Thi-Qar Medical Journal

Background: cisplatin chemotherapy can cause acute kidney injury (AKI) in about 30% of patients
that act as a major dose-limiting problem complicating chemotherapy by cisplatin that still
commonly indicated as first line treatment of cancer management without relatively less toxic and
equally effective substitutes. Cisplatin induced-DNA damage and oxidative- inflammatory hyper
reactivity with apoptosis are the bases for cisplatin-induced AKI. Erythropoietin has approved
antioxidant, anti-inflammatory and to some extent antiapoptotic effects that may have ameliorative
effect on early cisplatin-induced AKI. Kidney injury molecules-1 (KIM-1) and interleukin-18 (IL-18)
were assumed to be more sensitive for detecting AKI than the traditional kidney function tests (serum
creatinine and urea).
Objective: assess the effect of erythropoietin on early upregulation of kidney injury parameters after
cisplatin treatment.

Background: Nephrotoxicity is a major dose-limiting side effect facing cisplatin-based
chemotherapy of a wide variety of cancers. Acute kidney injury occurs after cisplatin chemotherapy
in approximately 30% of patients where severe and lifelong nephrotoxicity can result regardless of
the use of powerful hydration with normal saline. In spite of scientific efforts to find relatively less
toxic but equally effective substitutes, cisplatin continues to be widely involved in chemotherapy as
first line antitumor agent. Apoptosis and necrosis, due to DNA damage response pathways, oxidative
stress in association with severe inflammatory response and caspase activation, are the major sources
of acute kidney injury due to cisplatin. L-carnitine with their antioxidant, anti-inflammatory and to
some extent antiapoptotic effects may have ameliorative effect on nephrotoxicity.
Aim: To assess the effects of L-carnitine in protection from cisplatin–induced nephrotoxicity
in cancer patients.
Patients and methods: 28 patients were participated in the study and successfully
completed their treatment cycles. They were randomized into two groups (N=14 in each). In
group I, patients received six cycles of cisplatin based regimen with 21 days-intervals. In
group II, patients received L-carnitine (500 mg oral tablet twice daily) plus cisplatin based
regimen. GFR (Modification of Diet in renal Diseases formula) was measured at base line
and 21 days after 1, 2, 4 and 6 cycles but IL-18 was measured at base line and 1 day after 1,
2, 4 and 6 cycles of cisplatin based regimen.
Results: In patients of group I, cisplatin-based regimen caused significant (P<0.05)
increment in serum creatinine and urea levels, highly significant (P<0.01) increment in
serum urinary IL-18 levels, and significant (P<0.05) decrement in GFR in comparison to
base line levels.
Conclusions: Each of L-carnitine significantly ameliorated nephrotoxicity in patients that
received cisplatin.

Background—The urokinase type plasminogen activator receptor (uPAR) may play a
critical role in cancer invasion and metastasis.
Aims—To study the involvement of uPAR in colorectal carcinogenesis.
Methods— fourty four cases of colorectal adenocarcinoma were obtained and diagnosed as
colonic carcinoma with it's grade received as formalin fixed, paraffin embedded tissue in
AL-nassiriyah teaching hospital with cases of carcinoma also 6 cases of normal endoscopic
biopsies used as control –ve and 10 cases of adenoma with dysplastic changes all these cases
stain by immunohistochemical methods for expression and localisation of uPAR.
Results_ all the cases of endoscopic biopsies were –ve for this receptors so used as –ve
control, while cases of adenoma 3 out of 10 cases showing focal positivity in areas of
dysplasia, while the cases of invasive carcinoma showing diffused positivity and the case
percent of positivity depend on grade so high grade tumor showing high percentage of
positivity.
Conclusions—Colorectal adenoma uPAR, expressed essentially in dysplastic epithelial
cells, was upregulated with increasing severity of atypia, and increased notably during the
critical transition from severe dysplasic adenoma to invasive carcinoma. These findings
implicate uPAR expression in the invasive and metastatic processes of colorectal cancer.

Diabetic Nephropathy (DN) poses a major health problem. There is strong evidence for a
potential role of the eNOS gene. The aim of this case control study was to investigate the
possible role of genetic variants of the endothelial Nitric Oxide Synthase (eNOS)
gene(VNTR) in the pathogenesis of nephropathy in patients with diabetes mellitus. The
study included 196 subjects (145 T2DM and 51 normal control) T2DM were classified into
2 groups: 97 diagnosed with DN, and 48 diabetic without nephropathy and hypertension as
+ve control. randomly selected was conducted to assess the association of SNP eNOS intron
4a/b VNTR polymorphism gene with diabetic nephropathy in Iraqi population. Blood
samples from subjects and controls were analyzed to investigate the eNOS genotypes No
significant differences were found in the frequency of eNOS genotypes between diabetic
patients (either in group 1 or group 2) and controls (p >0.05). Also, no significant differences
were found in the frequency of eNOS genotypes between group 1 and group 2 (p >0.05).

Background:
Ophthalmological disease especially (ocular allergy) represents one of the most common
conditions encountered by ophthalmologists. Some of them are often underdiagnosed and
consequently undertreated. Basic and clinical research has provided a better understanding of
the cells, mediators, and immunologic events.
Aim: To study the epidemiology profile of ophthalmological disease in Al-Nasiriya at 2018.
Materials and methods: Cross-sectional analytical study involved 1000 patients, attending Al
Habboby Teaching hospital _Ophthalmology out patient in Al Nasiriya , the study extended from
February to September 2018. Sociodemographic factor ,current history of ophthalmology
disease and some determinants, specific investigation had implemented from each patient to
assess the frequency ,determinants ,distributions of the commonest ophthalmological disease,
(SPSS) version 23 had been in used to analysis data when be p-value <0.05 considered as
significant statistically.
Results: Female to male ratio was (1.277) Commonest affecting age (35-+2.0) , the highest
Prevalence ophthalmological disease according prevalence rank as fallow (allergy, viral
conjunctivitis , cataract ,bacterial conjunctivitis and foreign body) the result was
(32.1%,14.5%,9.5%,4.6% , 4.1%) respectively. While lowest prevalence of ophthalmological
disease was (astigmatism ,hyphema ,lazy eye, hordeolum, sebaceous cyst) the result was
(0.1%.0.1%,0.1%,0.1%,0.1%)respectively. Where residence and education had significant
statistical association.
Conclusion: Allergy are the more commonest ophthalmological diseases in Al-Nasiriya ;
Increasing levels of allergy carry significant clinical and economic implications, with more
people at risk of the sight-threatening complications associated with high allergy.

The hemoglobinopathies are a group of disorders that acquired through families in which there
is abnormal creation or structure of the hemoglobin molecule, which cause a considerable public
health problem. The carriers of Hb diseases worldwide are estimated to be 269 million with
about 400,000 births a year. The birth of effected child, consequently, places extensive
physical, physiological and fiscal burden, not only on the affected child and its family, but also
on the society and the nation at large.
Methodology: In this cross- sectional study 601 patients with hemoglobinopathies (317 males
and 284 females), Whose age ranged from months to ≥40 years. They were attending genetic
blood disease center at Al- Habobi hospital in Thi-Qar governorate during the data collection
period (1st March to 31 May 2016).
Results:
Thalassemia has high prevalence than other hemoblobinopathies (76.53) and majority of cases
was blood group O. The highly percentage of cases was at age ≤ 10 years (54.08) followed by
21-30 years was (34.44), highly percentage of cases was in urban (60.90).
Recommendations: Adequate and suitable therapeutic and preventive measures should be taken
to diminish birth of effected children such as health education of individuals about importance
of premarital screening program for all couple to identify gen carrier individual of
hemoglobinopathies.

Background:
population as well as in clinical practice. In clinical studies, there is a strong relationship between
gastrointestinal symptoms and depression and the gastrointestinal symptoms remain for longer
time and are more serious than inpatients without depression.

A case control study was conducted in Thi-Qar governorate, south of Iraq, included a total
154 individuals 104 of theme were infertile patients while the other 50 males were fertile
healthy control males, who attended the infertility center in A Al- Hussein Teaching
hospital, from 20/10/ 2016 to 16/1/ 2018. aged between (l8-5l) years with mean of age was
(29.95±0.68) and (50) healthy controls males aged between (23-37) years with mean age was
(27.58±0.51). All patient submitted full reports about their medical status history, in addition
to their infertility type (primary or secondary). Seminal fluid samples were collected by
masturbation after three days of sexual avoidance. All patients and healthy control males
were tested for presence of anti-spermatozoa antibodies in their seminal fluid. seminal fluid
analysis in this study showed there were significant differences (p < 0.05) between fertile
control group and infertile males (patients) in (The seminal fluid viscosity, Liquefaction
time, Semen volume, Sperm motility and total sperm account while the results revealed
there were no significant differences in the seminal fluid parameters between infertile
patients and fertile control group in semen color, pH and sperm morphology . The overall
prevalence of ASA in seminal plasma among studied papulation was 16.23% (25/l54).
Among healthy control group anti-sperm antibody in seminal plasma were positive in 6% (3
/50) and negative in 94% (47/50) with mean concentration of anti-sperm antibody was
24.97±3.7 U/ml (normal range 0 – 60 U/ml). Among infertile patients anti-sperm antibody
was positive in 21.15% (22/104) whereas negative in 78.84 % (82/104). The mean
concentration of anti-sperm antibody was 40.71±2.32 U/ml. The statistical analysis revealed
highly significant differences (P <0.05) in presence of ASA in seminal plasma of infertile
patients compered to normal fertile males, also concentrations of ASA in seminal plasma
was significantly higher in patients compered to healthy control males. In conclusion ASA
was proportionally high among patient with infertility compered to healthy fertile control
group.

Background: Spinal block, a known technique to obtain anaesthesia for infra umbilical
surgeries. Now physician have advantage of using adjuvant to prolong the effect of intrathecal
block, which can be given either intravenously or intrathecally, dexmedetomidine is one of
them. We studied effect of intravenous dexmedetomidine for prolongation of duration of
intrathecal block of 0.5% bupivacaine block.

Aim: To evaluate the effect of intravenous dexmedetomidine on sensory and motor blockade
duration after subarachnoid block (SAB) with bupivacaine 0.5% .

Methods: a prospective ,randomized ,double blind ,placebo controlled study was carried out in
general surgical operation theaters of Baghdad teaching hospital, during the period from 1st
March to 30th April 2016 Fifty patients of ASA grade I , II are posted for elective infraumblical
surgeries were included in the study and randomly allocated into two groups. Group D contain
25 patients received intrathecal 0.5% hyperbaric bupivacaine , followed after 10 minutes by
infusion of intravenous dexmedetomidine 1mic/kg in 100 ml normal saline over 10 min.
Group (C) contain 25 patients received intrathecal 0.5% hyperbaric bupivacaine 3ml followed
after 10 minutes by infusion of same volume of normal saline as placebo . -Person's chi-squre was used to assess statistical association between categorical data. -Analysis
of variance(ANOVA) was used to assess the difference between the continuous variables. level
of p-value less than 0.05 was significant.

Result: .Duration of analgesia in group D was 202.28+_4.46 and in group C was 159.6+_3.12
min. highly significant ( p < 0.0001 ).
Duration of motor blockage in group D was 154 .44+_ 7.06 minutes and in group C was 131.04
min. highly significant ( P = < 0.0001 )
Conclusion :
Administration of intravenous dexmedetomidine 10 min. after SAB ( infusion of 1mcg/kg over
10 min. ) prolongs the duration of sensory and motor block.

 Background
Neonatal jaundice is the most common reason for admission in the neonatal period. The
yellow coloration of the skin and sclera in newborn with jaundice is the result of
accumulation of unconjugated bilirubin. Neonatal physiological jaundice results from
simultaneous occurrence of two phenomena, bilirubin production is elevated and hepatic
excretory capacity is low (1).The aim of this study is to determine the etiology,severity,risk
factors and management of neonatal jaundice.
 Methods
A retrospective study was conducted on 100 case_sheets (random sample) to neonates
who had jaundice in Almosawi paediatric hospital in Nasiryiah city.The obtained data
were analysed and the results were tabulated.
 Results
100 case_sheets of neonates who have jaundice were studied.ABO blood group
incompatibility were the most common cause of jaundice.Phototherapy is the mainstay of
hyperbilirubinemia treatment in neonates.It has resulted in a marked reduction in the
need to perform exchange transfusion.
 Conclusion
Blood group incompatibility,and unknown causes,are the most common cause of
neonatal jaundice .The less common cause is G6pd deficiency.Most of neonates who have
jaundice were breast feeding,lowbirth weight and preterm are risk facters.

Background: lower limb vascular injuries are encountered in a vast number of settings, ranging
from blast, bullet , stab wounds injuries, to causes as small as blood sampling procedures.
Surgery for vascular repair is sometimes indicated without angiography. Broadly speaking,
options for repair after assessment of vasculature include simple vessel wall repair, venous
patching, resection with end-to-end anastomosis or with inter-positioning graft, bypass graft,
ligation or amputation.
Aim: The general objective of this study is to identify the etiology, presentations, management
and outcome of lower limb vascular injuries in Ghazi Al Hariri hospital, Baghdad, Iraq, from 1st
January 2015 to 31st December 2015.
Patients and Methods: The study design was retrospective hospital based study and the study
population included all patients who referred to the vascular surgery consultation clinic in Ghazi
Al Hariri Hospital and to emergency department. Ninety patients had lower limb vascular
injuries. Data collected using structured checklist and analyzed.
Results: Eighty-five (94.5%) were males and five (5.5%) were females. The most common age
at presentation was 21–30 years (50%), followed by 31–40 (24.4%). Blast penetrating shell
injuries were the highest cause for lower limb vascular injury with incidence rate of 50%, while
second cause is bullet penetrating injuries presented at 40%. Most common artery injured was
the popliteal artery (40 patients; 44.4%) followed by the femoral artery (29 patients; 32.3%).
Limb salvage rate was 85% and mortality rate was 7.8%.
Conclusions: Our results revealed that blast injuries are the most frequent cause of lower
extremity vascular injuries in Ghazi Al Hariri hospital at the period of our study. Appropriate
intervention and rapid restoration of blood flow is crucial to have a good outcome and is the key
to successfully salvage the injured limb. Amputation rate was the highest in patients with
popliteal artery injuries.

Background:- T1DM is the most common endocrine-metabolic disorder of childhood
and adolescence, with important consequences for physical and emotional development.
Individuals with T1DM confront serious lifestyle alterations that include an absolute daily
requirement for exogenous insulin, the need to monitor their own glucose level, and the
need to pay attention to dietary intake.
Objective:- to assess the main factors and patient characters associated with uncontrolled
T1DM that should be aware by Iraqi's Pediatricians.
Patient and method:- A cross sectional analytical study had been conducted on children
and adolescents with type1 DM visiting the diabetic clinic in Al- Nasiriya Diabetes and
endocrine specialized center (south of Iraq), from 1st of June 2016 to the end of May 2017.
The patients selected to be as uncontrolled status ( fair and poor control) according to
their HbA1C level results. Demographic factors, disease-related characteristics, checking
of blood glucose, dietary control, type, dose and regime of insulin injection and other
related aspect, and anthropometric measures were included.
Result: - Two hundred and one( 201) type 1 diabetic patients selected to be uncontrolled
status with mean age of( 9.530 year ±3.2526),with no significant difference in sex.
Majority of them were with poor control status (71.1%), and 28.9% were with fair control
status. The residence, mother education, dietary control, regular follow up and regular
checking of blood glucose level, syringe use, insulin injection technique, lipodystrophy at
injection sites, and person who give the insulin were the main independent factors that
had a significant statistical association with the control status in this study, while multi
variant analysis revealed that dietary control, person who are responsible for giving insulin
and changing site of injection were significantly associated with control status.