Iraqi Postgraduate Medical Journal

Chronic low back pain (CLBP) remains a leading
global cause of pain and disability, with
degenerative disc disease (DDD) historically
implicated as the predominant aetiology. Recent
research has introduced the concept of
vertebrogenic back pain (VLBP), a condition
where vertebral endplates contribute significantly
to CLBP. The Basi-vertebral nerve (BVN), which
innervates the vertebral endplates, has emerged as
a key target for therapeutic intervention in VLBP.
While BVN ablation (BVNA) has shown promise,
its integration into clinical practice remains in the
early stages. Supported by robust pre-clinical and
clinical evidence, the American Society of Pain
and Neuroscience (ASPN) has recognized the
need for evidence-based guidelines to guide
patient selection for BVNA. The ASPN’s
workgroup, which reviewed available literature,
concluded that BVNA offers Level A evidence,
confirming its substantial benefit in appropriately
selected individuals.

BACKGROUND:
Pulmonary arterial hypertensions defined as the mean pulmonary arterial pressures more than 25mmHg at rest or more than 30mmHg with exercise no matter what age, or Tricuspid regurgitation with a Doppler velocity of more than 2.5 m/sec. In pediatric patients, it is defined as systolic pulmonary artery pressure exceeds 50% of systolic systemic pressure.
OBJECTIVE:
To describe the congenital cardiac defects that lead to pulmonary arterial hypertension in children, estimate the severity of pulmonary arterial hypertension associated with congenital heart disease, and to describe and evaluate the modality of diagnosis and treatment of pulmonary arterial hypertension in children with congenital heart disease.
PATIENTS AND METHOD:
Cross sectional study done in Iraqi center for cardiac disease in Gazi Al Hareri Hospital from 14th of December 2016 to 12th of July 2017. The study included 47 child their ages from (1-156 months)who approved to had Pulmonary arterial hypertension with congenital heart disease by echo study and or cardiac catheterization that done by pediatric cardiologist. Information were collected
from their caregivers that included age,sex, time at diagnosis, family history ofcongenital heart disease , mode of diagnosis, type of treatment that child receive. Type ofcongenital heart disease and the severity of pulmonary arterial hypertension were approved by pediatric cardiologist.
RESULTS:
From a total number of 47 child that had congenital heart disease with Pulmonary arterial hypertension, 29 (61.7%) was males and 18( 38.3%) was females. In this study, ventricular septal defect was found as the most common cause of pulmonary arterial hypertension. The mean age of the study group was 56months with range ( 1- 156) month. The mean age at diagnosis of congenital heart disease is 10month and the mean age of diagnosis of is Pulmonary arterial hypertension16month . Where 38 (80.9 % ) patients were diagnosed with pulmonary arterial hypertension at early infancy , 2 ( 4.3 % ) patients were diagnosed during late infancy and 7 ( 14.9 % ) patients were diagnosed after infancy. There was statistically significant difference between the age of the patients and the severity of pulmonary arterial hypertension (P value 0.05) and there was statistical significance between the severity of Pulmonary arterial hypertension that associated with congenital heart disease and family history (P value 0.02).This study show there was no statistical significance between the severity of Pulmonary arterial hypertension and the type of congenital heart disease.
CONCLUSION:
The prevalence of severe pulmonary arterial hypertension in Iraq is high.

BACKGROUND:
The clinical manifestations of anterior abdominal wall diseases are diverse. Cross-sectional imaging
frequently reveals abdominal wall lesions, which are typically unnoticed. It can be difficult to
distinguish between various sorts of masses based only on imaging characteristics.
OBJECTIVE:
To assess the diagnostic accuracy of ultrasonography for anterior abdominal wall lesions.
PATIENTS AND METHODS:
From January 2022 to December 2022, researchers from Al-Yarmouk Teaching Hospital conducted
a prospective study. A total of 102 individuals with anterior abdominal wall swellings were included
in the research. All of the patients had undergone a targeted ultrasound examination. The findings
were compared to the patients' surgical findings and histological findings.
RESULTS:
The most prevalent pathologies were hernia (31.38%), post-operative collections (25.48%), and
endometriosis (14.71%). In compared to surgical and histological findings, ultrasonography
demonstrated 99% sensitivity, 97.06% accuracy, and 98.02% positive predictive value (PPV) for
the identification of different anterior abdominal wall lesions.
CONCLUSION:
Abdominal wall lesions are common clinical manifestation. Although there are multiple possible
diagnoses, in most cases, an accurate diagnosis can be made or the scope of the differential diagnosis
can be narrowed by combining clinical and imaging features. A few types of masses, however, still
require pathological diagnosis.

BACKGROUND:
Brain metastasis represent a significant source of morbidity and mortality in patients with systemic
cancer, they are neoplasms that originate in tissues outside the central nervous system (CNS) and
spread secondarily to the brain. SRS is delivered using dedicated radiosurgery platforms such as the
Gamma Knife.
OBJECTIVE:
The aim of this study is to evaluate the role of gamma knife radiosurgery as a treatment of secondary
metastatic brain tumors.
PATIENTS AND METHODS:
This is a prospective clinical study performed in Dr. Saad Al-Witry Neuroscience Hospital, Gamma
Knife Department, to evaluate the role of gamma knife radiosurgery as a treatment of secondary
metastatic brain tumors, depending on tumor volume, peritumoral edema and presenting clinical
features with their effect on quality of life and survival, between January 2019 to January 2020.
Mean age was (63.02± 11.98), 21 patients were >65 years, while 29 patients were
<65 years. 13 of patients were males and 37 were females. Lung cancer was primary lesion in 68%,
breast cancer in 22%, both prostate cancer and RCC were 4%, and unknown origin was 2%. 64% of
patients was without previous brain treatment, only 36% was with previous brain treatment.
Majority of patients had headache 44%.
RESULTS:
After 12 months of follow up, mean tumor volume post (GKRS) regressed from 6.48cm3 to
3.38cm3. Age of patients <65 years, KPS >70, patients with small tumor volume and patients without
previous treatment (surgery, chemotherapy and WBRT) had good prognosis.
CONCLUSION:
GKRS is efficient and safe in treating patients with secondary brain metastasis, Age groups less than
65 years, KPS more than 70, decrease in tumor volume post . are associated with increased survival
rate, improvement in clinical features associated with better quality of life, multiplicity of
metastasis is an ominous sign of mortality.

BACKGROUND:
Careful assessment of abdominal and pelvic lymph nodes on computed tomography is a final job in
radiological training particularly in oncological reporting. Node –RADS1.0 was used to form a steady
construction for radiological reporting of lymph nodes.
OBJECTIVE:
Intended to assess lymph nodes metastasis among a sample of Iraqi patients with primary
abdominopelvic tumors based on Node–RADS version 1.0 in comparison with histopathological
results.
PATIENTS &METHODS:
This prospective comparative study was conducted at the CT unit of Oncology Teaching Hospital in
Baghdad Medical City for period from March 2021 to December 2022. The study sample included
(70) patients with abdomen/ pelvic malignancies, CT scan study was done, both unenhanced and
contrast enhanced CT studies were included. The patients were followed up after surgery for
the result of their histopathological examination to be compared with the Node-RADS score.
RESULTS:
The study shows that Node-RADS v 1.0 category 2 was the most one registered among 18 (25.7%) of
the patients, followed by 4 among 15 (21.4%), category 3 among 13(18.6%( patients and category 1
and 5 among 12 (17.1%) of the patients respectively. Regarded histopathology there was equal
percentage (50.0%) of the positive and negative result, there was a significant association between
the histopathological finding with the Node-RADS results, 81.5% of positive histopathology had
Node-RADS category (4 and 5) and this finding found to be significant as p value was less than 0.05.
The sensitivity of the Node-RADS test compares with the gold standard test (Histopathology) found to
be 81.5% and the specificity of the Node-RADS was 69.8%.
CONCLUSION:
The Node Reporting and Data System 1.0 regulates reporting of cancer nodal contribution on CT
imaging. There is high sensitivity and good specificity of Node-RADS in comparison to
histopathological study.

BACKGROUND:
In pregnant women with gestational diabetes mellitus, the insulin and lipids levels are altered indicating
metabolicg changes that manifests during pregnancy.
OBJECTIVE:
To identify the relation of maternal triglyceride, cholesterol levels and amniotic fluid index to the
newborn birth weight in the obstetric population with gestational diabetes mellitus.
METHODS:
A cross sectional study conducted at Obstetrics and Gynecology Department in Al-Elwyia Maternity
Teaching Hospital in Baghdad, including 100 pregnant women (gestational age ≥ 37 weeks) having
gestational diabetes mellitus. Serum total cholesterol, triglyceride, and glucose concentrations and
amniotic fluid index were measured then neonatal birth weight was measured at labor.
RESULTS:
In this study, 12% of study patients had high cholesterol level and 47% had high Triglyceride level and
32% had high amniotic fluid index. Mean birth weight is reported to be higher in babies whose mothers
have dyslipidemia when compared to those without dyslipidemia. A positive correlation was detected
between birth weight and with both serum cholesterol , serum triglyceride. But no statistical significant
correlation detected between amniotic fluid index and birth weight.
CONCLUSION:
Serum Cholesterol and triglyceride levels in gestational diabetes pregnant women could be significantly
correlated with neonatal birth weight unlike the amniotic fluid index.

BACKGROUND:
Contracting the coronavirus results in the development of COVID-19, a condition characterized by
swift human-to-human transmission and varying levels of mortality. Fatalities often stem from
complications such as acute respiratory distress syndrome, multi-organ failure, and other severe
health issues. The global application of the neutrophil-to-lymphocyte ratio serves as a widely
utilized indicator to assess the prognosis of patients dealing with various infectious diseases, such as
pneumonia, as well as non-infectious conditions like cancer.
OBJECTIVE:
The aim is to assess the diagnostic and severity predictive efficacy of the neutrophil-to-lymphocyte
ratio in patients with Coronavirus disease.
METHODS:
A cross-sectional study done in the emergency department of Baghdad Teaching Hospital in
Baghdad City-Iraq. Sample collected randomly and 528 patients who had symptoms of Corona
virus disease were enrolled prospectively in the study.
RESULT:
Patients with a neutrophil-to-lymphocyte ratio ≥3.6 exhibited a 20.3 times higher likelihood of
having Coronavirus disease compared to those with a neutrophil-to-lymphocyte ratio of ≤3.6. The
neutrophil-to-lymphocyte ratio demonstrated a significant increase with the severity of the disease.
While the age difference among patients did not show statistical significance in terms of diagnosis,
it appeared to play a significant role in determining the severity of the disease. The optimal
threshold at 4.3 for the neutrophil-to-lymphocyte ratio displayed superior predictive capabilities for
identifying patients at risk of developing severe to critical disease, especially among those aged
51.5 years and older, showcasing the highest sensitivity and specificity.
CONCLUSION:
An increased neutrophil-to-lymphocyte ratio serves as an independent biomarker for both
diagnosing and predicting the severity of Coronavirus disease. Additionally, age and the neutrophilto-lymphocyte ratio emerge as independent risk factors influencing the severity of the infection.

BACKGROUND:
Children with epilepsy have a high burden of physical comorbidity, and they experience poor longterm medical outcomes even after remission of their epilepsy. Little is known about types of these
comorbidities and their occurrence in children epilepsy in Iraq.
OBJECTIVE:
The aim of this study to assess bone and growth status in children with epilepsy.
PATIENTS AND METHODS:
A cross sectional case-control study was conducted in Children Welfare Teaching Hospital, in
the period from November 2018 to October 2019. The study included 40 children diagnosed with
epilepsy and another 40 healthy children, age- and sex-matched. The following parameters were
measured in both groups: body weight, height, body mass index (BMI), bone mineral density (BMD)
and vitamin D level.
RESULTS:
In the epileptic children group, 28(70%) males and 12 (30%) females were reported. The
predominant epilepsy type was focal 30 children (75%). Among the epileptic children, sixteen (40%)
epileptic patients were placed on monotherapy treatment, while 24 (60%) were placed on polytherapy
The level of Alkaline Phosphatase and phosphorus level was significantly higher in epileptic patients
than in controls while there were no significant difference in calcium levels between patients and
control groups. On the other hand, vitamin D found to be lower in epilepsy children with statistical
significance. The growth parameters (weight, height and body mass index) show no significance
between patent and control groups, the standard normal distribution (Z-score) of DXA scan also show
no significance in both groups.
CONCLUSION:
The children with epilepsy and on treatment with AEDs are at higher risk of hypovitaminosis D,
There were no significant radiological changes (measured by DXA scan) in the epileptic children
placed on AEDs for at least one year, in comparison to the healthy children.

BACKGROUND:
Management of poorly functioning kidneys with ureteropelvic junction obstruction (UPJO) is
controversial, with some recommending direct nephrectomy others direct pyeloplasty, and others
temporary diversion.
OBJECTIVE:
To find whether pyeloplasty allows for functional recovery in poorly functioning kidneys in pediatric
age group.
PATIENT AND METHOD:
A prospective review of 25 patients with unilateral UPJO who underwent open Anderson-Hynes
pyeloplasty (AHP) with a split renal function (SRF) of 10-20% at Baghdad Medical City from
December 2019 to September 2022 was conducted. The changes in the SRF measured by the MAG-3
study after 1 year were compared. The informed consent forms given by the parents of all cases were
reviewed.
Deterioration of SRF by more than 5% of the preoperative value was deemed to be FAILURE
(deterioration). An increase in SRF of more than 5% in the ipsilateral kidney was deemed as
SUCCESS (improvement). A change in SRF of within ± 5% was considered STABLE renal function
RESULTS:
25 patients divided into two groups: below (52%) and above (48%) 1-year-olds with preoperative SRF
on 10% to 20% of the affected side.
Mean preoperative SRF was 15.4±2.8% in all cases, which increased postoperatively in the success
group from 15.5±2.9% to 23.7±4.7%, and this improvement was highly significant, while in two cases
with failure with SRF from 13.5±2.1% to 5.5±2.1%.
The success rate was 92%, whereas a secondary nephrectomy was necessary for two (8.0%).
CONCLUSION:
Poorly functioning renal units with SRF 10% - 20%, can show functional improvement and
recoverability, so in these renal units, we can’t rush to do a nephrectomy instead, we can proceed to
pyeloplasty.

BACKGROUND:
Due to the increasing resistance of staphylococcal strains, vancomycin is often used as empiric therapy in
neonatal late-onset sepsis. The Infectious Disease Society of America 2011 methicillin-resistant
Staphylococcus aureus guidelines recommended that the goal serum trough level concentration for
vancomycin to be increased from 5-10 mg/L to 10 to 20 mg/L in children and adults. Neonatal references
have also recommended these target levels but dosing recommendations remained the same as previous.
OBJECTIVE:
This study aimed to assess the percentage of neonates attaining a serum trough level between 10 and 20
mg/L with empiric vancomycin dosing in a neonatal care unit patients and the evaluation of clinical
outcomes in relation to initial trough level.
PATIENTS AND METHODS:
A prospective cohort study conducted in the neonatal care unit of Children Welfare Teaching hospital of
Medical City on 43 neonates during the period from 27th of January 2020 through 15th of December
2020. Neonates included were treated with vancomycin with a minimum of three doses.
RESULTS:
Of the 43 vancomycin serum trough levels included in the primary outcome, only 14 (32.6%) achieved a
goal trough of 10 to 20 mg/L with empiric dosing. Overall, vancomycin trough values below 10 mg/L
were significantly associated with lower gestational age (<37 weeks) (P value 0.0394). No statistically
significant difference between the group of patients who achieved a trough of greater than 10 mg/L and
those who did not in terms of hospital stay and mortality
CONCLUSION:
The initial vancomycin dosing regimens result in low attainment of vancomycin target trough levels in
neonates. However the trough level does not predict mortality or clinical outcomes in patient with culture
confirmed late-onset sepsis.

BACKGROUND:
Laparoscopic sleeve gastrectomy (LSG) is a surgical surgery in which a substantial part of the stomach is
removed to restrict food intake and facilitate weight loss. It is less expensive than other weight-loss
operations like gastric bypass. Individuals with a BMI greater than 40 kg/m2 or a BMI greater than 35
kg/m2 with comorbidities who have failed to achieve and sustain weight loss by non-surgical techniques
might consider LSG.
OBJECTIVE:
The primary aim of our study was to critically evaluate the efficacy, safety, and operational efficiency of
the four-port laparoscopic sleeve gastrectomy (LSG) in comparison to existing methodologies, primarily
as described in Meta-Analysis A and Meta-Analysis B. This comparative framework serves as a rigorous
test bed, not merely to establish parity but to explore possible advantages of our approach.
METHODS:
The study involved 150 patients aged 18–45 years with a BMI between 35 and 50. The laparoscopic
sleeve gastrectomy procedure was performed using a four-port technique, using four trocars to puncture
the abdominal wall and access the surgical site.
RESULTS:
The study found that Laparoscopic sleeve gastrectomy using a four-port technique was successful in
94.6% of cases, with only 3.3% requiring extra ports. The procedure was relatively short, with a median
operating time of 55 minutes. Postoperatively, complications were low, with intra-abdominal bleeding,
staple-line leaks, and port site hernias being the most common.
CONCLUSION:
Our recommendation is to perform a 4-port laparoscopic sleeve gastrectomy in all patients with a body
mass index of less than 50 kg/m2, and if there is any struggle during the procedure, we can add more
ports at any time.

BACKGROUND:
The nasal dorsal hump reduction is common among patients seeking rhinoplasty. This surgery must be
based on conservative reduction of excessive nasal bone and cartilage with meticulous reconstruction of
nasal dorsum by different techniques. These techniques are suturing, spreader graft or spreader flap to
create pleasant dorsal aesthetic lines with preserving internal nasal valve function.
OBJECTIVE:
To evaluate and compare the nasal contour and patency between suturing technique and spreader graft
placement in hump reduction of primary external rhinoplasty.
METHODS:
A prospective observational comparative study was done in which 21 patients were selected for hump
reduction and then divided those patients randomly into two groups: Group A with spreader graft
placement technique after hump reduction and Group B with suturing technique after hump reduction.
The evaluation of all patients included the administration of a questionnaire, a clinical examination, and
the documentation of photographs both before and after the surgical procedure. Additionally, follow-up
assessments were conducted at the 1st, 3rd, and 6th months.
RESULTS:
(ROE) score, VAS scale, and photo documentation showed that group A was 100% satisfied with nose
look postoperatively, while group B was 90% satisfied.
Both groups A and B showed 100% and 90% preserved nasal patency, respectively, according to nasal
obstruction symptoms assessment (NOSE) and visual analogue scale for nasal patency.
CONCLUSION:
Spreader graft placement and suturing technique have a similar effect on reconstruction of nasal
appearance and preservation of nasal patency except in selected situations.

BACKGROUND:
Recurrent pregnancy loss is a heterogenous reproductive problem with multiple etiologies.
Antiphospholipid antibody has been associated with recurrent miscarriage. Vitamin D3 helps to support
successful implantation through immunological action. Vitamin D3 deficiency highly associated with
recurrent miscarriage.
OBJECTIVE:
To find association between antiphospholipid antibody and vitamin D3 (1, 25 dihydrocholecalcifrol) in
women with recurrent pregnancy loss.
PATIENTS AND METHODS:
A comparative cross sectional study done at Al-Elwiya Maternity Teaching Hospital in Baghdad
including A 58 participants suffering from recurrent miscarriage and another 58 control group. Vitamin
D3 level and antiphospholipid antibody were analyzed and data have arranged for analysis.
RESULTS:
Vitamin D3 was found to be low in 96.6% of women with recurrent miscarriage the mean was
(11ng/ml) which is significantly lower than mean vitamin D3 of the control group (37.6 ng/ml
(p<0.001))
Vitamin D3 deficiency and Antiphospholipid antibodies were present in 29.3% of women with
recurrent miscarriage. There were a highly significant association between vitamin D3 deficiency and
antiphospholipid antibodies in women with recurrent miscarriage (p<0.001).
CONCLUSION:
The antiphospholipid antibodies and vitamin D3 deficiency were found to be highly associated together
with recurrent miscarriage.

BACKGROUND:
Neonatal septicemia is a clinical syndrome characterize by signs and symptoms of infection in
the first month of life associated with high Morbidity and mortality rates if not treated properly.
Platelet indices (biomarkers of platelet activation which include mean platelet volume, platelet
distribution width, mean platelet mass, platelet large cell ratio, and immature platelet fraction) are of
diagnostic value in a variety of settings including the sepsis some are studied very rarely.
In automatic complete blood picture platelet count, mean platelet volume and platelet distribution
width are a group of platelet indices determined together related to morphology and proliferation
kinetics of the platelets.
OBJECTIVE:
To determine the role of platelet indices (platelet counts, MPV and PDW) in the diagnosis of neonatal
sepsis , to detect the value of these indices in determining the type of bacteria causing the sepsis and
to study the association of the platelet indices (platelet count, MPV & PDW) with gestational age,
birth weight and onset of sepsis.
PATIENTS AND METHODS:
A prospective, case–control study, conducted at Neonatal care unit in Children Welfare Teaching
hospital, from the first of June 2019 to the end of June 2020, included 90 neonates with signs and
symptoms of sepsis and positive blood culture considered as patients group with other 90 healthy
neonates as control group from outpatient clinic. Blood samples were drawn from each neonate of
sepsis and control groups for white blood cell, hemoglobin, absolute neutrophil count, platelet count,
MPV and PDW and blood culture were sent for patients groups.
RESULTS:
55 (61.1%) patients were males and 35(38.9%) patients were females, 24 (26.7%) patients below age
of 7 days, 39(43.3%) patients were preterm (GA<37wk), 45(50%) neonates of the sepsis group were
low birth weight (less than 2.5kg). In control group,70(77.8%) neonates below the age of 7 days,
41(45.6%) neonates were lowbirth weight, there were matching between control and sepsis groups
regarding gestational age and gender. Platelet indices including MPV and PDW (except plateletcount)
were increased with statistical significance in sepsis group in comparison to control group (P<0.05)
regardless of gestational age and birth weight. All these indices were statistical significant in early
onset sepsis but not in late onset sepsis. There were no statistical significant for platelet indices
(platelet count, MPV and PDW) between subgroups of sepsis neonates regarding gram stain,
onset ofsepsis, gestational age and birth weight (P>0.05).
CONCLUSION:
Neonatal sepsis has significantly increased platelet indices (MPV and PDW) compared to healthy
neonates regardless of Gestational age and birth weight. Thrombocytopenia and an increase in MPV
with PDW are seen significantly in neonates with EOS (Early onset sepsis) but not significant in late
onset sepsis compared to control. Platelet indices are not significantly different (decrease in platelet
count and increase in MPV with PDW) between Gram-positive and Gram-negative bacteria, so
the platelet indices are not specific findings in determining different types of sepsis bacteria.

BACKGROUND:
Avascular necrosis of the femoral head is a frequent cause of musculoskeletal disability. Its preoperative
staging is of utmost importance in determining the appropriate treatment option.
OBJECTIVE:
Magnetic Resonance evaluation of the distribution and staging of avascular necrosis of the femoral head
among a sample in Duhok City, Kurdistan region of Iraq.
PATIENTS AND METHODS:
In this retrospective cross-sectional study, data were collected from one hundred patients of various ages
,conducted from May 2022 to November 2023 to those patients who were referred and diagnosed with
avascular necrosis from specialized orthopedics at specialized hospitals in Duhok city, magnetic
resonance imaging study with different sequences suitable to the hip region has been undergone .Data
included information about the demographic and imaging distribution of the patients with avascular
necrosis of the femoral heads in addition to their imaging evaluation following the Ficat - Arlet and
Mitchell classifications.
RESULTS:
The age group most affected by the disease is between twenties and forties, accounting for 56% of the
cases. Males show statistically significant higher percentages than females, making up 86% of the total
number. Bilateral involvement is more common than unilateral involvement, accounting for 62%
compared to 38%. Trauma shows significant correlation as the most common risk factor for the disease,
accounting for 51% of cases. Bone marrow edema shows statistically significant values as the most
commonly found in aging character, accounting for 91% of cases. Stage II is the most common
stage among individuals under the age of 20. Stage III is the most common among individuals aged 21-
40. Stage IV is the most evaluated in the age group of 41-60 (Ficat and Arlet). Class D shows the most
common values, accounting for 37% of cases, followed by Class C at 34% (Mitchell).
CONCLUSION:
MRI is indispensable for the early and accurate detection and staging of AVN, which facilitates a better
response to treatment.

BACKGROUND:
Overweight and Obesity are major health problems characterized by excess adipose tissue. It is a
growing global epidemic issue that is demonstrated to cause several mental physical disorders,
including heart diseases, vascular disease, diabetes mellitus, and psychological disorders. Prostatic
Specific Antigen (PSA) is considered the most dependent tumor marker of carcinoma of prostate. It
is considering organ-specific tumor marker but not disease specific. It is the most prevalent screening
tool for carcinoma of prostate and most proportion of prostatic carcinoma are diagnosed with
prostatic biopsy when there is abnormally elevated level of serum PSA.
OBJECTIVE:
Our research study aimed to define the relationship of BMI (body mass index) as a marker of obesity
with serum PSA level and their correlation to age and prostatic volume. This knowledge will help to
avoid errors in the assessment of prostate disorders using PSA test for overweight and obese men.
PATIENTS AND METHODS:
Across sectional study was performed between the 3rd of May to the 28th of November 2022. Our
study involved 115 cases with their age was more than 55 years. In 35 cases, their age was between
55 and 59 years, in 53 cases their age was between 60 to 69 years, and in 27 cases, the age was above
70 years. Their BMI categorized into 3 groups: group 1 include obese people (BMI > 27kg/m2)
which includes 55 cases, group 2 overweights (BMI 23- 27 kg/m2) which include 37 cases, and
group 3 includes normal weights (BMI 18.5 - 23kg/m2) which include 23 cases. Body mass index,
total serum PSA and volume of prostate were measured for every case in this research and the results
are analyzed statistically by using IBM-SPSS 26. A P-value ≤ 0.05 deemed significant for this study.
RESULTS:
Obese individuals exhibited significantly lower median serum PSA in comparison to overweight and
normal BMI males 1.6, 2.2, 2.69 ng/ml, in group 1, group 2, and group 3 respectively. There is a
considerable significantly negative correlation of PSA with BMI (Spearman’s coefficient= -0396,
p=0.001). Also, there was no statistically significant variation found between the groups regarding
prostate size (p = 0.532). There was a positive correlation of serum PSA with the age (r= 203, p =
0.029). After adjusting for age, PSA was still negatively associated with BMI (p= 0.022). When the
linear regression model was applied, again inverse relationship between PSA level and BMI is found
(r = -0.335, P=0.0001), and serum PSA was level positively correlated to age (r = 0.207, p = 0.018).

BACKGROUND:
The cerebellopontine angle and internal auditory canal are cerebrospinal fluid filled spaces located at
the posterior cranial fossa within the edges of temporal bones, the anatomical relation of anterior
inferior cerebellar artery is variable within each spaces and it’s a possible etiology of an unexplained
vestibular-auditory symptoms including tinnitus, vertigo, and sensory neural hearing loss, by forming
vascular loops affecting the course of vestibulocochlear nerves. This condition may be detected more
precisely by using high resolution 3tesla MRI machine.
OBJECTIVE:
To compare anatomical relation of anterior inferior vascular loop and vestibulocochlear nerves in
relation to vestibular-auditory symptoms.
PATIENTS AND METHODS:
This study is a cross-sectional case control including 116 adult individuals, 86 patients presented with
unexplained vestibular-auditory symptoms comparing with 30 control adults who were investigated at
Al-Yarmouk teaching hospital from December 2021 to October 2022. Data collected from patients
through direct interview and fulfilling prepared questionnaire. MRI imaging use, 3D DRIVE thin slice
T2-wieghted images in order to identify the vascular loops in all individuals in relation to
vestibulocochlear nerves and classify the finding through two grading systems and correlate them with
patient’s symptom.
RESULTS:
No statistically significant association detected between presence of different grades or types of
vascular contact and any patients complaining from any audio-vestibular symptoms according to both
types of included classification systems (Chavda and Gorrie).
CONCLUSION:
There are independence between MRI findings and the clinical profile, suggesting that there is no
direct, exclusive relationship between the diagnosis of vascular loop on an MRI scan and the
corresponding otoneurological profile.

BACKGROUND:
Idiopathic intracranial hypertension (IIH) is an idiopathic condition. MRI is essential to exclude elevated
cerebrospinal fluid pressure due to other causes such as brain tumour, dural sinus
thrombosis, hydrocephalus, etc.
OBJECTIVE:
To determine the role of brain magnetic resonance imaging and venography in the diagnosis of idiopathic
intracranial hypertension and to determine the sensitivity and specificity of each single radiological sign
and in combination.
PATIENTS AND METHOD:
A prospective case control study was done in Al- Imamain Al-Kadhmain medical city between September
2021 and November 2022. A random selection of 40 patients (3 males and 37 females) with clinical
features, neurological examination, brain MRI/ MRV and confirmed diagnosis of IIH. Forty controls were
also randomly selected. A total of 10 brains MRI/MRV signs were evaluated.
RESULTS:
There is significant difference of the 10 MRI signs between patient group and control group. Regarding the
sensitivity and specificity of each MRI sign: empty sella (97% sensitive, 77% specific), flat sclera (82%,
95%), Perioptic nerve sheath distension (90%, 95%), Intraocular protrusion (22%, 100%), vertical
tortouisity f the optic nerve (35%, 95%), enlarged meckel’s cave (82%, 92%), posterior displacement of the
stalk (67%, 75%), slit like ventricle (55%, 97%), meningoceles (15%, 97%) and cerebral venous sinus
stenosis (70%, 92%). Combination of MRI signs increases the sensitivity and specificity with combination
of 3 signs and above would reach 100% specificity.
CONCLUSION:
Five MRI signs have the highest sensitivity and specificity (flat sclera, perioptic nerve sheath distension,
empty sella, large meckel’s cave, and cerebral venous sinus stenosis). Combination of MRI signs especially
(optic nerve tortuosity/ optic nerve distension) and (flat sclera/ optic nerve distension) has significantly
increased the sensitivity and specificity. Presence of 3 signs or more has the highest specificity.

BACKGROUND:
Estimation of gestational age is vital in obstetric management. Active management and delivery
require knowledge of gestational age especially in high risk pregnancies, unreliable precise
gestational age leads to adverse pregnancy outcome such as prematurity, low birth weight and
prenatal morbidity and mortality.
OBJECTIVE:
To evaluate the use of the transcerebellar diameter versus conventional fetal biometry (Biparietal
diameter, Femoral length, Head circumference and Abdominal circumference) for estimation of the
gestational age.
PATIENTS AND METHODS:
Prospective observational study over one year in AL–Yarmouk Teaching hospital in department of
obstetrics and Gynecology was done. One hundred pregnant women were recruited from outpatient
clinic and inpatient ward from 20 weeks of gestations. The patients were divided into two groups,
those who were followed till term and second group were admitting for emergency management and
delivery. Two U/S exams were done for the follow up group (first group), second emergency group
were examined once by U/S biometry. Post-delivery estimation of gestational age was done by a
pediatrician
RESULTS:
The results showed Transcerebellar diameter has a high accuracy for gestational age estimation P
value< 0.001 and R value = 0.994 and has superior accuracy than other fetal biometry (Biparietal
diameter, Femoral length, Abdominal circumference, Head circumference).
CONCLUSION:
Fetal transcerebellar diameter considers the most precise tool for estimation of gestational age as
revealed in this study. And as a result of high accuracy transcerebellar diameter can be used in
women not sure of her date or lactating women or those with poor antenatal care. Transcerebellar
diameter not affected by external factor so can be used in pregnancies that have medical conditions
as fetal cerebellum not affected by these condition apart from brain anomalies.

BACKGROUND:
Anti-Müllerian hormone (AMH) can serve as a good biomarker for the ovarian reserve that can predict
female fertility. Studying the biological factors that impact AMH levels is necessary for predicting
reproductive health outcomes. Obesity (general obesity by body mass index and central obesity by
waist circumference), is associated with negative reproductive outcomes that could be related to its
impact on AMH level. Female fecundity begins to decrease after women reach the age of 30 years due
to multifactorial causes that could be hormonal as AMH levels changes.
OBJECTIVE:
The study aims to find an association between anti-mullerian hormone (AMH) level, as a biomarker
for ovarian reserve & obesity (general and central), and other anthropometric measurements in
premenopausal women.
SUBJECTS AND METHODS:
This is a descriptive cross sectional study that has enrolled a total of 270 Iraqi women in the
reproductive age. Height ,weight and waist circumference were measured for all participants .Serum
AMH has been analyzed using Enzyme Linked Fluorescent Immune Assay technique (ELFIA).
Subjects were divided into three groups according to their body mass index (BMI), and into two
groups depending on WHO criteria for central obesity, and into three groups according to WHO
criteria for their susceptibility to metabolic risk, and into four groups according to their age. Statistical
analyses were performed using SPSS software.
RESULTS:
AMH level was significantly lower in obese and overweight women than in normal weight women
also in women with central obesity than those without it and in married women than in singles.
Women with increased and substantially increased risk for metabolic complications have significantly
lower AMH level than those with no metabolic risk.
CONCLUSION:
AMH has a negative association with BMI , waist circumference , and age .