole.
Conclusion: The present study concluded that the leaves ofEucalyptussp. possess the bioactive
products which are needed to be separatedas the pure compoundsby using techniques of
chromatography in order to separately tested in vitro and in vivo, then application of spectrometry
techniques for characterization of their chemical structure. Finally, these compounds can be used
to treat diseasesas drugs in hospitals.

Purpose:To determine post lasik aim of refraction in young myopic patient that ensure slight
over correction (safe margin of hypermetropiaSMH) which help in reducing possibility of
regressionand post lasik myopic shift, however this SMH should be easily overcomedby
accommodation , doesn’t affect UCVA or induce eyestrain.
Patients and methods:400 patients (800 eyes) were taken in this study, all of them had myopia
and myopic astigmatism with -1.0 to – 6.0 D(spherical equivalent) during the period between
2008-2014 in Nassirya city, south of Iraq. Those patients were divided into 5 groups each group
with 80 patients (160 eyes) and planned to have post lasik refraction ofemmetrope, +0.5, +0.75,
+1.0 and +1.25 D, for groups from no.1 to no.5 respectively and these groups followed up in
term of UCVA, spherical equivalent, myopic shift, and asthenopia (eyestrain) for three years.
Result:Three yearsfollow up for the 5 groups showed that, in group no.1 (27.5%) of eyes had
VA of 6/9 or worse, (33.125%) of eyes had myopic shift and(11.25%) of patients had
eyestrain. In group no.2 (19.375%) of eyes had VA of 6/9 or worse ( 21.875%) of eyes had
myopic shift and (8.75%) of patients had eyestrain. In group no.3 (11.25%)of eyes had VA of
6/9 or worse (9.375%) of eyes had myopic shift and (2.5%) of patients had eyestrain. In group
no.4 ( 4.375%) of eyes had VA of 6/9 or worse, no myopic shift and (2.5%) of patients had
eyestrain. In group no.5(12.5%) of eyes had VA of 6/9 or worse, no myopic shift and (15%) of
patients had eye strain.
Conclusion: In young myopic patients with low to moderate myopia, we can choose post lasik
aim of refraction of +1.0 D, this safe margin of hypermetropia SMH can ensure best UCVA
without eyestrain (asthenopia), help in reducing regression and myopic shift.

Breast cancer is the commonest type of malignancy in Iraq. For this reason we study risk
factors that associated with this disease in Thi Qar province patients. Such as mutations
of breast cancer susceptibility genes 1 and 2 (BRCA1 and BRCA2), clinicopathological
parameter ( age, family history and tumor site) .
Eighty five blood samples were taken from patients who attended Al-Hussain teaching
hospital and oncology unit in Al-Habboby hospital during the period (from August /2014
to April /2017) , fifty blood samples were collected from healthy women as a control.
Blood samples were using in genetic study. For histopathological analysis fifty tissue
samples were collected from fifty patients with breast cancer who were undergoing
surgical resection (mastectomy) to prepare paraffin embedded blocks which have been
used for histopathological diagnosis.
The present study results revealed that a highest incidence of breast cancer occur in the
age group between 40-49 years of age (41%),there is a significant difference among
patients age groups (P ≤ 0.01).
Family history of breast cancer indicates a strong association with risk of developing
breast cancer. The present study showed that family history positive in 31 cases (36.47%),
and 54 cases (63.52%) had negative family history of breast cancer. Also the results of
present study showed that the 34 cases (41.5%) had first birth at age (20-29years), 18
cases (23.37%) had their first birth in age groups (15-19 years) and (30-39 years), and 7
cases (9.09%) had first birth at age (≥40 years). Most of patients (50.5%) breast cancers
were located in right breast and (38.8%) of cases breast cancers were located in left side.
Histopathologically, carcinoma was divided into 44 cases (88%) were ductal carcinoma
{from which 42 cases(84%) were invasive ductal carcinoma, and 2 cases (4%) were
comedocarcinoma}, and 6 (12%) cases were invasive lobular carcinoma. Results revealed
that 2 cases (4%) were stage I, 13 cases (26%) were stage II, 24 cases (48%) were stage
III and 11 cases (22%) were stage IV, also our results showed that 2 cases (4%) were
grade I, 23 cases (46%) were grade II, and 25 cases (50%) were grade III.
The DNA was extracted from blood samples by using Accupower® genomic DNA
extraction kit. The concentration and purity of all DNA samples have been measured by
Nanodrop. Samples with a purity ranged from 1.7 to 1.9 have been enrolled in this study
for the molecular detection of BRCA1/2 gene mutation in patients and control groups. In
08
85 cases of breast cancer, detection of BRCA1/2 gene mutation by multiplex PCR done
for the serum revealed that; (185 del AG) mutation in BRCA1 gene was detected in 6
patients (7.05%), and (5382 ins C) mutation in the same gene was detected in 2

patients (2.35%). Regarding (6174 del T) mutation in BRCA2 gene was detected in 3
patients (3.52%). In the control patients gene mutations of any types didn’t detected.

Background
Joint hypermobility is a common condition characterized by joint laxity and an increased range
of joint motion and may be associated with joint pain. joint pain is common in inflammatory
bowel disease (IBD) and is often attributed to seronegative arthropathy.
Objective
To assess JHM in Iraqi patients with IBD and to evaluate the associates of this possible
relationship.
Patients And Method
A case-control study was conducted on 83 patients with IBD who were randomly seen between
December 2014 and June 2015 at the gastrointestinal and liver diseases center of the medical
city and the endoscopy unit of Baghdad Teaching Hospital compared to a 83 healthy
individuals served as a control group who were randomly selected during the period of the
study and matched for age and sex to the patient group.. Full history was taken and complete
clinical examination was done for all individuals in both groups . Beighton’s Score for joint
hypermobility was performed on patients and controls.

Background:
The biological activity of NPs strongly depends on physicochemical parameters but these
are not routinely considered in toxicity screening, such as dose metrics which is studied by
many researchers.Titanium dioxide nanoparticles (nano-TiO2) are extensively used in the
cosmetics, pharmaceutical, and paint industries as a coloring material due to its high stability,
anticorrosion and photocatalytic properties
Aim: This study represents the study of TiO2 nanoparticles induction for biological
systems.
Method:Curve fitting in matlab program is used to study the effect of parameters of the
system on the cell levels with existence TNPs.
Results:
The Consequences showed that nanoparticles induce human embryonic kidney cells (HEK
293) the generation of reactive oxygen species (ROS) followed by significant depletion of
glutathione levels and increased lipid peroxidation.
From the results, we observe that the behavior of can be predicated by estimating the
equations which described the variation of culler effecting by increased the TNPs
concentration at different exposure times.

Objective : To present the advantages of native radio-cephalic AVF creation over
native brachio-cephalic AVF creation in patients with chronic renal failure and on
regular hemo – dialysis.
Patients : This is a retrospective study of 50 patients for whom native radio-cephalic
AVF was created in the upper limb under local anesthesia over a period of about
seven years ( from 1st of March 2013 till 1st of February 2019 ).
Methods: The case sheets of relevant patients for whom an AVF was created were
reviewed to collect information like patient's sex, age, site of AVF, type of
anastomosis, etc…
Results : Native radio-cephalic AVF creation was offered for different age groups and
for both sexes. Side to side anastomosis was carried out for most patients and the
preferred site was just above the wrist joint on the lateral aspect of forearm between
the radial artery and a nearby superficial vein which was mostly the cephalic vein or
one of it's tributaries. The time of first cannulation after AVF creation was variable
depending on several factors. Different complications but no mortality had been
recorded perioperatively.
Conclusions : Native radio-cephalic AVF creation is always preferred over native
brachio-cephalic AVF creation and every effort was made to search for a suitable
distally located superficial vein for the purpose of AVF creation.
The region just above the wrist joint on the lateral aspect of forearm was a suitable
site for patients with CKD and those with comorbidities because the proximal
locations of AVF creation are associated with more complications than the distal
ones. Side to side anastomosis for AVF creation was the procedure of choice and the
priority was for the non dominant upper limb if possible.

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.

Background: The morbidity of solitary thyroid nodule to be benign or malignantaffecting
different age group and gender are generallynotwellestablished need to more focus about details
histopathology and identified the characters of histopathology.
Aim of study: To know histopathological characters of solitary thyroid nodule in patients
undergoing in Nasiriya city at (2015_2016_2017).
Patients and method: This cross-sectional analytical study was carried out at the
department of general surgery, Al_Hussain teaching hospital. It is retrospective study during 3
years ago(2015,2016,2017).
The study include the collection samples of known cases of solitary thyroid nodule from
operation room in ,Al_Hussain teaching hospital for 3 years about 162 cases and send it into
histopathology in lab. In same hospital in Nasiriya city about 360 km south Baghdad the capital,
and take the result of histopathology from lab. In same hospital.
The study include different ages All age groups were included in this study. Classified into :
 Child and adolescence less than 18 years old
 Young adult(18_45) years old
 Old adult (45_65) years old
 Elderly (65years old and above)
And both sexes (male and female).

BACKGROUND AND OBJECTIVE:
Vitamin D deficiency is recognized as a global public health problem which has effect on the
health of the skeletal and extra skeletal tissues. The goal of this study was to determine the
prevalence of Vitamin D deficiency in the Sulaimanyah population and to compare different age
groups, gender and season of the year.
MATERIALS AND METHODS:
This was a cross sectional study that involved 19,267 patients who visited Sulaimanyah (private
and governerate) clinical laboratories, of which 6304 males and 12,963 females their ages ranged
between (1-95) years in the period between January 2013 and January 2017, all vitamin D
measured by electrochemiluminescence (ECL) techniques were enrolled in this study.
RESULTS:
A total of 19,267 persons were analyzed, the overall vitamin D deficiency (below 20 ng/ml) was
68.1%. The prevalence of vitamin D deficiency was increased in those patients their age groups
between 30-39 years (13.6%), was greater among women (48.8%) and more common during
winter (19.6%).
CONCLUSION:
The currently available study on the Sulaimanyah population suggests that the Vitamin D
deficiency is common. This indicates that strategies are needed at the population level to
improve vitamin D status of Sulaimanyah province.

Hospital contamination is an important cause of nosocomial infection. This study aims to
assess the occurrence of bacterial contamination in 70 different departments of two
private and five public hospitals in Nasseriah city (south of Iraq) during 2016. From 50 to
200 swabs collected weekly from each wards, were isolated 213 positive culture bacterial
isolates, comprised 11 bacterial species detected by biochemical and enzymatic tests. The
contamination was ranged between Pseudomonas species that represent the most
contaminant species (30%) to Micrococcus spp. and Citrobacters pp were the fewest
(0.46%). Generally, the private hospitals were less contaminated than public ones, the
winter and summer months were less contaminated than spring and autumn, and multi-
specialty hospital have more contamination than single-specialty one.

We report our experience with a rare case of brain hydated cyst which
required urgent surgery because of the life threatening elevation of
intra cranial pressure( ICP) . Totally removal of the cyst en block was
achieved, and the resumed his daily activity without neurological
deficit. Brain hydrated cyst is usually treated by scheduled operations
, but it may develop an emergent statu s in the involved patient
.Immediate decompressive surgery by en block removal of the lesion
Following minimum clinical investigations are recommended in any
operations.