Iraqi Postgraduate Medical Journal

Today, psychosurgery is a minimally invasive
and highly selective treatment performed only on
some patients with severe, refractory treatment,
affective, anxious, or obsessive-compulsive
disorders. Recent advancements in technology
and functional neuroanatomy as well as
economic pressures to lower the cost of caring
for the chronically ill may provide
an opportunity for psychosurgery to become
a more attractive option in the treatment of
psychiatric disease. (1)
Gamma knife radiosurgery is an option of
noninvasive procedures that treating different
psychiatric disorders without the need for
open surgery and general anaesthesia, and
it is an effective procedure with gradual
improvement

ABSTRACT:
BACKGROUND:
Lung cancer is the leading cause of cancer death worldwide, it comprises small cell and non
cell subtypes. Small cell lung cancer carries a poorer prognosis,
smoking.
OBJECTIVE:
To assess response rate of extensive stage small cell lung cancer to first line chemotherapy and
assess patient profile with pattern of presentation in Iraqi patients.
METHOD:
A cross-sectional study for small cell lung cancer patients who were treated at oncology teaching
hospital, from January 1st 2020 to September 30th 2020 and included 30 patients with extensive
stage small cell lung cancer.
RESULT:
Sixty patients with small cell lung cancer
this study. The mean age of the patients was 58.27±9.71years. Males represented more than three
quarters of the patients (76.67%). The male female ratio was 1:0.3. The mean weight, height and
body mass index of the patients were 67.2±12.52 kg, 168.93±8.8 cm and 23.48±3.58 kg/m2,
respectively. Almost all patients were either ex
common presentation encountered in 11 patients (36.67%). Eight patients (26.67%)
response to the treatment, while 22 patients (73.3%) had clinical benefit of which 10 patients
(33.33%) were stable, 10 patients (33.33%) had partial response and two patients (6.67%) had
complete remission. Mean progression free survival time w
After three months, in 8 patients (26.67%) the disease progressed, while almost all other patients
had progression free survival till 7
CONCLUSION:
Extensive stage small cell lung cancer is an
progressive in Iraqi patients. It is adherent to tobacco exposure with male to female ratio of 1:0.3.
Affected population is mostly middle age group, presenting with cough.

BACKGROUND:
Diabetes, whether type 1 or 2, is one of the world’s biggest health problems. The disease may affect
all organ systems. The relationship between diabetes and bone mineral density (BMD) is a matter of
debate.
OBJECTIVE:
To assess the effect of type 1 diabetes mellitus (T1DM) and type 2 diabetes mellitus (T2DM) on
the bone mineral density in adult patients.
PATIENTS AND METHODS:
This is a cross-sectional study which included a total of 25 patients with T1DM, 25 patients
withT2DM and other 25 apparently healthy subjects. Bone mineral density was measured using
densitometry. Serum calcium, phosphorus, alkaline phosphatase (ALP were measured
spectrophotometrically.
RESULTS:
Hip BMD and spine BMD were higher in T2DM (1.24±0.19
than T1DM (0.94±0.78 g/m2 and 11.02±0.3 g/m
group, spine Z-score had a positive significant correlation with BMI (r= 0.882, p<0.001). In T2DM
group, Spine Z-score also had significant positive correlation with each of weight (r= 0.913, p<0.001)
and BMI (r= 0.952, p<0.001).
CONCLUSION:
Patients with T1DM have lower BMD in terms of spine and hip Z
healthy controls. Bone mineral den

BACKGROUND:
Prostate cancer is the second most diagnosed malignancy in men and the sixth leading cause of cancer
mortality among males worldwide. The incidence rate of prostate cancer varies across the regions and
populations new cases of prostate cancer were register
in men.
OBJECTIVE:
To assess prostatic biopsies from patients with prostatic cancer in a sample of Iraqi patients according
to 2014 modified Gleason Grading and Grade groups, and to study the relation of Gleason grading and
grade group with clinical and laboratory data avail
MATERIAL AND METHODS:
A cross sectional study conducted in Department of Pathology/College of Medicine /Al
University for a period from January 2021 to march 2022. Cases and control were collected f
Baghdad Medical City /Ghazi Al
had prostatic carcinoma and control group included 57 patients with benign prostatic hyperplasia.
RESULTS:
This study revealed the age distribution of
(50-88) years and prostatic adenocarcinoma ranged from (50
antigen levels in prostatic adenocarcinoma 75 (79.8%) of cases had high prostatic specific ant
levels (4ng/mL or Higher) while in benign prostatic hyperplasia 22(14.6%) of cases had high prostatic
specific antigen levels. The frequency of perineural invasion in studied sample 39.4%, while vascular
invasion only 5.3%.
CONCLUSION:
There was no statistically significant association was found between Gleason score and age, the same
applies to the Gleason grade group. Also no statistically, significant association was found between
the Gleason grade group and prostatic specific antigen le
between Gleason score and prostatic specific antigen level. There is no correlation was found between
Gleason score, and perineural invasion.

BACKGROUND:
The incidence of thyroid cancer has been increasing significantly since the mid
have revealed that in thyroid gland, the galectin
carcinoma. For that, it is may be one of the markers that may help to assist in distinguishing thyroid
neoplasms.
OBJECTIVE:
To detect the frequency of immunohistochemical expression and diagnostic value of Galectin
different types of thyroid neoplasms.
immunoprofile data of CD56. To correlate the result of immunohistochemical expression of Galectin
with the age and gender of the sampled cases.
PATIENTS AND METHODS
A retrospective case series study was intended in fifty surgically removed cases of primary thyroid
neoplasm whose CD56 status had been tested by immunohistochemical technique. The galectin
protein was tested on formalin fixed paraffin embedded section by imm
Ab-1, isotype IgG1, clone 9C4, Mouse Monoclonal Antibody.
RESULTS:
Galectin-3 was positive in 52 % of the cases. Relation of galectin
neoplasm and malignant tumors versus benign was significant
The galectin-3 was expressed in most of non
the cases were galectin-3 positive/ CD56 negative and 38% of the cases were galectin
positive, the association of galectin
CONCLUSION:
Galectin-3 immune stain marker considered as a useful marker in differentiating malignant tumors with
non-follicular pattern, especially papillary thyroid carcino
association was found between Galectin
the CD65 is a negative marker for diagnosis of thyroid carcinoma.

BACKGROUND:
Obesity responsible for many diseases and regarded as an independent risk factor for having erectile
dysfunction (ED).
OBJECTIVE:
To assess the effect of weight loss after laparoscopic sleeve gastrectomy (LSG) on ED.
PATIENTS AND METHODS:
A retrospective review of 22 cases referred by urological and infertility clinic to the National Center of
Obesity suffering from obesity and ED; who have undergone LSG. Primary follow
loss and assessment of international index
RESULTS:
22 consecutive male patients, mean age 39 ±7.9 included in this study; their mean BMI 49.7±5.8 kg/m
with mean IIED score of 28.1± 5.6.
with statistically significant improvement in their IIED 33.3±6.1(p value < 0.0001).
percentile excess weight loss was 70±17kg/m
(p value <0.0001). The scatter plot and linear regression show a linear relation between weight loss
and IIED.
CONCLUSION:
ED improved after weight loss in LSG with direct relationship to the degree of weight loss and the more
weight loss the more improvement in virility.

BACKGROUND:
Acne vulgaris is one of the most presenting skin diseases that affecting late adolescents not only in Iraq,
but also worldwide. The disturbance of skin lipids arrangement are strongly related to acne occurrence
and accordingly to that, further information
balanced lipid metabolism to control acne.
OBJECTIVE:
To establish the presence of lipid alteration in acne patients and its relation to the severity of acne.
PATIENTS AND METHODS:
This is cross-sectional study to investigate the correlation between serum lipid profiles and severity of
acne vulgaris among young patients conducted in the Department of Dermatology and Venereology in
Al-Kindy Teaching Hospital, Baghdad, Iraq during a period fro
The study included 160 patients. For each patient, severity of acne vulgaris was assessed together with
lipid profile, Body mass index and socioeconomic state.
RESULTS:
The mean age was 20.7 (± 2.1) years, wi
old. The males represented 55 (34.4%) with male to female ratio 1:2. Two third of them the BMI was
above 25 kg/m2. There were 85 (53.1%) patients have dyslipidemia.
cholesterol was significantly higher among overweight and obese patients (p value = 0.001).
only 3 patients out of 40 patients with mild acne group had dyslipidemia. While majority of patients
(more than 80%) have dyslipidemia in severe and very severe group. There was a significant association
between dyslipidemia and severity of acne (p value = <0.0001). There was significantly higher mean of
total cholesterol and LDL among severe and very severe group in comparis
<0.0001). Also, There was significantly higher mean of TG among severe group in comparison to other
group (P value <0.0001). The maximum contribution to the severity of acne was observed from total
cholesterol and LDL, both were
<0.0001).
CONCLUSION:
The lipid profile alteration has a significant association with the severity of acne vulgaris among Iraqi
patients. The cholesterol and LDL have the major impact than TG on the severity of acne vulgaris.

BACKGROUND:
In Laparoscopic bariatric surgeries,
have severe consequences (1). This
enoxaparin and fondaparinux, two
bariatric surgeries.
OBJECTIVE:
The objective of this study is to
for VTE prophylaxis in laparoscopic
PATIENTS AND METHODS:
This prospective randomized
gastrectomy and compared the
the prevention of venous thromboembo
at random: group A received postoperative
subcutaneously once a day; Group
subcutaneously once daily. The anticoagulant
both groups, with administration
the incidence of VTE events and
4 weeks postoperatively.
RESULTS:
The study found that there were
comorbidity prevalence rates, venous
loss, minor drain bleeding, leakage,
risk assessment scores, indicating
CONCLUSION:
Enoxaparin and fondaparinux are
Selection should consider patients'
effects. The study found no significant
preventing VTE for LSG surgery

Postoperative hoarseness of voice and sore throat are most common undesirable outcome at postoperative period. They are attributed to mucosal dehydration or edema, tracheal ischemia due to relatively high cuff pressure during endotracheal intubation. However, other demographic and perioperative factors could also have their own influence.
Our study aimed to assess the cuff pressure with the incidence of postoperative hoarseness and sore throat.
This experimental clinical trial included (60) consecutive adult patients undergoing elective surgery who required endotracheal intubation. The patients were divided into two equal groups according to cuff pressure: with low cuff pressure (25 cmH2O) and high cuff pressure (28 cmH2O). The incidence of postoperative hoarseness and sore throat during the first 24 to 72 hours post operation was recorded.
The results showed that none of demographic or clinical factors of the patients had a significant effect on the incidence of hoarseness and sore throat. The overall incidence of hoarseness and sore throat was (16.67%) and (13.33%), respectively. Hoarseness and sore throat were more common in high pressure group (26.67% and 23.33%, respectively) than low pressure group (6.67% and 3.33%, respectively) with significant differences.
It can be concluded from the current study that the high cuff pressure (28 cmH2O) was associated with increased incidence of postoperative hoarseness and sore throat.

Background: Arteriovenous fistula (AVF) has been the preferred vascular access ‎in hemodialysis. Doppler ultrasonography is the main imaging modality of ‎hemodialysis arterio-venous (AV fistula). ‎
Aim: to study the role of Color Doppler Ultrasonography (CDUS) in assessment ‎of suspected complication of brachiocephalic fistulas in hemodialysis patients. ‎
Patients and methods: Prospective cross-sectional study carried out in the ‎Radiology Department at Al-Imamain Al-Kadhimain Medical city, between ‎November 2021 and November 2022. The study included 50 patients with end ‎stage kidney disease and had suspected non-functioning brachiocephalic fistula. ‎All patients were examined by using linear probe and occasionally curvilinear ‎probe. Color Doppler was done for assessment of associated brachiocephalic ‎arteriovenous fistula (BCAVF) complications. Doppler parameters in the arterial ‎and venous side, blood volume through the fistula, and the type of complication.‎
Results: the mean age of the patients was 43.8±12.2 with an age range of (27-68) ‎The fistula was functioning among 12 (24%) patients, functioning with ‎complication among 11 (22%) patients, and not functioning among 27 (54%) ‎patients. Regarding patients with adequate flow and associated complications 5 ‎‎(45.5%) had stenosis, and 6 (54.5%) had aneurysm in comparison of those with ‎fistula dysfunction where thrombosis is shown in 12 (44.44%), stenosis in 10 ‎‎(37.04%), aneurysm in 2 (7.41%) and steal syndrome in 3 (11.11%). ‎
Conclusions: CDUS is a good modality for evaluation of quantity and quality of ‎the AVF and detection of early and late complications. Stenosis and thrombosis ‎were the most common complications.‎
Key words: Ultrasonography, Brachiocephalic Fistulas, Hemodialysis.‎

Background: Diffusion Weighted Imaging (DWI) has gained increasing use in
diagnosing pathology in the spine, and is becoming valuable in the assessment of
a variety of diseases including tumor and infection. Modic type 1degenerative ‎changes on conventional MR imaging can mimicor suggest infection, leading to ‎additional costly and sometimes invasiveinvestigations.‎
Aims: To study the role of DWI in uncertain (doubtful) cases with overlapping ‎conventional MRI signal features between Modic1 degenerativechange and ‎infectious spondylodiscitis and describe different patterns of diffusionrestriction.
Patients and methods: Cross sectional study was done at radiology department
of Al-Imamain Al Kadhimain Medical city.Studywas done from October 2021 ‎and November 2022 with a convenient sample of 53patients. The patients were ‎sent for spinalMRI and had clinically suspected to have Modic type 1change or ‎discitis.Conventional MRI with sagittal DWI was done for all patients. Patients ‎were classified as either had Modictype 1 degenerative changes or discitis.
Results: Thirty-six of patients (68%) were Modic type 1 degenerative changes
and 17 (32%) patients had spondylodiscitis.The definite Claw sign was found ‎among 19(52.8%) of the patients, probableClaw sign found among 10(27.8%), ‎questionable Claw sign foundamong 6(16.7%)of the patients, while none of ‎those (0%) of those with spondylodiscitis had thesesigns. Diffused Abnormal ‎DWI (negative claw sign) signal found among 1(2.8%)of those with Modic 1 in ‎comparison to 3(16.7%) of those with discitis.‎
Conclusion: DWI is useful for differentiating Modic type 1 degenerative changes ‎andinfectious spondylodiscitis. The claw sign is useful and accurate sign for ‎distinguishing Modic type 1 endplatedegenerative changes from spondylodiscitis.‎
Key words: Diffusion Weighted Imaging, Modic Change, Spondylodiscitits.‎

Background: The psoriatic arthritis considered a commonest related systemic ‎symptom of psoriasis and asymmetric oligoarthritis of the smaller joints of the feet ‎and hands being the major presentation. ‎
Aim of the study: to study value of musculoskeletal (MSK) ultrasonography of ‎small enthesis of the hands in detection of asymptomatic enthesopathies in patient ‎with psoriasis. ‎
Patients and Methods: This is a cross-sectional analytic study included 35patients ‎of either gender (16 Male, 19 Female) with confirmed diagnosis of psoriasis. The high-‎resolution MSK ultrasound assessment was performed and three entheses of hand ‎‎(EDP, FDS, and EPB) were scanned in longitudinal and axial planes‎
Results: MSK ultrasonography of hand entheses shows enthesitis in 68.5% of ‎psoriatic patients and 43.8% of total entheses sites.‎
The most frequently involved enthesis site was proximal insertion of Extensor ‎digitorum communis tendon (EDC) followed by proximal insertion of FDS and EPB ‎tendons. The ultrasound element of hypoechogenicity was the most frequently ‎noticed followed by enthesophytes, calcification, entheseal thickening, least likely ‎seen parameter was bony erosion. No power Doppler vascularity was seen in all ‎examined enthesis sites.‎

Conclusions: Ultrasound examination of functional entheses at hand level is a ‎useful tool in detection of subclinical abnormalities of psoriatic arthropathy. ‎Ultrasound images can clearly documented elementary component of ‎enthesopathy inform of hypoechogenicity, calcification, tendon thickening ‎enthesophyte, and bony entheseal erosions.‎

BACKGROUND:
Cardio-toxicity is a major complication of chemotherapy for breast cancer women, and so evaluation of cardiac function is important to protect the heart from harmful drug toxic effects.
OBJECTIVE:
To assess and evaluate the cardio-toxic sequelae of chemotherapy used in the treatment of breast cancer on the left and right ventricular systolic functions by Transthoracic Echocardiography.
PATIENTS AND METHODS:
This is a cross-sectional study that was carried out in Baghdad Teaching Hospital in Baghdad . A sample of 60 women with breast cancer on chemotherapy combination: Endoxan (Cyclophosphamide) + Doxorubicin and Herceptin(Trastuzumab) + Taxol (Paclitaxel) and 30 healthy women without chemotherapy were enrolled in the study Specific echocardiographic parameters for right and left ventricular functions, in addition to hemodynamic measurements, were assessed by the transthoracic echocardiography.
RESULTS:
There were significant differences regarding left ventricular ejection fraction, which was significantly reduced in women receiving chemotherapy (P=0.003). Left ventricular systolic myocardial velocity showed significant reduction in women receiving chemotherapy (P=0.0001). The mitral annular plane systolic excursion was significantly reduced in women receiving chemotherapy (P=0.0002). A significant decline in the fractional area change of the right ventricle among chemotherapy women receivers, P=0.005. Also, the Tricuspid annular plane systolic excursion was statistically with significant reduction (P=0.0001).
CONCLUSION:
This study demonstrated that chemotherapy for Breast cancer causes a decrease in both left ventricular and right ventricular systolic functions.
Moreover, the transthoracic echocardiographic study showed that the effect on left ventricle functions was more evident than on right ventricular functions.

Clinical Patterns of Guillain-Barré Syndrome Associated with the COVID-19 Pandemic
Background: Guillain Barré Syndrome is an autoimmune disease, with progressive weakness and areflexia, it can be triggered due to antigenic mimicry, and the association of COVID-19 and GBS cases throughout the pandemic has been reported worldwide.
Objective: to identify the clinical patterns of GBS associated with COVID-19 and its neurophysiological variants.
Method: (51) patients were collected during 2021 who were admitted to Baghdad Medical City and Neuroscience Hospital, and diagnosed with GBS according to the Asbury criteria, all of them had serological or radiological evidence of current or recent COVID-19 infection, the neurophysiological study was done for all of them and variants were identified.
Results: males were (56.9%), half of GBS cases were presented in late spring after the peak of the second COVID-19 wave, the mean time interval between antecedent COVID-19 and GBS onset was 3.45 weeks, (82.4%) was ascending pattern, (5.9%) paraparetic, (5.9%) bilateral facial with distal paraesthesia, about (64.7%) had the demyelinating variant on Neurophysiological study, axonal in (29.4%) and equivocal in (5.9%).
Conclusion: Despite the limitations of our study, being a descriptive cross-sectional one, it represents the first snapshot of the relationship between COVID-19 and GBS in a large cohort of patients in Iraq, the classical ascending pattern is the most common clinical pattern associated with COVID-19 and demyelinating variant in neurophysiological studies.

Background: CNS tumors diagnosis represents a challenge in histopathological examination. EMA and GFAP are widely used markers in neurosurgical pathology that help in the diagnosis of many commonly occurring tumors and differentiating them from other mimickers.
Aim of study: To assess the value of EMA and GFAP in the diagnosis of ependymal tumors compared with other glial tumors. Evaluate the pattern of expression of these markers. The value of glial fibrillary acidic protein positivity in the diagnosis of ependymoma and diffuse fibrillary astrocytoma.
Materials and method: The present study is a retrospective study over a period of one year, the paraffin blocks were collected from the archive of the department of pathology, Ghazi Al –Hariri specialized surgical hospital, over the period of 4 years, from March 2015 to October 2019, they included 15 cases of ependymoma and 15 cases of diffuse fibrillary astrocytoma. Total number was 30 cases. The markers used were EMA, and GFAP. The manual method of staining was used in this study.
Result: Both markers showed positivity in studied cases, the finding of 5 EMA dots/ high-power field was associated with a sensitivity of 86% and a specificity of 80%. The presence of ring-like EMA positive structures was less sensitive (33%), but highly specific (100%). GFAP was useful in highlighting the growth pattern of these tumors, and in ependymoma it was mostly expressed in cells and fibrillary processes around vessels (pseudorosettes) and in true rosettes.
Conclusion: Distinct punctate and ring like EMA staining might serve as sensitive and specific markers of ependymal differentiation in glial tumors and, thus, may aid the diagnosis of ependymoma. As for GFAP marker, although it was expressed in both ependymoma and glial tumors, it can provide significant value in highlighting the growth pattern of these tumors, and in excluding other mimickers.

Background: Acne vulgaris is a common skin conditions; about 74% of patients with acne have moderate to severe effect on their quality of life. Acne management aims to alleviate symptoms, clear existing lesions, limit disease activity by preventing new lesions forming and scars developing and avoid negative impact on quality of life.
Objective: To evaluate the effectiveness of both Clindamycin and Ciprofloxacin solutions topically in the treatment of mild to moderate acne vulgaris.
Method: A single blinded therapeutic trial that was conducted at Baghdad Teaching Hospital/ department of dermatology, out clinic, for the period (April 2019 - March 2020). All patients with mild - moderate acne vulgaris attended to the out clinic of dermatology were enrolled in the study. Sixty six patients were participated in this study and divided in to 2 groups (Ciprofloxacin group: 33 patients were treated topically with Ciprofloxacin solution 2% and Clindamycin group: 33 patients were treated topically with Clindamycin solution 1.5%). The important ethical approval and formal consent was obtained from MOH and patients respectively. Severity index was recorded. Statistical analysis was done using SPSS V26.
Results: Mean acne severity index (ASI) for Ciprofloxacin group in the first visit was significantly higher than that at week 12th after topical application of Ciprofloxacin. Total percent reduction was 32.3% (P<0.001). Mean ASI for Clindamycin group in the first visit was significantly higher than that at week 12th after topical application of Finasteride. Total percent reduction was 31.8% (P<0.001). No statistical significant among both groups regarding the reduction in comedones mean; P>0.05. Statistical significant was observed among Ciprofloxacin group regarding the reduction of papules and pustules in comparison to Clindamycin group; P<0.05
Conclusion: Ciprofloxacin and clindamycin when used topically are all effective in treatment of mild to moderate acne vulgaris. Both have antibacterial and anti-inflammatory actions

BACKGROUND:
Knee joint pain is considered one of the leading causes of morbidity and disability throughout all age groups. Its variable pathogenesis, ranging from minor injuries to various disease processes, necessitates precise evaluation.
OBJECTIVE:
Evaluation of knee joint lesions using magnetic resonance imaging to characterize various types of traumatic and non-traumatic conditions leading to the joint pain.
PATIENTS AND METHODS:
This retrospective cross-sectional study was conducted among 900 patients referred to the radiology departments of major medical centers in Duhok city over a period of 26 months. MRI scans were performed on patients of different age groups and both sexes using Samsung 1.5 Tesla MRI scanners. The evaluation of different causes of knee joint pain was performed by the referring specialists, examined by the globally proved gold standard radiological method (MRI), data from the resulting investigations collected and analysed.
RESULTS:
The age group most affected by knee pathology was between 21-30 years for both genders. The most common knee pathologies observed were synovial fluid effusion, meniscal injury, bone lesions, and ACL injuries. Horizontal tears were the most frequent type of tears observed in both menisci. Grade 3 tears were more prevalent in the medial menisci, while grade 2 tears were more prevalent in the lateral menisci. Partial tears were the frequent findings in the cruciate and collateral ligaments. Degenerative joint changes were the most common additional MRI findings, followed by joint infectious changes. Baker's cysts were the most frequent cystic lesions followed by parameniscal cysts. Bony enchondroma was the more frequently observed joint related tumor, followed by chondroblastoma.
CONCLUSION:
Magnetic Resonance Imaging is an extremely useful imaging modality for evaluating changes in the knee joint. It provides valuable information to the referring orthopedic surgeon for planning the course of treatment, whether it is conservative management or surgery.

Background
The most typical setting for performing an elective cesarean section is under spinal anesthesia. To lessen the patients' dread and foster greater acceptance, a sleeping dose of anesthetic medication (propofol or midazolam) is necessary.

Objective
The ability of a sleep-inducing dose of propofol or midazolam to increase pregnant women undergoing elective c/s under spinal anesthesia's acceptance of regional anesthetic

Patients and method
75 American Society of Anesthesiologists (ASA) physical status II pregnant ladies undergoing elective C/S under spinal anesthesia (bupivacaine 12mg 0,5%) and after clamping the umbilical cord, we gave normal saline immediately for the first group (IV 1 ml, n = 25, which is considered group A), the second group received propofol (bolus 1 mg/kg, n = 25, which is considered group B), and the third group received midazolam (bolus 1–2 mg, n = 25, which is considered group C)
And we recorded the Ramsey score, blood pressure, pulse rates, nausea, and vomiting.

Results:
We found a significant difference in the p-value in the modified Ramsay score in the 1st minute (group A was 1.5±0,8), group B was 4,0 ± 1,01, and group C was 4.5 ± 1,08). In the 15th minute, (group A was 1± 2,1), (group B was 3 ± 0,7), and (group C was 3.5 ± 1,04).

Conclusion:
The study shows that using a sleeping dose of propofol or midazolam will improve the patient's well-being and increase the acceptance of regional anesthesia. And there are no significant hemodynamic