Iraqi Postgraduate Medical Journal

Chronic cough (cch) is very frequent in clinical
practice. The cause is not always obvious. (C Ch.)
may be the main manifestation of important and
common group of diseases or syndromes as (GERD),
(UCSA) or asthma where its usual cardinal symptom
or signs are not evident and cough in fact is the main
marker for many entities. To think of these entities
and to treat them may solve the problem in sizable
bulk of patients, publication in English from 1980
until 2008 were reviewed and relevant information is
referred to lengthy, costly, and repeated
investigations may be needed.
(ACE) inhibitors should be inquired about from the
beginning of the workup, and (NAEB) should be
thought of. Diagnosis of psychogenic cough is
overused and this should only settled at after
excluding all organic cases.
Appropriate treatments may achieve relieve or cure
as treating (GERD) with lifestyle, (PPI) and
prokinetics or even surgery. On similar ground
treating (C Ch.) in asthma variant treating as a
conventional case of asthma may terminate the
patients suffering.

BACKGROUND:
Percutaneous Coronary Intervention ; PCI has become important tool of treating patients with Ischaemic
Heart Disease however it is associated with serious complications.
OBJECTIVE:
This paper is a survey of the complications that occur during hospitalization for such treatment of patients
with Non-ST-Elevation Acute Coronary syndrome, assess relation of those complications with the clinical
severity, and with number of five classical predisposing Risk Factors for atherosclerosis
METHODS:
Data of 142 consecutive hospital pts with Non-ST-Elevation Acute Coronary syndrome were analyzed. All
patients had early coronary angiography following stabilization. Apart of 27 patients who had either
medical treatment only or surgery 115 pts had PCI
RESULT:
Complications were reported in 19 out of the 115 pts who underwent PCI (16.5%%. They were; 1-
Significant Coronary Artery dissection in 13 pts (11%}, 2- Signif. Coronary thrombi, 3 pts {3%)
culminating in NSE-MI in two, 3- Signif. Creatine Kinase rise; NSE-AMI, 2 pts (2%), 4- Arterial Rupture
and death 1 pt; 1%. These primary complications had led to Secondary complications in 9 pts and tertiary
complications in six. Dissection, the most frequent primary complication had culminated in five of the ten
infarcts (NSTE-AMI). B-Predictors of complications:- Complications rate was not affected by worsening
of clinical severity of the various groups of pts while it was directly linked to the no. of risk factors. Their
rates were zero, 12%, 15% and 33% in pts with no risk factor, 1 , 2, and 3-5 Risk Factors respectively
The data of the 79 patients with one or two risk factors suggested that hypertension was associated with
the highest rate of complications ;(27%). This was probably attributed to the finding in this study that
Likelihood of sustaining dissection, the precursor of most complications, was more than twice frequent in
the hypertensive pts compared to those without hypertension (18% compared to 8% respectively).
CONCLUSION:
Inhospital Complications of coronary intervention in patients with NSTE-ACS were in one sixth of
patients (16.5%). Dissection was most common complication (11%). It had precipitated five of the eight
cases of coronary thrombosis (63%) and five of the ten Acute myocardial Infarctions (50%).
Complications had probably increased with the increment of the number of Risk Factors but they were not
related to clinical severity. Hypertension probably was associated with highest complication rate, this
might be due a possible association between dissection and hypertension and underlined the need for
further study

BACKGROUND:
Helicobacter Pylori play an important role in pathogenesis of gastritis and peptic ulcer disease in uraemic
patients
OBJECTIVE:
To assess the prevalence of helicobacter pylori infection in uraemic , and to find the relationship
endoscopic findings and the H. pylori infection
PATIENTS AND METHODS :
Forty patient with chronic renal failure were studied and compared with 38 patients with dyspepsia with out
any known history of renal disease.
All underwent upper gastrointestinal endoscopy and antral biopsies were taken for detection of H.pylori
infection using the rapid uraease test as agoldstandard for confirmation of the infection
RESULT:
The prevalence of H.pylori infection was 32.5% in uraemic patient and abnormal endoscopic finding were
detected in 70% of the patients with abnormal endoscpic findings
CONCLUSION:
The prevalence of H.pylori in uraemic patients is lower than in patients with the normal renal function , but
the difference is not significant statistically

BACKGROUND:
Osteoporosis is a major co-morbidity in rheumatoid arthritis (RA). Bone mineral density (BMD) in adults
can be assessed precisely by dual-energy x-ray absorptiometry (DXA). In recent years, quantitative
ultrasound (QUS) technique has been used in radiation-free assessment of bone density by mean of
ultrasound waves attenuated by bone.
OBJECTIVE:
The aim of study was to compare QUS to DXA in assessing BMD in patients with RA.
PATIENTS AND METHODS:
Fifty women with RA (diagnosed according to ACR criteria) of 2-12 years duration, their ages range from
30-72 years, who were seen at Osteoporosis Clinic in Baghdad Teaching Hospital were recruited. Sixty
four percent were or had been receiving glucocorticoid treatment. All patients receiving disease
modifying anti-rheumatic drugs (DMARDs). Lumbar spine BMD was measured by DXA, and QUS for
calcaneum was performed in all patients.
RESULT:
T-scores measured by QUS were correlated significantly with lumbar spine BMD T-scores measured by
DXA (p<0.0005). Bone mineral density T-scores were negatively correlated with age and disease
duration. Patients taking glucocorticoids were associated with lower T-scores.
CONCLUSION:
The findings of this study support QUS as an alternative tool for assessing BMD in patients with RA.

BACKGROUND:
The meaningful association of androgenetic alopecia and coronary heart disease had been well
documented, but few studies had been focused on the importance of lipid parameters in patients with
androgenetic alopecia.
OBJECTIVE:
To investigate the lipid profile and its relation to female pattern alopecia.
PATIENTS & METHODS:
This is a case controlled study conducted at the Department of Dermatology & VenereologyBaghdad Teaching Hospital, between January 2001 and April 2002. Sixty female patients with
androgenetic alopecia were enrolled in this work. From each patient a detailed history and full
clinical examination were performed regarding all demographic points relative to the disease, grading
of alopecia and measurement of serum lipoproteins was done. Female pattern alopecia was classified
according to Sharquei’s classification
Sixty age and weight matched females with normal hair status were considered as a control group.
Measurement of serum lipoproteins also performed for them.
RESULT:
Sixty patients, their ages ranged between 20-60 years with mean + SD of 30.3 + 9.4 years. Twenty
(33.3%) patients were having grade I, 20 (33.3%) patients grade II and another 20 (33.3%) patients
grade III.. The mean levels of total serum cholesterol, triglycerides, low density lipoprotein and very
low density lipoprotein in all patients and those with grade II and III separately were significantly
higher when compared to the control group. On the other hand, the mean levels of high density
lipoprotein in all patients and those with grade I and III separately were lower in comparison to the
control.
CONCLUSION:
The atherogenic index or risk ratio was found to be significantly high in patients with female patteren
alopecia and this goes parallel with the severity of baldness.

BACKGROUND:
Ultrasound (U/S) is valuable modality for evaluating the hip in infants because it enables direct imaging
of the cartilaginous portion of the hip that cannot be seen on plain radiographs. Furthermore, U/S
examination enables dynamic study of the hip with stress maneuvering. U/S is the preferred imaging
modality which used to study the hip disorders like developmental dysplasia of hip ( DDH ), because it is
sensitive indicator of malposition, instability and lack of acetabular development. U/S accomplishes all of
these without exposing the infant to ionizing radiation, not expensive, non-invasive and available.
OBJECTIVE:
The aim of our study is to determine the effectiveness and sensitivity of ultrasound examination of
neonates to confirm the early clinical diagnosis of developmental dysplasia of hip ( DDH ) especially in
the high risk groups of neonates and young infants.
METHODS:
We conducted a retrospective review of ultrasonographic imaging in 60 neonates and young infants ( 36
females and 24 males ; age range, 1-9 months, median age , 4 months). U/S examination of the hip joint
were evaluated for, percent bony coverage (PBC), which indicates the percentage of the femoral head that
covered by the bony acetabulum, normally, 50% or over of the femoral head should be covered by bony
acetabulum. And evaluated for Graf angles, alpha angle which defines the bony acetabulum and normally
it is more than 60 degree and beta angle which indicates the cartilaginous development and it is normally
less than 55 degree. Also evaluate the femoral head flattening which usually associated with delayed
ossification , shortening and anteverting of the femoral neck .
RESULT:
DDH is more common in the female patients ( F:M = 3:1 ). Instability and dislocation is usually
unilateral, this is seen in 30 patients (50%), (unilateral :bilateral = 3:1). Left hip is more commonly
affected, this is seen in 24 patients(40%),( L:R = 4:1 ). Children born by caesarian section are more likely
to have associated instability or dislocation of the hip, 10 patients(25%). First born baby are more
affected, 4 patients(10%) and usually these children are more likely to have been breech presentation
during their gestation, 14 patients (35%). Family history of DDH is seen in 6 patients(15%).
CONCLUSION:
The U/S is the preferred modality for evaluating the hip in infants who are younger than 6 months. U/S of
infant's hip can be used in the diagnosis of DDH and also in monitoring of treatment or follow-up the
improvement in the acetabular maturity and morphology, as well as the location of femoral head can be
documented to assist in the guidance of therapy plan.

BACKGROUND:
Cleft palate repair aims at producing closure of the cleft with reasonably lengthy palate in order to have
competent velopharyngeal closure. Various procedures have been described and used for this purpose.
Primary lengthening of the nasal layer is one of these procedures.
OBJECTIVE:
The aim of this study is to evaluate two procedures of primary nasal layer lengthening, with or without
a turned in buccal flap.
METHODS:
The total number of our patients is 36. Twelve patients of our study did not undergo nasal layer
lengthening technique and considered as control ( group A). Twenty four patients underwent
lengthening of nasal layer technique.
In 12 of them (group B) the raw area of nasal layer was covered only by oral layer flaps and 12 cases of
them (group C) the raw area of nasal layer was covered by unilateral buccal flap.
RESULT:
All patients who had this technique (group B&C) obtained an acceptable lengthening of the palate and
it approached the posterior pharyngeal wall. Three patients to whom we used nasal layer lengthening
technique without buccal flap developed complications; two fistulas and one case of infection, while
patients with nasal layer lengthening with buccal flap and patient without nasal layer lengthening
technique showed lower level of complications.
CONCLUSION:
Nasal layer lengthening technique is a favorable technique for palatal lengthening in cleft palate repair
if accompanied by buccal flap.

BACKGROUND:
The externally deviated nose represents a complex cosmetic and functional problem. Its correction
remains one of the challenging problems in rhinoplasty.
OBJECTIVE:
To evaluate the result of correction of crooked nose by septorhinoplasty with fixation of nasal septum
to the anterior nasal spine.
METHODS:
54 patients have undergone primary septorhinoplasty through a closed approach including full
mobilization of the septal cartilage, osteotomy to reduce the displaced lateral nasal wall and finally
fixing the septal cartilage to the anterior nasal spine.
RESULT:
The minimum follow-up period was 6 months. Recurrence rate for nasal deviation 10%. The
aesthetic results were considered good to excellent in all patients, as judged by both the surgeons and
patients.
CONCLUSION:
Complete mobilization of septal cartilage without scoring along with its fixation to the anterior nasal
spine is satisfactory for correcting crooked nose.

BACKGROUND:
Treatment with tricyclic antidepressants agents is the mainly used therapy for nocturnal enuresis also
there are other agents such as anticholinergic drugs and desmopressin (nasal spray and oral) which are
used to lesser extent also other modalities are used such as behavior modification.
OBJECTIVE:
We prospectively evaluated the effect of imipramine for treating children with nocturnal enuresis
compared to oxybutynin and to non drug treatment.
METHODS:
We enrolled 149 patients of the age group more than 5 years from September 2006 to end of July 2007.
The children were randomly assigned into three groups; the first (60 patients) treated with imipramine, the
second (60 patients) treated with oxybutynin and the third (29 patients) treated with non drug therapy and
the three groups were followed for more than 3 months. Treatment response was measured monthly for 3-
6 months in terms of frequency of enuresis, tolerance to drugs and side effects of the drugs used . The
recurrence of enuresis after stopping the treatment was also reported.
RESULT:
Of the 149 children followed 96(64.45%) were boys and 53(35.55%) were girls with 1.8:1 male to female
ratio. Of those treated with imipramine 32 (53.34%) have complete dryness and 16 (26.66%) improved;
while those treated with oxybutynin20 (33.3%) were dry and 20 (33.3%) improved. For those with non
drug treatment 5 (17.2%) dry 14 (48.3%) improved and 10(34.5%) with no response.
CONCLUSION:
Treatment of nocturnal enuresis in children with imipramine was well tolerated and gave significantly
faster and more cost-effective results than oxybutynin or non drug treatment, females had a significantly
better response (P<0.05) than males in general.

BACK GROUND:
Cholera is an acute infectious disease characterized by profuse watery diarrhea and vomiting.It is
caused by Vibrio Cholerae O1and O139 sero-group
OBJECTIVE:
To find out clinical variety of the admitted cases of Vibriosis..
METHODS:
Clinical features of the illness were studied , and fresh stool specimens were sent for culture.The
stool is taken in seawater containers to the laboratory where further processing of the stool is done on
alkaline peptone and TCBS medium.
RESULT:
All patients presented with diarrhea and the majority had vomiting ( 65%) , ( 37.5%) of the patients
presented with sever dehydration and no patient died during this study .
The epidemic mainly caused by Ogawa serotype (75%) , and there was different antibiotic resistance
recorded especially for trimethoprim (47.5%) and tetracycline (25%) .
CONCLUSION:
Nearly all cases in vitro were susceptible to cefotaxime .

BACKGROUND:
Helicobacter pylori (HP) cause a continuous gastric inflammation in virtually all infected persons. It
induces a vigorous systemic and mucosal humoral and cellular immune response. In spite of these
responses, the vast majority of infected hosts are unable to clear the infection and it persists for decades.
OBJECTIVE:
Determination the humoral immune response to HP infection in dyspeptic patients.
PATIENTS AND METHODS:
The immunological serological tests were evaluated in 80 dyspeptic patients divided into two groups:
(HP +) and (HP-). Levels of specific HP IgG antibodies were determined through a specific
immunological non invasive Enzyme Linked Immuno Sorbent Assay (ELISA) test from Biohit PIC,
Helsinki, Finland. Immunoglobulin levels and complement were done (IgG, IgA, IgM, C3 and C4)
using single radial immune diffusion (BioMaghreb-Tunis).
RESULT:
About 62.5 % of dyspeptic patients had HP + infection. There was no significant differences between
two groups in the levels of (IgG, IgA, IgM, C3 and C4) and most of them were within normal values.
CONCLUSION:
Humoral immune response had an important role in the control and limits the inflammation of gastric
mucosa.

BACKGROUND:
A number of serologic immunoassays techniques have been developed in diagnostic virology with
different degrees of sensitivity and specificity for the detecting hepatitis B virus (HBV) antigens and
their relevant antibodies.
OBJECTIVE:
This study was designed to apply and assess the sensitivity and specificity of different commercially
available laboratory techniques for detecting hepatitis B surface antigen(HBsAg).
METHODS:
One hundred and twenty-one sera samples were collected from National Center for Blood transfusion,
Gastroenterology and Liver Diseases Hospital, Central Public Health Laboratories and Teaching
Laboratories. According to the manufacturer’s practical instructions, a group of commercially available
laboratory methods for detecting HBsAg were applied , including enzyme linked immunosorbent assay
(ELISA), enzyme linked fluorescent assay(ELFA), immunochromatographic assay(ICA), and latex
agglutination test(LAT).
RESULT:
Among ELISA, ELFA, ICA, and LAT methods for detecting HBsAg, the 3rd generation ELISA was
proved to have very high specificity (no false negative results) and the least one that has necessitated
few confirmatory repetitions. ELFA versus ELISA has showed relatively lower sensitivity (more false
negative results). However, similar to ELISA, ELFA showed very high specificity.
Immunochromatographic assay (ICA) confidentially appeared to be a good, rapid and simple technique
with comparable sensitivity and specificity to ELISA and ELFA techniques. Although LAT was
introduced as a rapid, simple and cheap technique for HBsAg screening, it showed frank lower
sensitivity and specificity that deranged it from competing with all those tested techniques.
CONCLUSION:
The concomitant use of ELFA with ELISA compensates its relatively lower sensitivity in front of
ELISA. Latex agglutination test for HBsAg has relatively lower sensitivity and specificity than all other
tests. For its comparable performance characteristics to ELISA, the use of ICA is ideally suited for
HBsAg screening, in respect to its lower cost, rapidity, simplicity and no need for expensive
equipments

BACKGROUND:
The sperm DNA integrity is a vital factor to transmit the genetic material and complete the process of
the formation of new generation. Many studies tried to explain the male infertility of unknown cause as
a result of the presence of high percentage of sperms with DNA damage and found its correlation with
the standard seminal analysis parameters.
OBJECTIVE:
This study was conducted to find the correlation between percentage of sperm death and percentage of
sperms with DNA fragmentation and to calculate the percentage of live sperms with DNA damage.
METHODS:
Thirty four infertile patients were included in this study. And twenty fertile patients were volunteered as
controls. Standard clinical semen analysis was performed according to World Health Organization
(1999) criteria. The stain eosin–Y was used to assess sperm viability. The Terminal deoxynucleotidyl
transferase-mediated dUTP- nick end labeling assay (TUNEL) was performed to observe the sperms
with DNA fragmentation.
RESULT:
The percentage of sperms with DNA damage in the seminal sample was significantly positively
correlated with the percentage of dead sperms (r=0.888; p=0.0001) and the percentage of sperms with
abnormal morphology (r=0.707; p=0.0001). The percentage of live sperms with DNA damage was
about 7% in infertile samples and about 11% in healthy samples.
CONCLUSION:
The small percentage of live sperms with DNA fragmentation in ejaculate could not explain idiopathic
male infertility. This study concluded also that sperm DNA fragmentation could be considered as an
independent parameter of sperm quality to differentiate infertile from fertile semen samples.

BACKGROUND:
Although Double J ureteral stent placement has been widely used to prevent steinstrasse after
fragmentation of larger stones. But, particularly more recently, its preventive efficacy has been
questioned.
OBJECTIVE:
It is to determine that patients with medium to large renal pelvic stone should be treated in situ shock
wave lithotripsy without auxiliary stenting.
PATIENTS & METHODS:
Between October 2007 and December 2008 a series of 55 patients with unilateral renal pelvic stone
with at least one diameter between 15 and 30mm. were treated with extracorporeal shock wave
lithotripsy in situ without auxiliary stenting.
RESULT:
Fifty five patients the mean age 40 years, 21 being males and 34 were females.
With renal pelvic stone, clearance of stone fragments was analyzed by x-ray KUB and ultrasound on
first month and three months after treatment or until stone fragments were cleared. Twenty three 42 %
were stone free three months after treatment while 32 patients 58% were having residual fragments.
Treatment complications consisted of steinstrasse in seven 12.7%, pyelonephritis in two, four of
steinstrasse cleared spontaneously, the other three steinstrasse were treated successfully with ESWL.
CONCLUSION:
Shock wave lithotripsy in situ for medium to large renal pelvic calculi (15 to 30 mm) is reasonable
procedure, avoiding the morbidity of ureteral stent and additional cost.

BACKGROUND:
The breast functions as a secretory gland during pregnancy due to the interaction of estrogen and
progesterone, where the secretory unit is the lobule.
OBJECTIVE:
Is to highlight breast lesions during pregnancy and to show the importance of fine needle
aspiration cytology in the diagnosis of these breast lesions.
PATIENTS AND METHOD:
This study was carried out within the Main Referral Training Center for Early Detection of
Breast Tumors, Medical City Teaching Hospital, Baghdad (from the beginning of May 2006 till
the end of August 2008). Fifty eight pregnant ladies presenting with different breast lesions were
included, all were subjected to physical breast examination, ultrasonography of the breast and
fine needle aspiration with 10 ml disposable syringe (20-22 gauge), spread on glass slides and
fixed in 95% alcohol, stained with Pap stain and examined under light microscope.
RESULT:
Clinicopathological study of 58 pregnant ladies presented with breast lesions including the age
(range between 17-42 years), chief complaint (pain 10(17.2%)cases, mass 30(51.8%) cases,
discharge 3(5.2%) cases, painful mass 11(18.9%) cases, axillary mass 3(5.2%) cases and pain
and discharge in 1(1.7%) case) , site of the lesion (left side 24(41.4%) cases, right side
27(46.5%) cases and bilateral in 7(12.1%) cases.), the time of presentation during pregnancy
(first trimester 19(32.8%) cases, second trimester 26(44.8%) and third trimester 13(22.4%)
cases.) Our results show that breast lesions presented during pregnancy were benign in 54
(93.1%) cases, and malignant in 4 (6.9%) cases (all were breast carcinoma), the benign lesions
include: fibroadenoma 15(25.9%) cases, inflammatory lesions 13(22.4%) cases, galactocele
8(13.8%) cases, fibrocystic changes 6(10.3%) cases, pregnancy related changes 5(8.6%) cases,
lactating adenoma 3(5.2%) cases, 2(3.5%) cases lipoma, and papilloma one (1.7%) case , and
one case was diagnosed as accessory axillary breast tissue.
CONCLUSION:
The majority of breast lesions during pregnancy are benign; however, a small percentage of these
lesions prove to be malignant. Aspiration cytology has a place in the work up of abnormal areas
found in pregnant breasts but an experienced cytologist with knowledge of the clinical setting is
required.

BACKGROUND:
The international surgical centres recognised the progressive importance of archiving the written
pathological data as well as the pathological materials such as paraffin blocks and slides using
updated techniques to facilitate possible future retrieval of patients' pathological data and research
plans.
OBJECTIVE:
To highlight the difficulties and pitfalls of the current pathological archive of urology in Iraq and
demonstrate the characteristics of urology archives in advanced urology centres represented by
Torino University (Italy) and Johannes Gutenberg University – Mainz (Germany). Recommendations
are suggested to optimise our surgical pathology archive in general and urology archive in particular
in the third millennium.
CONCLUSION:
Surgical pathology archive is an essential component of the daily surgical practice and research
procedure. In Iraq clear legislation is needed to protect and regulate the surgical pathology archive
including that of urology, as well as adequate economic funding to implement new international
standards and techniques in this field.