Iraqi Postgraduate Medical Journal

OBJECTIVE:
To make correlation between clinical radiological electrocardiographic and echocardiographic
findings in cases of Pulmonary Hypertension.
METHODS:
140 patients refered to the medical departments, Baghdad Teaching Hospital ( 90 of them admitted
in this study were as follow);(52 (47%) cases having Ischemic heart disease,28(25%) cases having
C.O.P.D., 10(9%) cases having connective tissue diseases, 9(8%) cases of Rehematoid Arthritis, 1
case S.L.E.). The remaining 50 cases were excluded from the study because they have another
chronic disorder like Diabetus mellitus, Renal failure, Malignancy, Skeletal deformity.Fourty normal
volunteers were admitted in this study both groups were assessed clinically, radiologically,
electrocariograpically, echocardiographically plus the routine blood tests including F.B.S,
B.urea,lipid profile.
RESULTS:
90 cases of patients admitted in this study showed variable findings the prominent finding was loud
pulmonary sound "p2" in 100% of cases, 19.6% of cases showed cardiomegaly, 33% prominent
pulmonary marking, 11.4% percardial effusion, 28% Right Ventricular Hypertrophy.
CONCLUSION:
It is not necessary to find all the clinical, radiological, electrocardiographic and the
echocardiographic changes in any patient with pulmonary hypertention>30 mm Hg.

BACKGROUND:
Familial linkage of primary dilated cardiomyopathy (DCM) occurs more commonly than often is
appreciated. In 10-20 percent of patients, a first degree relative also shows evidence of primary DCM
suggesting that familial transmission is relatively frequent.
METHODS:
this study included 7 patients aged 40-70 years (2 females and 5 males) with familial dilated
cardiomyopathy (FDCM) and 17 healthy subjects aged 29-60 years (6 females and 11 males). Plasma
fasting total homocysteine tHCY, serum folic acid (FA), vitamin B6, total triiodothyronine (T3), and
total thyroxine (T4) were measured in these two groups.
RESULTS:
The mean value of plasma tHCY was significantly higher in patients with FDCM than in control
(P<0.001). The mean (±SD) values of serum folic acid and vitamin B6 were significantly decreased
in FDCM patients when compared with those of control group (P<0.05, P<0.01, respectively).
A significant inverse relationship between plasma tHCY concentration and the values of serum FA
was shown in the FDCM patients (r=-0.78, P<0.05). The mean values of serum T3 and T4 were
insignificantly decreased in patients with FDCM than in controls.
CONCLUSION:
The level of plasma tHCY is significantly higher in FDCM patients than in healthy control. This
severe hyperhomocyteinemia of FDCM patients may be related to evolution and development of
myopathic state in such patients.

OBJECTIVE:
To study the prevalence of echocardiographic findings in unselected population of patients with
rheumatoid arthritis (RA)
METHODS:
Fifty two RA patients and fifty two normal healthy people assessed clinically, Echo Cardiografically,
ECG, pulmonary function tests and laboratory investigations.
RESULTS:
Two-dimensional echocardiography demonstrated significant cardiac disease in (59%) of patients in
form of right ventricular dilatation (25%), left ventricular dilatation (11.5%), left atrial dilatation
(3.8%), mitral valve abnormalities (11.5%)(M.V.regurgitation, M.V.thickening, M.V.prolapsed,
M.V.stenosis), septal hypertrophy(5.8%), diastolic pressure dysfunction(5.8%), thick aortic calcified
cusps(3.8%), aortic regurgitation(5.8%), mild pericardial effusion(13.5%), tricuspid Regurgitation
(11.5%) and raised pulmonary artery pressure above 30 mmHg (3.8%).The normal healthy people
had only two people one had M.V.regurgitation and the other had mild M.V.prolapse and there were
no other abnormalities in (ECG) of (PFT).
CONCLUSION:
Wide and frequent varieties of echocardiographic cardiac abnormalities were found in an unselected
population of patients with RA, using Doppler echocardiography giving different grades of severity
of cardiac manifestation.

BACKGROUND:
Up to the best of my knowledge, despite the fact that Arabs have a high prevalence of Familial
Mediterranean fever (FMF) and its gene, little information is available about the natural history of
this disease in Iraqi population.
OBJECTIVE:
This study had been designed to clarify the natural of FMF among Iraqi people.
METHODS:
This study is a Follow up (cohort) study that enrolled 23 patients with FMF, 17 of them were male.
The sample had been randomly selected from those had attended Al – Shaheed Al – Sadr Hospital
(Baghdad / Iraq ) during the period from the first of April, 2003 to the 31 st of March 2005. All of the
patients had been subjected to thorough physical examination and all of the required investigation
had been done.
RESULTS:
Age of the patients who had been included in this study ranged between (14 – 59) year old (21.57 +
18.7 year old). All of them were Arab Muslims. Fever and abdominal pain had been observed in all
of the patients included in this study at variable time during the disease course. All of the patients
included in this (23 patients) had responded well to colchicines treatment (dose of 2 mg/ day).
Statistical analysis revealed a significant reduction in the number of attacks per year with the use of
prophylactic colchicines (calculated t = 3.94, p value > 0.005).
CONCLUSION:
This study had shown that Iraqi Arabic population might have a batter survival and less risk, if
present, of developing amyloiedosis and all of its sequelae. This point needs to be clarified more by
doing much larger studies that enroll larger number of Arabs population and for longer period
.furthermore, this study had indicated that colchicines is effective in reducing the number of attacks
of familial Mediterranean fever per year of follow-up in addition to its efficacy in relieving the acute
attack.

ABSTRACT:
BACK GROUND:
Viruses may be involved in the pathogenesis of Type 1 Diabetes Mellitus (T1DM), either through direct
β-cell infection or as triggers of autoimmunity.
OBJECTIVE:
To evaluate the T- cell proliferation in response to Enterovirus antigens including Coxsackievirus B and
Poliovirus in addition to Adenovirus in an HLA- matched population of children with T1DM and children
who were healthy.
METHODS:
A total of 60 Iraqi T1DM children were included in the presents study. They were new onset of the
disease. For the purpose of comparisons, 50 apparently healthy control subjects were selected. HLA
typing was measured by microlymphocytotoxicity, while methylthiazoltetrazolium (MTT) assay was used
for lymphocyte proliferation by culturing peripheral blood lymphocytes (PBL) with Coxsackievirus B5,
Adenovirus 3, 4, and 7, and Poliovaccin.
RESULTS & CONCLUSION:
No significant differences were shown in the PBL proliferative percentage in response to Con-A mitogen
and tested viruses (CVB5 and Adenovirus) between T1DM and healthy controls, but PBL proliferative
percentage of patients showed a significant decline in response to Poliovaccine. HLA class II (-DR3,
DR4, DQ2 and DQ3) antigens were significantly increased in T1DM patients and they played an
important role in the etiology of the disease. Strong T-cell proliferation in response to the tested viral
antigens were observed to be related to HLA-DR4 and HLA-DQ3 antigens, whereas the HLA-DR3 and
HLA-DQ2 alleles were associated with week responsiveness to the same antigens. However, in children
with new- onset diabetes, responses were decreased and this could be caused by trapping of virus- specific
T- cells in the pancreas.

BACKGROUND:
Hyperlipidemia is a strong predictor risk of cardiovascular events. There are insufficient data on the
lipid profile in diabetics in Iraq. This study was carried out to determine the lipid profile among
diabetics in Al-Anbar governorate.
MATERIALS:
A total of 136 diabetics (116 were with type 2 diabetes and 20 were with type 1 diabetes) attending AlRamadi general hospital, Al-Anbar, were included in the study. Total cholesterol, triglyceride (TG),
high density lipoprotein (HDL), low density lipoprotein (LDL) and very low density lipoprotein
(VLDL) were estimated.
RESULTS:
Elevated total cholesterol, HDL, LDL, VLDL and TG were detected among patients with type1 and
type2 diabetes. Only level of TG was associated with the duration of type2 diabetes, while levels of
LDL, VLDL and HDL were significantly associated with duration of type 1 diabetes.
CONCLUSION:
Lipid and diabetes awareness program for Iraqi population should be applied in an attempt to improve
the overall health status of Iraqi population.

BACKGROUND:
The objective of this study is to shed more light on the role of trace metals and their mode of action
in hyperthyroidism. The content of the trace elements (Zn, Cu, Mn, and Se) in the serum of patients
was determined and compared to that of normal subjects.
METHODS:
Ninety eight (98) patients with hyperthyroidism were participated in this study and fifty normal
healthy persons were taken as control. Serum zinc and copper were determined using flame atomic
absorption spectrophotometer while serum manganese and selenium were estimated using flameless
atomic absorption spectrophotometer technique.
RESULTS:
The study showed that serum zinc and selenium level of hyperthyroidism patients were significantly
lower (p<0.05) than the level in normal subjects. While a significant increase in serum copper level
was demonstrated in patients as compared with that of the normal subjects. The results showed no
significant difference between the groups (p>0.05) in serum manganese.
CONCLUSION:
The present study confirmed a significant changes in the levels of serum Zn, Cu, and Se in
hyperthyroidism patients and these changes may be related to pathophysiology of thyroid disease

BACKGROUND:
Fetal growth may at any time during gestational period be affected by several factors that may cause
diseases to fetuses or neonates, and interfere with neonatal morbidity and mortality. Among these
factors are racial, genetic, socioeconomic factors and maternal malnutrition and illnesses like
diabetes, preeclampsia and anemia.
OBJECTIVES:
Our aim is to study the effect of maternal height, age, and illnesses on the anthropometric
measurements of full term singleton newborns.
METHODS:
Two hundred full term singleton newborns were studied cross-sectionally in the maternity wards of 2
hospitals in the medical city /Baghdad .They were assessed by measuring the newborn weight, length
and occipitofrontal circumference using standard methods of measurements. The gestational age was
assessed by simplified Ballard-Dubowitz method. Mother's height was also measured. The maternal
illnesses during pregnancy were listed in special questionnaire form. Statistical analysis was done by
statistician.
RESULTS:
Of 200 full term singleton newborns, 109 (54.5%) were females and 91 (45.5%) were males. Mean
body weight of males was 2850 grams, while that of females was 2600 grams. Mean length of males
was 48.75 cms, while that of females was 48 cms. Mean OFC of males was 34.5 cms, while that of
females was 33.5 cms. The weight of males was more than that of females at maternal height of 140-
150 cms, 161 -170 cms and 171 -180 cms. Males were longer at maternal height of 161 -180 cms.
Males had higher OFC than females at maternal height of 161 -180 cms. Males were lighter in weight
than females of preeclamptic mothers, but no such effect on length and OFC. Maternal anemia also
affect mainly newborn s` weight. There is no effect of other maternal diseases on weight, length, and
OFC. The largest number and heaviest weight of newborns were at maternal age of 26-35 years,
while male newborns of extreme maternal ages being longer than females. No effect of maternal age
on OFC.
CONCLUSIONS:
In this study, we found more female newborns than males, and the mean weight, length and OFC of
males were greater than that of females, and the heaviest newborns were at maternal height of 170-
180 cms .Maternal preeclampsia and anemia affecting newborns weight mainly. Maternal age of 26-
35 years gave heavier newborns. We recommend improving the maternal antenatal care, nutrition,
and controlling maternal illnesses to improve the neonatal anthropometric measurements, and also
recommend making wide national study to construct and apply local intrauterine growth curves
specific to our country.

BACKGROUND:
The World Health Organization (WHO) & UNICEF, have recommended for a decade that mothers
breastfeed for at least 2 years .
Recently, there has been a stress on exclusive breast feeding for the first four to six months of life .
METHODS:
By using the 'current status analysis method'. Mothers of 650 infants from 0 to 12 months of age
attending a Health Center were interviewed about the current feeding
patterns of the infants and other socioeconomic variables. Month-wise prevalence of feeding patterns
was determined.
RESULTS:
It was observed that breast feeding was maintained at a high level (more than 90%) throughout
infancy while exclusive breast feeding showed a rapid decline.
At 1 st month of age 78% , and at 4th month of age 50 % of infants were exclusively breast-fed.
CONCLUSION:
Breast feeding as such was maintained at a high level for the first 12 months of life while the
practice of exclusive breast feeding was much lower.

BACKGROUND:
Growth in patients with idiopathic nephrotic syndrome (INS) is influenced by several factors, they suffer
the influence of the disease itself as long as there is proteinuria, caused by the increase of the glomerular
permeability and leading to hypoproteinemia. The effects of the glucocorticoid treatment, which alters
growth by a direct action on the growth cartilage, or via disturbances of growth factors. In this study we
assess the effect of nephrotic syndrome, it's relapse rate and it's treatment (i.e. steroid), in the statural
growth of steroid sensitive nephrotic patients.
METHODS:
A Prospective study of 110 steroid responsive nephrotic patients collected from AL- Kadhemia Teaching
Hospital, Central Child Teaching Hospital, Child Wellfaire Teaching Hospital & AL-Karama Teaching
Hospital. The study started from first of June 2005 to first of June 2006. Data collected as following: age,
sex, date of first diagnosis, duration of disease, number of relapses per year, measurement of the height,
weight and body mass index and sign of steroid toxicity.
RESULTS:
Total number of our patients were 110, 74(67.3%) were males and 36(32.7%) were females, with male to
female ratio of 2:1. The age of our patients range from 2-18 years with a mean of 7.9+3.8 years.Thirtyone (28.2%) of them were with height below 3 rd percentile for their age, 24(77.4%) were males and
7(22.6%) were females.Twenty- five (22.7%) patients were at pubertal age. Eighteen (72%) were males
and 7(28%) were females, and 17(68%) of them have height below 3 rd percentile.Seventy –six (69%)
patients have their onset of the disease at age between 2 and 6 years. Forty-six (41.8%) of patients have
disease duration of less than 3 years, 3 (6.5%) of them were have height below 3 rd percentile, 46(41.8%)
with duration of 3-6years, 14(30.4%) them were have height below 3 rd percentile and 18(16.4%) with
duration of more than 6 years, 14(77.8%) of them have height below 3 rd percentile.Fifty-five (50%)
patients had frequent relapses, twenty-seven (49.1%) of them have height below 3 rd percentile, compared
to 4(7.3%) of those with infrequent relapse had height below 3 rd percentile.Forty-seven (42.7%) patients
show sign of steroid toxicity(cushigoid facial appearance with or with out
hypertention,obesity,hirsutism..etc) 25(53.2%) of them have height below 3 rd percentile, compared to
6(9.5%) of those who have no sign of toxicity.
CONCLUSSION:
Nephrotic syndrome is a potentially chronic disease with patients suffering a relapsing course and being at
risk of frequent courses of prednisolone therapy with increase the risk of growth delay especially in
patients reaching pubertal age and still taking steroid therapy.

BACKGROUND:
The studies on the relationships of sperm morphology and DNA was backdated for nearly 25 years. DNA
and morphology was studied in mammalian sperm by flow cytometry and DNA content of different
sperm types for normal and abnormal subfertile humans was recorded. The effects of some factors like
drugs, cigarette smoking, cryopreservation and sexual abstinence and others on sperm morphology and
DNA damage, denaturation and fragmentation in both normal fertile and abnormal infertile men were
reported. Several methods for the evaluation and estimation of DNA in spermatozoa have been reported.
AIM OF THE STUDY:
The objective of the present study was the determination of the DNA content of spermatozoa in subfertile
persons and its correlation with sperm morphology.
METHODS:
A random sample of 66 subfertile males attending the Institute for Embryo Research and Infertility
treatment, University of Baghdad,were enrolled in this study through years 2004-2005.The patients age
ranged 20-45 years and their semen samples were assessed for sperm morphology by direct light
microscopy. DNA content (µg/ml) was estimated using a microchemical spectrophotometric method, and
data were classified into two groups according to sperm percent abnormality (below and above 50%).
RESULTS:
The results showed that no statistically significant difference (P > 0.05) of DNA content between the two
groups was obtained. The DNA content (µg/ml) showed a negative non significant correlation with
percent morphology in the normal and abnormal groups (P>0.05).
CONCLUSION:
The level of the DNA content in the spermatozoa was not related to its percentage of morphological
abnormalities .

BACKGROUND:
Genetic skeletal abnormalities are a heterogeneous group of genetic disorders frequently presenting
with disproportionate short stature.
AIM OF THE STUDY:
To give an idea about the frequency of genetic skeletal abnormalities, and to find out whether these
disorders are really increasing in the last 16 years or not.
METHODS:
During the period extending from (Jan, 1 st 2003-April, 1 st 2007), all cases of genetic skeletal
disorders referred to the Genetic Counseling Clinic, Medical City – Baghdad who were born after
1991 were included in this study as the post-war group; the pre-war group, included all cases of
skeletal disorders referred prior to 1991 (Jan., 1 st 1987-Jan., 1 st 1990). The demographic parameters,
family history of the disease plus the parental consanguinity were studied.
RESULTS:
The post-war group constituted 3.199% while the pre-war group constituted 2.815%. Both groups
had a comparative age range. AR disorders constituted 39.75% of the post-war group and 40% in the
pre-war group; AD disorders come next in both groups (37.3% vs. 33.8%) respectively. There is a
noticeable increase in the occurrence of new mutations of AD disorders in the post-war group.
CONCLUSION:
Genetic skeletal dysplaisas are not uncommon disorders; their incidence seems to be truly
increasing.

BACKGROUND:
It has long been recognized that exposure to various metals is highly toxic, producing a wide variety
of illnesses, including cancer. The role of these metals in free radical formation and initiation of lipid
peroxidation was extensively studied; where the free form of iron or copper can effectively be
involved in a free radical generation.
OBJECTIVES:
To evaluate the effects of the some environmental conditions on the levels of the oxidative stress
markers, malondialdehyde (MDA) and glutathione (GSH), and some of the transition metals, iron,
copper and zinc, in he serum of Iraqi subjects who exposed to different environmental conditions.
METHODS:
Blood samples were taken from 137 healthy male adults who work in different types of jobs (25
farmers, 25 workers in gasoline, 25 workers in liquid propane gas, 25 workers in casting, 25 workers
in paints and 12 workers in plastic and rubber materials). The serum levels of MDA, GSH, iron
copper and zinc were estimated and compared in different groups.
RESULTS:
The result showed that exposure of healthy subjects to different occupational hazards produces
significantly different changes in the oxidative stress markers as revealed by excessive production of
the lipid peroxidation end product (MDA) and depletion of the soluble antioxidant (GSH); and
impairment of the trace element status (copper and zinc).
CONCLUSION:
The extracellular defense mechanisms were severely affected by the insults of oxidative stress
processes due to environmental pollution in some work places in Iraq.

ABSTRACT:
BACKGROUND:
It is known in recent years that stray cats can transmit several serious zoonotic parasitic diseases to
man especially immunocompromised patients.The aim of this study is to detect such parasites in stray
cats in Iraq.
METHODS:
Serum and faecal samples were taken from 126 stray cats from different areas of Baghdad, subjected
to serological test (IHAtest) and parasitological examination to detect cyst,oocyst,ova of zoonotic
arasites ,as well as careful examination of skin and hair for ectoparasites.
RESULTS:
Positive seroprevalence (72.2%) for Toxoplasma gondii were found in stray cats, 114 examined cats
(90.4%) were found to be infected with different zoonotic enteric parasites.Three types of
ectoparasites(73%) infested these cats..Some of these parasites were recorded for the first time in Iraq
which include: Cryptosporidium spp, Giardia spp, Capillaria spp, Toxascaris leonine,
Aelurostrongylus abstrusus, Ixodes spp, Felicola subrostratus .
CONCLUSION:
The high seroprevalence of T. gondii and high infection rates for zoonotic enteric parasites and
ectoparasites in stray cats could be the cause of theincreased incidence of human enteric and skin
diseases in this country.

The study demonstrated that zinc affected the liver cells by giving the mice particular doses of zinc as
Znso4. The mice were divided into four groups of 6 mice each. Both of moderate and high dose
groups showed various degrees of degenerative changes in the hepatocytes, such as increased size
and the presence of spaces, dark appearance of the cytoplasm, whereas none of these changes were
present in both group I (controls) and group II (low dose group) .
BACKGROUND:
According to previous studies, there is a correlation between certain doses of zinc and the changes
that may occur in the liver cells.
METHODS:
The study was conducted on mice, which were divided into four groups of six mice each. Group I
received tap water during the entire period of experimentation (30 days), group II, group III and
group IV were received 5 mg, 10 mg and 15 mg/Kg body weight zinc as Znso4 consecutively (orally
and daily) . Sections of livers were made and examined by light microscope.
RESULTS:
Zinc affected liver cells (hepatocytes) in mice under certain doses. Group III and group IV animals
which received 10 mg and 15 mg/kg body weight zinc as Znso4 consecutively showed various
degrees of degenerative changes in the hepatocytes, such as increased size and the presence of
spaces, dark appearance of the cytoplasm. The degree of these changes was more abundant in liver
cells of high dose group in comparison with the changes in liver cells of moderate dose group,
whereas none of these changes were present in both group I (controls) and group II (low dose group)
which received tap water and 5mg/kg body weight zinc consecutively .
CONCLUSION:
Certain doses of zinc could cause damages to the liver cells.

Cholecystectomy is the most common major
abdominal procedure (1). Pseudo-aneurysm of the
cystic artery is a well documented rare but serious
complication that might follow an open or
laparoscopic cholecystectomy (LC). It may be seen
in isolation or in association with bile duct injury
(2). It represents a technical failure and can be
avoided by adopting a standardized procedure.
We present three cases of cystic artery
pseudoaneurysm, one following an open and two
following laparoscopic cholecystectomy. All of
them presented with hemobilia but with different
scenario. These patients required laparotomy to
control their problem, two of them were
emergencies and one was elective laparotomy.