Thi-Qar Medical Journal

Background:
Systemic lupus erythematosus (SLE) is an autoimmune disease which is known to present
with a wide variety of clinical manifestations. Liver and spleen enlargement in SLE are
common finding but their prevalence and association with lymph node involvement not fully
studied in Iraqi patients.
Aim of study:
Assessment of hepatomegaly and splenomegaly and their relation with lymphadenopathy in
Iraqi patients having systemic lupus erythematosus.
Method:
A cross sectional analytical study was done on 50 systemic lupus erythematosus Iraqi patients
with active disease according to SLE disease activity index. The patients were attending
rheumatology and rehabilitation unit in Al-Hussein teaching hospital.
Results:
In our study we found that hepatomegaly was seen in 36% of patients, splenomegaly in 28%
while lymphadenopathy in 26%. We noticed that hepatomegaly and splenomegaly were
higher in those having lymphadenopathy compared to those without lymph node involvement.
Also liver, spleen and lymph node involvement associated with more mucocutaneuos and
constitutional manifestation, while no differences were noticed in renal and neuropsychiatric
manifestation .

Background: congenital anomalies are a significant but under recognized cause of disability and
mortality among infants and children under the age of five years. They can be life-threatening
conditions, result in long-term disability, and negatively affect health – care system, societies,
families and individual (2).
Objectives: to estimate the prevalence of congenital malformations in our locality Thi-Qar
province, most common type and any responsible factors for these anomalies.
Subjects and methods: a descriptive hospital-based prospective study in one year among
newborn delivered baby in Bent Al-Huda Teaching Hospital, Thi-Qar Governorate, Iraq from
January 2019 -December 2019. Both the mother and her baby were examined as a unit within 24
hours of birth A medical history was taken including parents age, residency, gestational age, and
thorough physical examination of the baby was made. all baby with identified birth defects were
admitted to neonatal care unit for observation, investigation, evaluation and management. The
data were analyzed by simple statistical techniques recording number and percentage of cases.
Results: The overall prevalence of congenital anomalies among neonates was 1.26%. The first
most prevalent congenital malformations were anencephaly 7.78%, down syndrome 6.11%,
upper and lower limb malformation 6.11% hydrocephalus 9%, heart malformation5%. More
than one system involvement was reported in (6.11%) cases. Most congenital malformations
occurred in male children 52.73% anomalies, 62% > 2.5 Kg body weight &36.67% in term baby.
The highest congenital abnormality is reported among babies delivered by mothers aged 20-45
years of age (i.e.,94%). More than 62 % of urban resident.
Conclusion: nervous system anomalies, down syndrome, and musculoskeletal system anomalies
are most prevalent congenital malformations in Thi-Qar while the low birth prevalence of other
birth defect 1.26% may be a result of institutional and personal characteristics of the
documentation system.
Recommendation: The more wide extensive screening programs to detect the exact prevalence,
type, causes and distribution of birth defects is needed and implemented as health program.

Congenital anomalies is structural or functional abnormalities present at birth. A total of 88 infants
with different types of birth defects were included in this study, The data were collected in the period
between 2/1/2017 to 31/12/2018 in Al-Nasiriya city/south of Iraq under the aim and title of detection
of the types, trend and characters of congenital anomalies, after full ethical approval data were
collected using a structured questionnaire. The highest rate was detected among males for the year
2018, while the highest percentage was among females in 2017. As well, the highest rate for infants
weighing > 4kg was the highest in 2017 (70%),while the high percentage of group < 4kg (37.5%) was
seen in 2018, The CS comprise high percent of delivery than NVD under (P<0.05). While the higher
percentage was for spina bifida (0.88%) in 2018, followed by hydrocephalus and cleft lip
(0.71%).while distribution was of multiple distortions, the rate was high(0.46%) in 2017.While
distribution was of CHD and pul Atresia, the rate was high(0.5) in 2017 and 2018. Also, The results of
this study were significant (p 0.0341) between percent of death in 2017 and 2018.The study conclude
the necessity to provides important background information for potential prevention and better
management of female who may have children with birth defects and the importance of further
researches is required to determine the factors responsible for different types of birth defects.

Background: Lung abscess is a type of liquefactive necrosis of the lung tissue and
formation of cavities (more than 2 cm) containing necrotic debris or fluid caused by
microbial infection. It can be caused by aspiration, which may occur during altered
consciousness and it usually causes a pus-filled cavity. Moreover, alcoholism is the most
common condition predisposing to lung abscesses.
Aim: To present the effectiveness of conservative treatment in lung abscess and the rare
indication of surgery for such disease in AL-Hussein teaching hospital in Thi-Qar
Governorate and to compare our study with other study in Iraq and abroad Iraq.
Patients and Methods: This is a retrospective study of 50 patients suffering from lung
abscess over a period of 5 years from the first of May 2013 till the first May 2018 in AL
Hussein teaching hospital in Thi-Qar governorate. The patient was admitted and received
heavy antibiotics intravenously. In addition, good hydration was provided and also
mucolytics, analgesic and antipyretic drugs were given along with good physiotherapy.
Management continued on an inpatient basis for an average of 7 days. Follow up continued
on an outpatient basis.
Results: Males and and females were affected nearly equally. The ages affected ranged from
( 10 - 60 ) years at presentation. 80% of the patients suffered from cough and most of our
patients ( 90% ) had anorexia and fever.
Conservative management was very effective in more than 90% of patients with lung
abscess.
Conclusions: Lung abscess was treated in most cases by conservative measures.
All patients received initially injectable antibiotics and the treatment may continue for
several weeks to several months. Hemoptysis was recorded in several patients only.
Recommendations: Treatment should always begin by injectable antibiotics. Co-morbidities
should be treated simultaneously with lung abscess. Malignancy should always be excluded
especially in old aged people. Surgery is indicated only when conservative measures fail.

Background
Despite the prevailing impression among many professional that parasitic infection is very common in
our population, and despite the usual blame we put on parasitic infections as a cause of ill-health, yet,
scientific studies to document such a problem are scanty. In Thi-Gar governorate, the situation is not
exceptional. This study is an attempt to quantify the prevalence of two important parasitic infections :
namely Entamoeba histolytica and Giardia lamblia in Nasiryiah city, and to describe the relationship
of prevalence of these infections to selected socioeconomic variables.
Methods
The study is cross-sectional household survey, it was conducted during April and May of 2019.Two
districts (Aledaralmahalia and Alsader town) were selected in Nasiryah city. The selection depend
upon the difference in socioeconomic status, assuming that they represent the wide spectrum of
socioeconomic variation in the city population, but it must be admitted that this only assumption and
no more.
Results
There are generally many difference between the two districts.Aledaralmahalia has relatively better
sanitation, people live in better housing conditions, they are moderately educated and 16% of houses
are rented. Alsader town has poorer sanitation , over-crowded housing conditions and 28% of houses
are rented. The prevalence rates are higher in Alsader town(E.H.15.09%,G.L.11.09%),than those in
Aledaralmahalia (E.H.11.18%,G.L.10.4%).
Conclusion
The result of study revealed that the prevalence rates of Entamoeba histolytica and Giardia lamblia
were higher in Alsader town than in Aledaralmahalia.

ABSTRACT:
The past decade has seen a profound increase in use of technology by children, some as young
as one year of age. Critical milestones for child sensory, motor and attachment development
are not being met. Developmental delay, obesity, mental illness, and attention deficit ,sleep
disruption , and also Social disorders such as: communication, aggression and declining
empathy ,are now becoming the norm.
The aims: of this study are to determine if there is any significant statistical association
between excessive usage of smart devices and change in child behavior and health ( either
positive effect or negative effect ) . And to explore the purpose role of family about this
problem .
Method: This is a comparative study done on population of children aged between 3-14 years
who are living in Thi-qar Governorate, south of Iraq, during period from August, 2018 till
April, 2019.
The study included 200 healthy children chosen selectively from the relatives of patients who
consult outpatient departments of the hospitals and neighbors. One hundred of them are
exposed to the risk factor (use smart devices) and considered as a cases and other 100 are not
exposed
to
Results
:
the
The study shows that
risk
most
factor
and
considered
as
control.
of children who use the smart devices are from urban area
( 73 % ) versus ( 27 % ) are from rural area and 69 % of them are using the devices less than 5
hours \ day and 31 % of them are using it more than 5 hours \ day .
Also the study shows there is a significant adverse effect of prolong use of digital devices by
children on their vision , playing with others and the sleep patterns . Also it associated with
significant increase in the percentage of headache and neck pain, but it is associated with
increase
in
their
learning
abilities.
Conclusions: Prolong using of smart devices have many adverse effects on child health and
behaviors in the form of aggressive behavior , decrease in school performance , headache ,
neck pain, visual problems and appetite disturbances , but its usage might increase their
learning abilities.
Recommendations: To encourage zero media usage for children under 2 years of age and
limited time for those over 10 years of age and this problem need further studies to follow up
the effect of digital devices on child health and behavior.

Background: Febrile seizures are the most common cause of convulsions in children. Most are simple
in nature, although those with focal type , prolonged duration more than (15 min) or those that recur
within 24 hours or within the same febrile illness are considered complex.
Objective: This is case- control study was carried out to :-Analyze the risk factors associated with first
febrile convulsion in comparison to control group of the same age.Analyze the risk factors associated
with complex febrile comvulsions.
Subjects and Methods: Patients: A case –control study had been done at Basrah peadiatric
teaching hospital in pediatric medical department on 115 patients admitted with first attack of
convulsion and fever,their ages ranged from six months to six years.They had been admitted during
the
time from January2015 to the end of August 2015. Sixty - nine were males and 46 were
females.Cases were matched with control group of 130 children without fever or fit in relation to age
(6 months -6 years).
Results: The significant risk factors were positive family history of febrile convulsion P-value <
0.001, positive family history of developmental delay P-value < 0.01& patient s, history of preterm
gestational age P-value < 0.01. Other risk factors were not found to be significantly correlated with
first febrile convulsion .The study has revealed that there is a significant correlation between first
complex febrile convulsion and young age of patients (≤15 months), P-value < 0.05. The common
infections leading to febrile
convulsions were upper respiratory infections (40 % of the all causes) , which was significantly
associated with simple febrile convulsions.
Conclusoin: From this study three risk factors for first attack febrile seizure were identified ,which
may help in the prevention include
positive history of febrile seizures in the family and
developmental delay and history of the prematurity .Complex type was found in 49.6 % of patients
with febrile seizure and was related to young age ( ≤ 15 months) .Upper respiratory tract infections
were the most common factor related to increase temperture in children with febrile convulsion &
related to the simple type of febrile convulsions.

Abstract
Background : Congenital Hiatal Hernia is herniation of a viscus or a part of it through the
esophageal hiatus to an intra-thoracic position.
Aim : To review our experience in surgical management of Congenital Hiatal Hernia in view of
published literature .
Study design : Retrospective and Comparative.
Patients and Method : during a sixteen –year period (2000-2016) in a single thoracic surgery
center , Detailed history taking and thorough physical examination were performed . The
investigations included chest radiographs , contrast swallow studies , and rigid esophagoscopy
mainly . Surgical techniques used to explore and repair hernia through laparotomy and left
thoracotomy or both .
Results : Twenty-six cases of Congenital Hiatal Hernia were operated, in M:F ratio of (1.16:1) ,
age range (25 days – 6 years ) Mean age of presentation (1.84 Year) . Chief presenting symptoms
werew frequent vomiting (20 patients) , recurrent chest infections . The diagnosis depended
primarily on contrast studies . Statistical analysis showed better outcome regarding hospitalization(
7.77 days compared with 9.125 ) and postoperative complication with Nissen procedure . 1
mortality included in this study caused by mediastinitis and septicemia .
Conclusion : Early recognition of Congenital Hiatal Hernia is of high importance in reducing
postoperative complications and improving outcome . although SAGES guidelines / No. 8 / 2013
stated (Hiatal hernias can effectively be repaired by a transabdominal or transthoracic approach
(++++, strong) ) , Nissen fundoplication done to infant age group with excellent outcome , and
our experience was better using Nissen fundoplication. The study recommend the need for
carrying out a multicenter study on a national level., team management of Congenital Hiatal
Hernia .

Background: HER2\neu and BRCA1 expression in tumors is consider as a important
prognostic marker in relation to the use of adjuvant therapy specially in a patients with worse
prognosis in which that result in improvement in their survival. this research was done to assess the
HER2\neu and BRCA1 immunohistochemical expression in colorectal tumors in correlation with
some clinicopathological parameters.
Methods: in this study(which was done retrospectively), A 44 cases include22 benign colonic
lesions and 22 colonic adenocarcinoma in addition 6 normal resection (non tumors) margin were
used as a control group, paraffin embedded archival materials from this cases were collected for
the period between Nov 2015- July 2016.the expression of 2 markers (HER2/neu and
BRCA1)were assessed and then were correlated with different clinicopathological parameters .
Results: the immunohistochemical expression of HER2\neu was (45%) of CRC, in (27%) of
colorectal polyps and in (4) out of (6) non-neoplastic colonic tissues.
HER2\neu was expressed more frequently in the colon in about (46%),in female (39%), in the age
group of more than 40 years (43%) , in well differentiated adenocarcinoma (67%), in non
mucinous adenocarcinoma (90%), in T2 (54%) and the tumor size of more than 4 cm (66%)
although the results were statistically not significant..
BRCA1 immunostaining was found in (6%) of colorectal tumor and there were (14%) positive
cases of colorectal polyps, the result was statistically not significant.
BRCA1 expressed more frequently in the colon (20%), in male (8%) and age group of more than
40 years(10%) the results were statistically not significant. there was no difference in BRCA1
expression between tumor size of more or less than 4 cm .
Conclusions: In this study researchers concluded that expression of HER2\neu in colorectal
tumors (benign and malignant) is not infrequent phenomena , HER2\neu expression was obviously
increased in non-neoplastic tissues and adenoma, Low expression of BRCA1 in colorectal tumors
and no significant correlation of BRCA1 expression in relation to the clinicopathological parameter
(age, gender, tumors types, site and size).

Objective: To determine serum 1,5- anhydroglucitol (1,5-AG) levels among patients with
type 2 diabetes (T2D) in Basrah, and to evaluate the changes in 1,5-AG levels with regard to
the status of glycaemic control.
Methods: The present study included 76 patients with T2D, 33 males and 43
females, 30-78 years of age. Height, weight, waist circumference , systolic blood
pressure, and diastolic blood pressure were measured. Fasting blood glucose (FBG),
glycated haemoglobin (HbA1c) and serum 1,5-AG levels were determined.
Results: The study revealed that T2D patients have low serum
1,5-AG
concentrations (3.62 ±1.56) µg/ml. The comparative male and female values were
(3.69±1.55) µg/ml and (3.57±1.58) µg/ml. The vast majority of the included diabetic
patients (90.8%) were in a state of poor glycemic control, with 6.6%
have an sub
optimal
2.6
metabolic control. On the other hand, good glycemic was documented in
% of patients. There were no significant differences in plasma 1,5-AG
concentrations with regard to the status of glycaemic control (P > 0.05).
Conclusion: T2D patients have reduced
serum 1,5-AG concentrations. Thus, it
could be, potentially, valuable test for the diagnosis of diabetes mellitus. Diabetic
patients were in poor glycaemic state. Therefore, they are at a substantial
risk for the
development of diverse diabetic complications.

Background: Henoch-Schönlein purpura is an acute immunoglobulin A (IgA)–mediated
disorder characterized by a generalized vasculitis involving the small vessels of the skin,
gastrointestinal (GI) tract, kidneys, joints, and rarely the lungs and the central nervous system
(CNS).
Objectives: An attempt to identify the characteristics of this disease that is considered as quite
common problem in our city, to identify the epidemiological, clinical, laboratory features and
complications of HSP in our locality and to find the mode of treatments used by pediatricians
and trying to uniform the management in a scientific way.
Patients and Methods: Sixty five patients with HSP hospitalized in Sulaimaniyah pediatric
Teaching Hospital in Kurdistan/ Iraq were included in this retrospective study from 1st of January
2013 to 31st of December 2014; they were selected by Case sheets based on the diagnosis of
HSP at discharge time.
Results: Of 65 patients, 37 (56.9%) were boys and 28 (43.1) were females, with a male to female
ratio of 1.3:1. The patients’ ages ranged from (2 to 12) years, with a mean of 6 years.
Approximately 61% of cases were presented during winter and spring. Upper respiratory tract
infection preceded HSP in (36.9%) of the patients. The main clinical features included skin rash
(100%), skeletal manifestation (66%), gastrointestinal manifestation (70.8%), renal involvement
(26.16%), and Genital involvement (5.4%) in males. Fecal occult bloods were positive in
10/29(34.5%) of the patients. Forty one (63%) patients received corticosteroid therapy.
Conclusions: There were no major differences in the epidemiological and clinical criteria of
HSP in Sulaimaniyah with that most of similar studies done elsewhere. GIT involvement more
common than skeletal involvement. Many patients had been treated with corticosteroid therapy.

Otitis media with effusion (OME) is a common condition affecting children ,if not
managed appropriately may lead to a serious complications.
Our study was planned to measure the pure tone audiometry and tympanometry findings in
OME regarding the type and the degree of hearing loss. The study include 50 patients with
age range from 4-15 years old of different gender. The thresholds in the involved cases
(conductive deafness) were 31dBHL in the ranging between (0-50) dBHL. 500Hz is the
frequency mostly affected, 2000Hz most less affected. In bone hearing threshold
(sensorineural problem), the frequency 1000Hz is mostly affected, while the least affected
was 250Hz.

Background: A born baby with no any life signs within or after 28 weeks of gestation is define as
stillbirth, . 3rd trimester SB account 2.6 million globally at 2015.
Objectives: to compare SBR by the 2 places of birth in Al-Nasiriyah city, and to determine the
expected determinants of the still birth.
Methodology: An analytical-comparative, hospital based study, extending all over the past 1
years; from 1st day of January till the end of December of 2019 in Bint Al-Huda maternity and
pediatrics hospital-Thi-qar/Iraq. Including all Still birth, from 2 different places of labor that
including: Main labor room and operative theater room, informed consent also was taken from all
participants parent. SPSS version 25 had been used, P value <0.05 is considered significant.
Results: Among 8772 delivered fetus as a normal vaginal delivery, 136 delivered died with a total
still birth rate 0f 15.5/1000, compared to a total deliveries by cesarean section of 5810, were the total
still birth of 97 delivered died with a rate of 16.7/1000.Still birth rates difference was of not a great
values in their distribution according to different months and seasons of the year 2019. Age of the
parents and weight of SB had a significant role in SBR.
Conclusion: delivery by CS and NVD show no significant statistical difference of the SBR
between those who are., also no difference in monthly trends of SBR all-over the period of the
study, whether was by CS or NVD. Different age groups in different places and within the same
place show a highly significant statistical association, B. wt. of deliverd baby was also one of the
main determinants of the SBR and the age of father that extending the 41 years show significant
difference in the occurance of the SB.

In the case of burned infections, the current study aims to identify and study
the antimicrobial susceptibility of bacterial isolates. Between October 2012 to June
2013, 90 burn swabs were obtained between patients and 42 environment swabs who
had both-sex bacterial burn disease admitted to the Al-Imam Al-Hussein hospital.
Enterobacter spp. (25.6%) has originate to be the m
i
i
i
i
ost public iso
vlate follo
wed b
y
Staphylococcus epidrmiditis (17.8%), Pseudomonas aeruginosa ( 12.2%),
Acinetobacter baumannii ( 11.1%) , Aeromonas hydrophila ( 5.6%) , while (3.33%)
for each from Klebsiella pneumonia, E . coli, Streptococcus spp. and Citrobacter
spp. , (2.22%) for each from Photobacter dansela , Proteus mirabilis , Lactobacillus
spp. and Pantoea spp. finally (1.1%) for each from Bacillus spp., Staphylococcus
aureus , Flavinous oryzihabitans , Morganella morganii and Burkholderia cepacia .
Bacterial isolates were tested for antimicrobial susceptibility against 10 antibiotics,
where Levofloxacin was shown to become the most effective medicine to most Gram
negative and Gram-positive isolates led by Gentamicin, whereas Cephalothin and
Ceftriaxone are extremely resistant (100%).