Iraqi Postgraduate Medical Journal

BACKGROUND:
Renal involvement is considered a poor prognostic factor and not frequently a cause of death in patients
with scleroderma. Renal involvement can be divided into scleroderma renal crisis and non-renal crisis
abnormalities.
OBJECTIVE:
To evaluate the frequency of renal involvement in 25 Iraqi patients with systemic sclerosis (SSc).
METHODS:
Twenty five patients with SSc (21 female and 4 male) were included in a case-controlled study. All
patients fulfilled the American College of Rheumatology criteria for SSc. All patients were of diffuse
type. Other types of SSc were excluded. All patients underwent measurement of blood pressure and
investigations had been done for them which included: hemoglobin (Hb), white blood cell (WBC) count,
platelet count, erythrocyte sedimentation rate (ESR), blood urea (BU), serum creatinine (SCr), general
urine examination (GUE), and rheumatoid factor (RF). Same investigations were done for 25 healthy
person (considered as control group).
RESULT:
All patients (100%) had Raynaud’s phenomenon, 23 patients (29%) had dysphagia, 21 patients (84%) had
arthralgia, 10 patients (40%) had telangiectasia and 2 patients (8%) had subcutaneous calcification. Three
patients (12%) had moderate hypertension. Fourteen patients (56%) had anemia, 2 patients (8%) had
leukocytosis, 6 patients (24%) had elevated ESR, 1 patient (4%) had elevated BU, 1 patient (4%) had
albuminuria and 4 patients (16%) had positive RF. Platelet count and SCr were normal in all patients.
Only 1 patient (4%) had renal involvement in form of combination of azotemia, albuminuria and
hypertension.
CONCLUSION:
Renal involvement in systemic sclerosis among Iraqi patients is rare.

BACKGROUND:
Acne is a multifactorial disease with multiple pathogenic factors, hence combination therapies are
needed. Combination therapies using agents with complementary mechanisms of action increasingly
are recognized as an effective strategy for treating acne.
OBJECTIVE:
The rationale of utilizing topical retinoids with azithromycin in treating facial acne vulgaris will be
highlighted, particularly in relation to improvement.
METHODS:
A randomized, clinical trial was carried out at the outpatient Department of Dermatology and
Venereology, Baghdad Teaching Hospital between April 2007 and August 2008.
A total of 48 patients with moderate to severe papulopustular acne vulgaris were allocated to two
groups, azithromycin and azithromycin plus isotretinoin gel, both groups received Azithromycin for
two months. Azithromycin 250 mg was prescribed every day for one month and every other day for
the following month. Patients in second group were instructed to apply Isotretinoin gel 0.05% once
daily over a 3 months treatment period. The clinical assessment was done by counting the number of
inflammatory lesions in three occasions: baseline, two months and three months.
RESULT:
After two months, both groups showed a statistically significant difference from the baseline in
reducing inflammatory lesions and improving acne. Adding topical isotretinoin gel produced a higher
percentage of reduction in their lesional counts, but differences between the two groups were not
statistically significant. After three months, regression in the percentage of reduction of the lesional
count from 57.7% to 32.4% in the first group. While in the second group the reduction was maintain
in 69.8%.
CONCLUSION:
Adding topical 0.05 per cent isotretinoin gel to oral azithromycin enhances and maintains the rate of
improvement of facial acne vulgaris.

BACKGROUND:
Perniosis(chilblains) is a common skin problem. This condition results from abnormal reaction to cold
which is usually seen during the cold months of year.
OBJECTIVE:
The aim of the present study is to shed a light on different clinical and epidemiological aspects of
perniosis in Iraq.
METHODS:
A total of 40 patients with perniosis were seen between January to march 2008 in the department of
dermatology and venereology of Baghdad Teaching Hospital.
A detailed history was taken from each patient regarding age, sex, occupation, duration of attack,
family history, smoking, drug history, medical history, relieving and aggrevating factors and previous
treatment modality.
Full examination was done to each patient to assess the distribution and extent and morphology of the
lesions and to see if there other skin diseases. Biopsies was done for 6 patients for histopathological
study.
RESULTS:
A total of 40 patients were assessed. Their ages ranged from 5-60 years with a mean age of 22 SD± 6.2,
31 females and 9 males (3.5:1).
Main sites of involvemnt were; toes 39% , fingers 22% ,heals 10% and nose 2.5% .
Main types of lesions were ; erythematous cyanotic swellings 82% , vesicular lesions 23% ,ulcerations
10% and erythema multiforme like lesions 15%. Family history was positive in 22.5% of patients.
CONCLUSION:
Perniosis occur mainly in females between 10-20 years . Most common sites of involvement are toes
and fingers . genetic susceptibility is an important factor in the development of the disease. Majority of
patients are healthy without any medical or dermatological diseases .Majority are non smokers and did
not have any history of drug intake.

BACKGROUND:
There are many circulatory changes that occur during exercise including the stimulatory effects on
the circulation by the mass sympathetic discharge, the increased arterial pressure and cardiac output.
OBJECTIVE:
To investigate the effect of aging process on the heart rate and blood pressure responses during
exercise in normal Iraqi male subjects.
METHODS:
The subjects involved in the study were normal healthy people, their total number was 80 persons all
of them were males. They were grouped into three age groups; 20 ≤ 29 years, 30 ≤ 39 years and 40
≤ 50 years. Each subject performed the exercise on motor driven treadmill device. Testing was
conducted at The Medical City Teaching Hospital-Treadmill and Echo unit. Blood pressure was
measured indirectly by auscultation. The heart rate was determined by ECG.
RESULT:
There was a significant differences in heart rate after the exercise between the three age groups, a
significant differences in systolic blood pressure after the exercise between group2 and group3 was
also noted, a non significant decrease in diastolic blood pressure among the three age groups and
there was a significant increase in mean blood pressure between group2 and group3.
CONCLUSION:
There was a negative linear correlation between heart rate after the exercise and increasing age, while
a positive linear correlation between systolic blood pressure and increasing age was found and there
was a positive linear correlation between age and the mean blood pressure after the exercise.

BACK GROUND:
Spinal cord problems is an important complication of spinal cord injury. Deep vein thrombosis is a
critical sequel & need early diagnosis and management.
OBJECTIVE:
To determine the frequency and time of occurrence of deep vein thrombosis (DVT) in Iraqi Spinal
Cord Injured patients, and a possible etiologic relationship between DVT and Spinal Cord Injuries
(SCI) types.
METHODS:
One hundred nine Iraqi patients with spinal cord injury admitted at Ibn_Alkuff SCI Hospital from the
1st of January till 30th of June 2006 were studied, full history was taken and complete clinical
examination was done for all patients. DVT was diagnosed by physical examination and confirmed
by Doppler ultrasound. Special scales and scores were included in this study to assess spinal cord
injury impairment (American spinal injury association scale/score and Modified Ashworth spasticity
scale).
RESULT:
A total sample of 109 Iraqi patients were included in this descriptive cross sectional study, 100 males
(91.7%) and 9 females (8.3%), the age of patients ranged from 11 to 65 years (mean 33.8 years), the
disease duration ranged from 1 to 240 months (mean 20.5 months). Eleven patients (10.1%) were
having DVT (were male patients).Our study showed statistically significant association between the
presence of deep vein thrombosis and neurological level of spinal cord injury, flaccidity and ASIA
scale (A and B). (p=0.011, p=0.017 and p=0.006 respectively) Our results showed no statistical
significant association between age, gender, duration of spinal cord injury and causes of spinal cord
injury in determining the presence of DVT. (p=0.71, p=0.36, p=0.68 and p=0.34 respectively)
CONCLUSION:
DVT is more likely to develop in Iraqi spinal cord injured patients who have a lumbar neurological
level of injury or who have flaccid paralysis. Also SCI patients with ASIA scale A and B are more
liable to develop DVT. These groups of patients needs close observation and monitoring.

BACKGROUND:
Obesity has become a leading health concern; this condition is a chronic, complex, multifactorial
disease in which a person's weight is ≥ 20% of the ideal weight for a given height.
OBJECTIVE:
To measure serum leptin level and lipid profiles levels in Iraqi obese individuals comparing the results
with matching non obese subjects.
METHODS:
The study was carried on 30 individuals divided into two groups:
1. Obese subjects group (n=20).
2. Non-obese subjects group (n=10).
For all subjects studied measurements of fasting serum leptin and lipid profile have been done.
RESULT:
Our study showed that mean serum leptin level was significantly higher in obese than non-obese
individuals (P<0.001). In addition serum leptin correlates positively and strongly with body mass index
(BMI) ( r=0.765,P<0.01). Serum leptin also correlates positively with both triglyceride (TC)(r =0.394,
P<0.05) and low density lipoprotein (LDL) (r=0.366,P<0.05) but correlates negatively with high
density lipoprotein (HDL)(r=-0.408,P<0.05).
CONCLUSION:
circulating leptin levels appear to be one of the best biological markers of obesity and hyperleptinemia
is closely associated with several risk factors related to obesity syndrome.

BACKGROUND:
Acute renal failure (ARF) is a common condition in hospitalized patients, characterized by a rapid
fall in glomerular filtration rate (GFR), carries a high morbidity and mortality, often preventable, so
rapid recognition and treatment may prevent irreversible loss of nephrons.
OBJECTIVE:
To find out the cause of acute renal failure in children and to study the clinical presentation and
management modalities and sequel.
METHODS:
A prospective study done in Central Teaching Hospital for children from January 2006 to December
2006. 120 patients aged 1month- to 12 years who were diagnosed and treated as cases of acute renal
failure were collected & analyzed. And the distribution of patients according to (age, sex, type of
presentation, laboratory finding, type of management and sequel) were done.
RESULTS:
From hundred twenty patients, there were 77 male and 43 female with 1.7:1 ratio distributed into 93
infant, 14 preschool and 13 school age group .The main type of presentation was acidosis ,oliguria &
dehydration. The main causes were gastroenteritis, sepsis and obstructed uropathy in infancy and
preschool children, glomerular disease in school age group. 97 need conservative treatments and 23
need urgent peritoneal dialysis (PD) with mortality rate 5.15%, 30.51% respectively.
CONCLUSION:
Acute renal failure occurred more in infancy and most of them were prerenal acute renal failure can
be handled with conservative treatment; peritoneal dialysis is a good choice for treatment of acute
renal failure not resolved by conservative therapy.

BACKGROUND:
Acute lower respiratory tract infections (ALRI) are the leading cause of morbidity and mortality
among children in developing countries, causing one – third of all deaths in childhood. Pulse
oxymetry is a simple technique to determine the oxygen saturations.
OBJECTIVE:
It is important to accurately identify hypoxemic children by use of clinical signs alone.
METHODS:
A well matched case control study was performed on 104 children from 2 months to 5 years of age
admitted with ALRI to the emergency department of Children Welfare Teaching Hospital -Medical
City - Baghdad in the period from 15thMarch -15thJune 2006.Clinical symptoms and signs were
recorded .Hypoxemia was defined as oxygen saturation less than 95%.The ability of various clinical
symptoms and signs to predict the presence of hypoxemia was evaluated.
RESULTS:
Fifty (48.1%) children were hypoxemic. The median O2 saturation was 91.2%with a range of 82-94%
Physical signs including tachypnea, intercostal and subcostal retractions, supraclavicular recessions,
grunting and nasal flaring were statistically significantly associated with hypoxemiUse of
combinations e.g. Tachypnea or head nodding ( P. 0.02 , sensitivity 70% , specificity
48%),tachypnea or suprasternal recessions( P.0.05 ,sensitivity 70% ,specificity 44%)only slightly
improved the predictive ability.
CONCLUSION:
None of the clinical features either alone or in combinations have sufficient sensitively and
specificity to predict hypoxemia in children with acute lower respiratory tract infections, therefore
pulse oxymetry is desirable for identification of hypoxemia.

BACKGROUND:
Nephrotic syndrome (N.S.) is clinical manifestation of different histopathological subtypes
OBJECTIVE:
This study was conducted to analyze the trend of histopathological subtypes in idiopathic nephrotic
syndrome.
METHODS:
A prospective study was performed from January 2004 to May 2005, at Central child teaching hospital
and Al-karama teaching hospital involving 113 patients aged up to 18 years with nephrotic syndrome.
The following parameters were studied (age, gender, initial episode, relapse, predisposing factors, positive
family history of nephrotic syndrome, clinical presentation and investigation, treatment and
complication).
RESULT:
One hundred thirteen patients enrolled in this study, 71(63%) were males and 42(37%) were females,
male to female ratio was 1.7/1. 23(20.3%) patients were with initial attack of nephrotic syndrome, while
90(79.6%) patients with relapse. Age at onset ranged between 0.7-14 (median 2.3) years. Family history
of nephrotic syndrome was found in 8 (7%) patients. Biopsies was done in 74(65%) patients. 36(48.6%)
patients showed focal segmental glomerulosclerosis. 17(22.9%) patients showed minimal change
disease.10(13.5%) patients showed membranoproleferative glomerulonephritis. Other histopathological
sub types were 6(8%) patients with mesangioproleferative glomerulonephritis, 3(4%) patients with global
masengial sclerosis, and 2 (2.7%) patients with amyloidosis.
CONCLUSION:
This trend of histopathologic patterns has profound prognostic significance and has significant
implications in the management of childhood nephrotic syndrome. There is shift toward an increasing
incidence of focal segmental glomerulosclerosis and to lesser extent, the membranoproleferative
glomerulonephritis in Iraqi children presenting with idiopathic nephrotic syndrome. Our finding is in
agreement with the recommendation of performing renal biopsies on children with idiopathic nephrotic
syndrome who are steroid dependant in addition to those who are steroid resistant particularly before
starting cytotoxic medication.

BACKGROUND:
Compound fracture olecranon alone or associated other injuries is common in Iraq in last years due to
different type of war injuries. Different methods of treatment used in its management. In this study I asses the
validity of using tension band wiring and intramedullary K-wires in treatment of such fractures and
comparing this result with others studies.
OBJECTIVE:
Of the study is to asses the validity of this technique in the management of compound fracture olecranon.
METHODS:
Non-Randomized clinical trial (NRCT)done in Al-Kindy teaching hospital and Al-Jarah private hospital in
the period between Jan,2001 and Dec.2006.two hundred twelve patients visited these hospitals. A 96 patients
were selected according to certain criteria (type B ASIF classification and type 1 and 2 Gustillo
classification).We divided those patients in to two groups ,group A 62 patients with isolated compound
fractures olecranon ,and group B 32 patients with neglected fractures (treated in other hospitals either they
treat them without fixation or they were dealt with other injuries and leave the olecranon fracture later on
Those patients visited these hospitals within 4-6 weeks.
RESULT:
Male to female ratio was3.77:1for the sample “group A and B”. In group A; the highest age group was 20-29
year (48.4%).The rate of union was 61.3% healed within the first three months .The range of motion was
61.3% got full rang of motion and 3.23% developed loss of extension 15-20 degrees. The incidence of
infection was 11.3% and mostly superficial. Follow up for two years. In group B ,the male to female ratio was
7.5:1 also the highest age group was 20 -29 year (44.1%).The rate of union was 8.8% during the first three
months while 38.2% within 6-9 months and 26.5%within 9-12 months. The incidence of infection was
8.82%.Gaining full range of motion 5.9% while loss of extension 10-15degrees was 26/5% and loss of more
than 20 degrees was 11.8%.Follow up for two years.
CONCLUSION:
Tension band wiring and intramedullary K-wires proved to be the ideal method of fixation of compound
fracture olecranon as early as possible in order to get rapid union and excellent rang of motion.

BACK GROUND:
Children are not merely little adults, and the diseases they have are not merely variants of adult
diseases (1,2). Pediatric neoplasm as a group causes more deaths in children than any other disease
(2) .Histologically many of the malignant pediatric tumors are unique, with primitive (embryonal)
microscopic appearance and exhibit features of organogenesis specific to the sites of tumor origin, so
they are frequently designated as blastomas (1,2) .We managed to collect- 175 - cases of solid
pediatric tumors
OBJECTIVE:
1-To identify different histopathological types of solid pediatric tumors .
2-To find out their relative frequencies ,sites , age &sex distribution .
3-To compare our results with others.
METHODS:
This is a Prospective study conducted During a period of one year from July 2003 through August
2004; (175) biopsies of children in Mosul with solid tumors were Collected. The surgical specimens
were collected from; Al-Salaam teaching hospital, Al-Zahrawi teaching hospital, Al-khansa teaching
hospital and few private laboratories.
RESULT:
There were 92 cases (52.57%) of benign tumors and 83 cases of malignant tumors (47.4%).The
leading malignant tumors were Lymphomas 20 cases (24.09%), followed by CNS tumors 14 cases
(16.8%)
CONCLUSION:
1-Benign tumors are more frequent than malignant ones, with hemangiomas being the prevailing
one.
2-Lymphomas constitute the commonest malignant tumors with predominance of non Hodgkin
variety.
3-Among the reported tumors with noticeable rise in relative frequency are CNS tumors and
Retinoblastomas. This rise may be due to genuine increase in incidence.

BACKGROUND:
Menstrual cycle define and reflect the women internal endocrine environment. Ovarian hormones,
estrogens and progesterone, are not secreted in constant amounts throughout the cycle. Estrogen and
progesterone have been shown to inhibit aspects of both innate and acquired immunity at the
systemic or local level furthermore they have been shown to influence on maturation and
keratinization of oral mucosa. So there may be possible influence of the menstrual cycle on the
adherence of Candida to human oral epithelial cells, and may implicate hormonal factors in the
aetiology of oral Candidiasis.
OBJECTIVE:
The purpose of this study was to estimate the prevalence of Candida albicans and other different
Candida species in the oral cavity during different periods of menstrual cycle.
METHODS:
One hundred and seventy six oral swabs were taken from 44 females’ patients attending dental clinic
during the period from May to September2007 with age range 14-49 years old at different periods of
menstrual cycle on days 5, 13, 22 and 28, which represent menstrual phase, ovulatory phase, midluteal phase and premenstrual phase respectively.
Swabs were taken from the tongue for isolation of Candida species. The swabs were inoculated on
Sabouraud’s glucose agar incubated at 37º for 72 hours; Candida species were identified by gram
stain method, germ tube method and fermentation of sugar set.
RESULTS:
The prevalence of Candida in the oral cavity at 5th, 13th, 22nd and 28th days of menstrual cycle were
31.8%, 22.7%, 40.9% and 25% respectively. The study shows that the prevalence of Candida in the
oral cavity was non-significantly higher at 22nd day of menstrual cycle.
CONCLUSION:
There was no significant influence of menstrual cycle on the prevalence of Candida in the oral cavity
during different periods.
The prevalence of Candida albicans was higher during different periods of menstrual cycle in
comparison to Candida tropicalis and Candida parapsilosis.

BACKGROUND:
Celiac plexus neurolysis (CPN), a chemical splanchnicectomy of the celiac plexus, is used to treat
pain caused by pancreatic cancer. Originally performed by anesthesiologists and radiologists via a
posterior approach, recent advances in endoscopic ultrasonography (EUS) have made this technique
an attractive alternative. EUS guided celiac plexus neurolysis (CPN) is simple to perform and avoids
serious complications such as paraplegia or pneumothorax that are associated with the posterior
percutaneous approach.
OBJECTIVE:
To assess the efficacy and safety of EUS guided celiac plexus neurolysis in the management of pain
caused by pancreatic cancer.
METHODS:
This study included (310) patients with painful and inoperable pancreatic cancer were submitted to
EUS guided celiac plexus neurolysis (CPN) at a tertiary referral center. The following data were
collected: age, gender, tumor location, vascular invasion, adjuvant therapy, and laboratory tests
including prothrombin time, and complete blood counts were obtained at baseline (before EUS celiac
plexus neurolysis).
RESULTS:
Of 310 procedures performed, 217(70%) patients develop immediate and complete pain relieves
(within 24 hours of procedure) and no need for narcotic analgesia during follows up (12 weeks).
Sixty-one (20%) patients had partial response to the procedure (decreasing in the need for narcotic
analgesia during follow up). Thirty-two (10%) patients were lost to follow up and no outcome of
procedure obtained.
CONCLUSION:
EUS is more safe, feasible, and more effective than other methods in performing CPN and controls
pain caused by unresectable pancreatic cancer.

BACK GROUND:
Psychiatric disorders and coronary heart disease are not uncommonly seen together in the same patient
especially in association with myocardial infarction these disorders vary from simple anxiety,
depression, posttraumatic stress disorder, adjustment disorder.
OBJECTIVE:
Studying the depressive disorders in the Iraqi cardiac patients and its prevalence after April 2003. and
trying to ascertain any mispractice in management of such patients by ignoring the psychiatric cause.
METHODS:
260 patients admitted to Baghdad teaching hospital medical departments over the period December
2005- October 2007. Those patients were having cither stable angina unstable angina and myocardial
infraction. A uniform questionnaire was used for all patients to find out the prevalence any psychiatric
disorders.
RESULTS:
This study showed the presence of depression during the pre and post cardiac events in 70 cases (27%)
anxiety was also a very common problem in about 60 cases (23%), however the percentage of patients
whom were had psychiatric disorders after an acute events due to un settled security in the country
since 2003 were as follow depression (21% cases 8%) from the total number of cases respectively.
CONCLUSION:
Psychiatric disorders are becoming a common problem in many Iraqi cardiac patients because of the
difficulties of their daily life since 2003 and it represents about 50% of the cases of psychiatrics
disorders. This may make it an important issue to use antidepressant drugs in many of those patients.

BACKGROUND:
The annoying feeling of mistakenly thinking that you can hear your mobile phone ringing. This audio
illusion is familiar and unnerving sensation is so widespread and now it has an official name:
ringxiety.
OBJECTIVE:
This study was conducted to determine whether "Ringxiety" is common among Iraqi peoples and its
correlation with age, sex, education, mobile type, and mobile using time.
METHODS:
Two hundred adult persons of either sex with a mean age of 20 ± 3 years were asked to answer a
questioner with 14 questions.
RESULT:
The results of this study revealed that 73% of the individual involved experienced the phenomenon of
ringxiety from time to time, in addition to 4% who experienced frequent ringxiety.
Significant correlations were found between this sign and using mobile for more than 30 minutes per
day and also a significant correlation was found between mobile addicts and ringxiety (P value
<0.05).
42% of studied subjects experienced mobile vibration mistakenly feeling, which occurs always with
ringxiety but not the reverse. This sign was only correlated with the high mobile using time.
No association was found between ringxiety and age, education, type of ring tone, or short messages
(SMS) using.
CONCLUSION:
This study has proved that ringxiety is common among mobile users and could be one of the side
effects of radio waves or just a malfunction of the brain due to the life heavy duties. Ringxiety might
cause discomfort or loss of concentration during car driving or using dangerous machine.

A 25 – year old man presented with a forgotten left
ureteral stent for 10 years. The stent was heavily
encrusted particularly at the upper and lower ends
with severe hydronephrosis of the kidney. In view
of the limited therapeutic options including the
endourologic facilities, the patient underwent
vesicolithotomy of the lower end of the stent. The
residual stent was left for a second step procedure
but the patient disappeared. A brief review of the
literature for the current international experience of
such cases was carried out.