Thi-Qar Medical Journal

D-dimer is sensitive and early marker of both inflammatory and thrombotic insult, extremely elevated
D-dimer might herald a serious events especially following receiving a shot of COVID-19 vaccine. The
adverse effects of COVID-19 vaccine is simulating the rare but catastrophic thrombotic events following
vaccination.so early alertness to this complication mandate search for this serious entity. D-dimer although
non-specific but it is highly sensitive and early marker of thrombotic as well as other serious pathologies,
we present a case with nonspecific symptoms with the only laboratory abnormality is lonely elevation in
D-dimer. To our knowledge this is the first reported case of elevated D-dimer without clinically manifest
thrombosis highlighting to possible newly emerging practice of using D-dimer as an early evidence of
hidden thrombosis.

Background: cancer of the cervix is the second cancer among women after breast cancer. Screening
for pre-invasive disease prevent progression to malignancy. Setting: Clinic for early detection of
cervical cancer, Basra Maternity Hospital. Study Design: Retrospective cross sectional observational
study. Methods: All women attended the cervical cancer-screening clinic at Basra Maternity
Hospital during the years 2016, 2017, whom underwent Pap smear were included in the study by
reviewing their data sheet, which arranged in a special questionnaire form provided by Ministry of
Health and includes many variable, analysis of data done and presented in tables as number and
percentage. Results: A total of 317 women, their age range from 25-65 years.95 (30%) of those
women had normal cervical smear, 104 (32.8%) had infection and 114 (36%) had premalignant
results.(4 cases reported abnormal result without specifications). We found significant association
with postcoital bleeding and with history of infertility. No significant correlation found with vaginal
discharge, post-menopausal bleeding and intermenstrual bleeding, age of women, residency and level
of education. Conclusion: appreciable proportion of women investigated by pap smear diagnosed
with premalignant lesion, therefore the need for national guideline and protocols to increase the
awareness of the importance of pap smear as it is in case of early detection of breast cancer.

Background:
Control of infection in chronic suppurative otitis media can be achieved by performing surgical techniques
as well as medical treatment can be beneficial. Persistent otorrhoea and/or occasionally hearing impairment
can be relatively reduced by surgical technique.
Although several surgical techniques exist for the treatment of chronic suppurative otitis media, the
procedure is selected based on the audiological finding, surgeon experience, and extent of disease.
Patients & Methods:
A prospective study was performed within eight months. Thirty-four patients included (24 males &10
females); age range was (9-40 years), with chronic suppurative otitis media attended Otolaryngology
Department for surgery.
A thorough history and examination, audiological, laboratory & radiological investigations were recorded &
analyzed. Ear drops and antibiotics were given to all patients before and after surgery.
All included patients underwent tympano-mastoidectomy; 11 cases (5 males and 6 females) by intact canal
wall technique & 23 cases (19 males and 4 females) by canal wall down technique with follow up 8
months& data recorded& analyzed.
Results: -Through a period of 8 months all patients were followed up in scheduled visits at 1st week, 1st month, 3rd
months, 6th months & 8th month postoperatively. -The overall satisfactory control was achieved in 23patients (67.6%) who have dry ears, while 11patients
(32.4%) remained with wet ears. -Out of 23 patients with dry ears, 19(55.8%) patients have cholesteatoma & 4(11.8%) patients have active
mucosal disease. -The canal wall down (modified radical) technique was performed in 23 patients & resulted in 18(78.3%)
patients having dry ears (15patients have cholesteatoma &3patients had the active mucosal disease), while
the other 5(21.7%) patients remained with wet ears (2patients have cholesteatoma&3patients have an active
mucosal disease). -The intact canal wall technique was performed in 11(32.4%) patients & resulted in 5(45.5%) patients
having dry ears (4patients have cholesteatoma &1patient had active mucosal disease), while the other
6(54.5%) patients remained with wet ears (all of them have an active mucosal disease).
Conclusion -It is evident that surgery performed in patients with chronic suppurative otitis media gives better chance for
control infection. -Canal wall down technique is effective in the treatment of chronic suppurative otitis media with or without
cholesteatoma - Cholesteatoma (55.8%) did significantly better than chronic mucosal disease (11.8%)

Background: Veno-Arterial handling is an important clinical issue in the management of chronic
hemodialysis patients. Several complications may occur during treatment period. Aim: The aims of
this study were to determine the most feasible AVF site to be created for hemodialysis and their
possible complications that may occur during treatment period. Patients and Methods: A cross
sectional comparative study was conducted in Ibn – Alnafees teaching hospital retrospectively ,
Department of Thoracic and Vascular Surgery from 2016-2012. Necessary approvals were taken from
the hospital adminstration regarding data collection . One hundred patients with end stage renal disease
were included in this study after signing a consent form. An arteriovenous fistula was created in
different sites preparing them for chronic haemodialysis program. The evaluations were based on the
most feasible site for AVF, complications that may occur during the treatment period in different sites.
Results: Most of the patient (98%) had successful creation of arteriovenous fistula, only two patients
(2%) were not fit. The most two common approaches were, Brachiocephalic and radiocephalic which
represent 70% and 20% respectively, followed by Anterior transposition of Basilica vein,4%,
Autogenous saphenous vein graft 2% while Gore-Tex graft and Femorofemoral Gore-Tex Loop graft
represent only 1% for each. Complications were seen in (15%) of the patients. Fistula failure was seen
in 3 patients, Wound infection 2 patients, Temporary edema 2 patients, Hematoma 2 patients and one
patient for each of the following complications, Continuous serous discharge, Steal syndrome, Sudden
closure, False aneurysm formation, Aneurysmal dilatation of the veins and Huge limb swelling.
Conclusion: Radiocephalic and the brachiocephalic AVF are the two types of vascular access with
the
longest
duration
of
function
and Radiocephalic is the most feasible site.

The aim of our study is to avoid complication associated with a craniotomy for removal of a big cerebral
hydatid cyst like cerebral hemorrhage ,CSF leak, cerebral shrinkage and to prevent the formation of a new
large volume acquired cyst instead of the original lesion.
Materials:
By this new maneuver study, cerebral hydatid cyst were evacuated completely in tow patients. Catheter fill
in ( 100 cubic centimeter) air/normal saline & put in hole of cyst till catheter occupies all hole of cyst .
Air/normal saline empting is going to average equal to 15 cubic centimeter | 24 hours then beyond a seven
days, Finally catheter released.
Outcome:
Hydatid cysts is evacuated with no bursting. No intra & postoperative complication are seen such as balloon
rupture , seizure, CSF leak, hemorrhage and serous infection.
Summary:
Balloon dowling maneuvers may be a good maneuver to a void cerebral shrinkage, intra and postoperative
complications associated with this maneuvers.
Key Words:
Dowling maneuvers, hydatid sand, cerebral cyst, intra operative complication, surgical maneuvers.
Collection of data:
In our research the collection of data performed in Nasiriyah teaching hospital, tow patient well prepared for
surgery with routine preoperative radiological and hematological investigations, fasting at least six hour pre
operatively, blood preparations and instruct the patient for preoperative order for steroids, antiepileptic
medications, prophylactic antibiotics and DVT prophylaxis like pneumatic compression boots or knee- high
TED hose.

Autism spectrum disorders (ASD ) are broad spectrum of conditions characterized by impairment in reciprocal
social communication and interaction and restricted , repetitive patterns of behavior ,language and interest .
Aim: To assess the effect of age on speech and learning among autistic children, and to find out the relationship
between mean birth order and its effect on speech and learning .
Patients and methods : A prospective case study was conducted at Thi-Qar governorate , south of Iraq
through the period from January 2018 to May 2019 .The study involved 70 autistic child (50 boys and 20 girls)
from Thi-Qar autistic children center at Al-Nassiryah city . Specialized designed questionnaire used including
gender , age at time of present study , order in the family ,speech ( any non-fluent speech considered speech
defect ) and learn defect and finally the residence of patients either from Al-Nassiriyah center or from the
periphery .The data was collected by direct interview in the presence of one or both parents . Statistical tests
used including : the mean ,slandered deviation ( S. D ) , a NOVA test and P value ( < 0.05 significant ).
Result : Among 70 autistic child , 50 ( 71.4% ) were boys and 20 ( 28.6%) were girls. The mean age for boys
were( 5.3 years) and (6 years ) for girls .The mean birth order for boys was ( 2.6 ) and ( 2.9 ) for girls . Among
autistic children 56 ( 80% ) with speech defect with mean age ( 5.1 years ) , while 14 ( 20% ) without speech
defect with mean age ( 7 years ) .The mean birth order for autistic children with speech defect was ( 2.9 ) ,while
the mean only ( 2 ) for those without speech defect . Among autistic children 47 ( 67% ) were with learn
defect with mean age ( 5.5 years ) , while 23 ( 33% ) were without learn defect with mean age ( 5.4 years ) .The
mean birth order for autistic children with learn defect was ( 2.8 ),while only ( 2.4 ) for those without learn
defect . Most autistic children from Al-Nassiriyah 35( 50% ) , 19 ( 27.1 ) from Shatra , 6 ( 8.6% ) from Suq Al
Sheyokh , from Al-Rifae 5 ( 7.1% ), 2 ( 2.9% ) from Cheybaish and three cases( 4.3% 0 from other areas .
Conclusion: Autism more in boys than girls similar to those reported by other studies . Boys diagnosed earlier
than girls and most of autistic children suffering from speech and learn defect .Mean age was significant for
those with speech defect , while not for those with learn defect . Mean birth order was significant in autistic
children with speech defect while not for those with learn defect . fifty percent of our cases were from central of
Thi-Qar governorate .

Background: The word “Halitosis” refers to the term “bad breath” which can be a result of colonization of
bacteria in the mouth or oral cavity, other causes like chronic systemic diseases, dental caries or infections of
the throat, mouth tonsils; in addition to bad or insufficient oral hygiene may cause halitosis.
Objectives: This study was aiming to determine how frequently is self-assessed halitosis among a sample of
Basra university students and the effect of the habit of oral hygiene and systemic diseases on it.
Material and Methods: The questionnaire−based survey included 590 students from different colleges in
Basrah university, (340 females and 250 males), Statistical analysis was done using the χ2 test.
Results: Among those questioned, 27% suffered from halitosis, 56.2% of whom experienced it every
morning. Fifty percent of students suffering from halitosis also suffered from xerostomia,
15.2 % of students discovered that they have mouth bad breaths from mates of a different gender from them,
while 3.3% of students were examined and informed by their dentists. Those who smelled bad mouth breaths
in others formed 94% of questioned students.
The number of times brushing teeth does not significantly affect the occurrence of mouth bad odor, even up
to 3 times per day(p = 0.08). products such as dental floss and mouthwashes were used often by the studied
university students. To a larger extent; chewing gum and fresheners of the mouth were also used more often
(74.5%) than flosses and mouthwashes(64%).
Chewing gum and breath fresheners were used more often (74.5%) than such additional agents as
mouthwash and floss (64%). Subjective halitosis decreased by using additional oral hygiene products
(mouthwash and dental floss); as (p = 0.00016).
Conclusions: Using additional oral hygiene agents rather than brushing more frequently reduces the self
assessed halitosis level. Chewing gum or breath fresheners are preferred by 74.5 percent of students over
dental floss or mouthwash (64 percent ). A substantial percentage of those polled had both halitosis and
xerostomia. Almost all of those polled (94%) reported smelling foul breath from others.

Nail-gun injuries are rare types of penetrating cardiac injuries with the right ventricle being the
most common site for injury. However, occurrence of these injuries continuously rises due to the
frequent utilization at the daily life setting with surgical intervention being the standard way of
management, but there are patients with such type of injury who had been treated conservatively
especially when the patient is hemodynamically stable and associated with mild hemopericardium.
These types of injuries can occur either accidentally or self-inflicted as a suicidal attempt. We
present a case of a young aged male patient who had been accidentally injured by an assumed
unloaded nail gun to the anterior aspect of the chest to the left of sternum near the nipple.

Background: Vitiligo is an immunologically-mediated skin disorder presents as pointedly well
demarcated pigmented macules or patches, which may appear anywhere in the body. Metabolic
syndrome (MS) is a group of disorders involving central obesity, impaired glucose tolerance,
hypertension and dyslipidemia. Autoimmunity and oxidative stress in Vitiligo could initiate several
inflammatory and immunological cascades responsible for the systemic manifestations and skin
involvement.
Objective: To determine the association between MS and Vitiligo.
Subjects and Methods: A cross sectional study included 73 patients with Vitiligo, 44 males and 29
females, 11 – 72 years of age and 84 non-Vitiligo subjects, 46 males and 38 females, 12-75 years age as
a control group. Physiological measurements include weight, height, waist circumference (WC), and
blood pressure (BP). Biochemical measurements include fasting plasma glucose (FPG), triglycerides
(TG) and high density lipoprotein-cholesterol
(HDL-C).
Results: The frequency of MS among male patients with Vitiligo was 59% compared to 48% among
male controls. In females, the frequency of MS among female patients was 38% in comparison to 24%
among female controls. The differences were statistically significant (P < 0.02). The frequencies of all
MS criteria were significantly higher among male patient with Vitiligo having MS as compared to those
without MS, (P < 0.05 for BP and FBS, P < 0.01 for WC, TG and HDL-C). Female patients with MS
showed significantly higher frequencies of MS components, WC, BP, FBS (P < 0.05), and TG (p <
0.01) in comparison to female patients without MS. On the other hand, there were no significant
differences between female patient with and without MS regarding HDL-C
(P > 0.05).
Conclusion: The frequency of MS was significantly higher among both male and female patients
with Vitiligo as compared with non-Vitiligo subjects. This implies that these patients are at a high risk
of type 2 diabetes and atherosclerotic cardiovascular disease and thereby at a considerable risk of
cardiovascular events.