Iraqi Postgraduate Medical Journal

ABSTRACT:
The “Setting Sun” sign is a neuro-ophthalmic
finding observed in infants with hydrocephalus,
characterized by conjugate downgaze due to
pressure effects on the posterior third ventricle and
midbrain. This sign can be perceived in about third
of infants with obstructive hydrocephalus, and
could serve as an early clinical indicator for the
progression in intracranial pressure. Despite its
significance, there is a paucity of standardization
to quantify the hydrocephalus severity, limiting
objective assessment and monitoring. Here, we
propose a novel, simple and sensitive grading
system based on the degree of iris and pupil
coverage by the lower eyelid. This system aims to
enhance early detection, facilitate disease
monitoring, and improve treatment decision-
making in the management of infantile
hydrocephalus

BACKGROUND:
Insulin therapy is the cornerstone treatment of type I diabetes mellitus in children and adolescents.
Different insulin types and administrative techniques are present with various efficacy and safety.
OBJECTIVE:
To evaluate the difference in the efficacy between conventional regimen and multiple daily doses regimen
in treatment and supervision of type I DM among the pediatric age group.
PATIENTS & METHODS:
The present study is a clinical prospective follow-up study conducted in the Diabetic clinic of the Children
Welfare Teaching Hospital at Medical Complex in Baghdad city- Iraq for a 10-month duration from the 1st
of December, 2020 till the 30th of September, 2021 on a convenient sample of 75 children and adolescents
with type I diabetes mellitus divided into two groups; group I (50 children treated by conventional insulin
therapy) and group II (25 children treated by basal-bolus dose insulin therapy). The outcomes assessed
were the number of diabetic ketoacidosis attacks & and causes, the number of hypoglycemia attacks &
and causes, anthropometric measures (weight, height & BMI), and HbA1c value. The pediatrics with type
I diabetes were checked out by direct contact for a 6-month from the 1st visit to the 2nd visit with phone
calling follow-up to record the outcomes.
RESULTS:
Mean HbA1c level in group II diabetic children was significantly lower than the mean HbA1c of group I
diabetic children at the 2nd visit (p<0.001) with no momentous discrepancy in weight, height, and BMI
between the two study groups. Growth velocity was calculated and in comparison, between conventional
insulin therapy and multiple daily injection regimes, no significant difference was observed (P > 0.05).
The insulin dose/Kg is marked up in type I diabetic children and adolescents treated with multiple daily
injection regimens.
CONCLUSION:
The multiple daily injection regimen of insulin therapy for type I diabetic children and young adults is
more effective in glycemic control.

ABSTRACT
Background:: Systmic lupus erythematosus is an autoimmune illness characterized by extensive immune complex deposition and consequent tissue damage. It is distinguished by the presence of antinuclear antibodies and the involvement of several organ systems.
Objective: is to assess serum anticarbamylated protein antibody (anti-CarP) level in SLE patients and evaluate the association between anti-CarP antibodies with different disease characteristics.
Subjects and Methods: Serum level of anti-CarP antibody was measured for a total of 40 adult female patients with SLE whom attended the Rheumatology Consultation Clinic of Baghdad Teaching Hospital / Medical City, compared with 40 apparently healthy controls matched in ages and sexes to the patients using Enzyme Linked Immuno-Sorbent Assay (ELISA) technique which is also used to measure serum anti ds-DNA levels.
Results: Serological data showed that the serum level of anti-CarP antibody was significantly higher in the SLE patients compared with controls p value (0.001). In SLE patients there was a significant correlation between anti-CarP antibody and both body mass index and serum ds-DNA antibody levels, however, did not correlate with SLEDAI score.
Conclusion: Serum anti-Carp antibody level was able to differentiate between patient with SLE and healthy control with sensitivity 80% , specificity 77.50% and accuracy 78%.

BACKGROUND:
Cardiovascular complications are more common among diabetic patients and are usually associated with
a significantly greater risk of morbidity and mortality than in nondiabetic subjects. Hyperglycemia
during stress situations, especially during Acute Coronary Syndrome, may also be seen in nondiabetic
patients. Regardless of diabetes status, hyperglycemia on arrival for patients presenting with Acute
Coronary Syndrome has been associated with adverse outcomes, including death.
OBJECTIVE:
To study the state of serum glucose concentration at hospital admission in diabetic patients with acute
coronary syndromes.
METHODS:
A cross sectional study that conducted at Al-Kindy Teaching Hospital for a period of twelve months
from the 1st of Mar. 2021 till the 1st of March 2022. It included 100 patients who were admitted to the
Coronary Care Unit and diagnosed with Acute Coronary Syndrome. Admission plasma glucose
concentrations from blood samples drawn on arrival in the emergency room were recorded.
RESULTS:
In this study, 53% of patients had admission acute phase hyperglycemia. the highest proportion of study
patients who did not smoke was diabetic (60.9%) with a significant association between study group and
smoking status. We noticed that 76.5% of patients with STEMI were diagnosed with admission acute
phase hyperglycemia with a significant association between acute phase hyperglycemia and Acute
Coronary Syndrome symptom.
CONCLUSION:
Newly-diagnosed hyperglycemia is obviously a common metabolic problem among patients with acute
coronary syndrome. Hyperglycemia is a major problem in our patients with and without past history of
diabetes when they are presented with Acute Coronary Syndrome.

BACKGROUND:
In β- thalassemia major, irregularly transfused patients, hepcidin usually high due to increased iron
load and the alleviation of ineffective erythropoiesis; rather than regularly transfused patients.
Elevation of interleukin-6 in β- thalassemia had been reported in few theses.
OBJECTIVE:
To evaluate the level of serum hepcidin, interleukin-6 and ferritin in patients with β-thalassemia
PATIENTS AND METHOD:
This was a case control study conducted at thalassemia center of Ibn Al-Atheer Teaching Hospital
in Nineveh Province during a period of six months between February and August 2022. It
included 180 participants divided into two groups: Case group included 90 patients diagnosed as
β-thalassemia major, aged between 5-40 years and control group included 90 healthy persons
matched in age and gender to the case group.
RESULTS:
In this study, means of IL-6, hepcidin, and ferritin were significantly higher with P-value (0.001,
0.001, 0.001) respectively, while mean of Hb was significantly lower with P-value (0.001) in case
group than that in controls. Strong negative correlation detected between ferritin and hepcidin,
weak negative correlation found between ferritin and IL-6, and weak positive correlation between
hepcidin and IL-6.
CONCLUSION:
Iron overload and alleviation of ineffective erythropoiesis made Hepcidin, interleukin-6 and
ferritin higher in β-thalassemia major patients. Hepcidin and interleukin-6 levels have significant
inverse correlation with serum level of ferritin. There was direct linear relationship between
Interleukin-6 and hepcidin.

BACKGROUND:
Osteoarthritis accounts for around 8% of the total burden of diseases worldwide. There is evidence
that patient education has the beneficial impact of pain reduction and function improvement. The
psychological advantages of patient education emphasized the effect of better knowledge on quality
of life along with reduction in health care visit for patients with knee osteoarthritis.
OBJECTIVES:
To assess the level of knowledge and highlights the educational needs of Iraqi patients about
osteoarthritis and to evaluate osteoarthritis patients’ attitude and practice as a part of self-
management approach.
PATIENTS AND METHODS:
A cross-sectional study conducted at Rheumatology Unit of Baghdad Teaching Hospital in Medical
City, Baghdad, Iraq during a period of eight months from (December 2021 to August 2022). It
included 100 patients who were known cases of osteoarthritis, aged ≥ 40 years. Questionnaire was
divided into four sections in the form of multiple-choice questions to assess knowledge, attitude,
and practice regarding osteoarthritis.
RESULTS:
Knowledge level was poor in 69% of patients. It was significantly higher among males and among
the patients who reported that persons with the same problem (neighbors, friends, and relatives)
were the source of information about osteoarthritis.
CONCLUSION:
Iraqi patients with osteoarthritis especially elderly is keen to live a pain free life but with the least
effort to find the best advice from specialists and instead they gain information about the disease
from their peers. There are many misconceptions and misbeliefs about the osteoarthritis and its
management that need to be corrected by focused efforts to achieve better education

BACKGROUND:
The operating microscope is a now a must in complex neurosurgical interventions. Endoscope
allows neurosurgeons to reach areas in the brain through minimally invasive approaches.
OBJECTIVE:
Colloid cysts in the third ventricle are benign intraventricular tumors, with surgical treatment often
recommended. This study compares the outcomes of endoscopic transcortical and microscopic
transcallosal approaches for colloid cyst removal.
PATIENTS AND METHODS:
A retrospective analysis of 22 patients (15 males, 7 females) who underwent colloid cyst resection
which was performed between March 2012 and December 2018. Patients underwent either a
transcallosal approach (14 patients) or an endoscopic approach (8 patients).
RESULTS:
Complete resection was achieved in 85% of transcallosal cases and 25% of endoscopic cases.
Complications were fewer in the transcallosal group, with two patients experiencing memory loss
and disconnection syndrome. The endoscopic group had more complications, including left-side
weakness, dysarthria, and CSF leak. Surgery duration was shorter for the transcallosal group (2.5
hours) than the endoscopic group (3.25 hours). Glasgow outcome scale results favored the
transcallosal group.
CONCLUSION:
Our study demonstrated that total resection was more common in transcallosal surgery, which also
had better Glasgow outcome scale results, shorter surgery times, and reduced hospitalization
durations.

BACKGROUND:
Thalassemia disorder is an inherited blood disorder causes the body to produce less hemoglobin, it
is classified to thalassemia major, thalassemia intermedia and thalassemia minor. Depression is a
mood disorder that causes persistent feeling of sadness or emptiness and loss of interest that
affects daily living..
OBJECTIVE:
To assess the prevalence of depression and its socio-demographic and clinical characteristics in a
sample of thalassemic patients.
PATIENTS AND METHOD:
A cross-sectional study done with 140 thalassemic patients, from April 2022 to march 2023, the
screening of depression was done by Beck Depression Inventory scale, the diagnosis of depression
was made according to DSM-5 criteria for major depression disorder. The demographic and
clinical data were also collected.
RESULTS:
The prevalence of depression was 32.9%, with the highest prevalence among thalassemia major
patients 50%, while it was 37.5% among thalassemia intermedia patients and 12% among
thalassemia minor patients. there was a significant association between depression and socio-
demographics’ data of thalassemia major and intermedia, And insignificant association in the data
of thalassemia minor.
CONCLUSION:
Depression was common among thalassemic patients. And the severe type (thalassemia major) had
the highest rate of depression, which makes them in increased need for psychosocial interventions
and support

BACKGROUND:
Behçet disease is an idiopathic chronic relapse multi-systemic vascular-inflammatory disease of
unknown origin. Central nervous system involvement is considered one of the most severe
manifestations of the disease, and it is categorized into primary or secondary. The primary neuro-
Behçet disease can be sub-classified into parenchymal and non-parenchymal disease.
OBJECTIVE:
To identify neuro-Behçet disease clinical and radiological manifestations, and categorize the various
presentations into characteristic patterns.
PATIENTS AND METHODS:
A case series study was conducted in Iraqi hospitals and outpatient clinics from March 2022 to
December 2022. Demographic data of the patients and the duration of BD at the time of NBD
diagnosis were recorded. The patients were clinically re-assessed for the fulfillment of Behçet disease
diagnostic criteria. The enrolled patients were evaluated by neurologists in each province, for the
manifestations of neuro-Behçet disease, whether current or previous presentation. Henceforth, a
revision of patients\' radiological reports was recorded.
RESULTS:
There were 80 patients in this study; the mean age of patients was 31.7 ± 9.1, with male predominance
(62%). The mean duration of Behçet disease at neuro-Behçet diagnosis was 2.8 ± 2.4 years.
Regarding cumulative clinical manifestations, parenchymal symptoms were the most common,
predominantly brainstem syndrome (67.5%). Non-parenchymal manifestations such as venous sinus
thrombosis and pseudotumor cerebri presented in 46.3% of patients with Behçet disease. MRI findings
reflected the clinical picture, with parenchymal involvement (55.1%) and brainstem hyperintensity
being the most common (40%), followed by venous sinus thrombosis (43.8%).
CONCLUSION:
Behçet disease neurological manifestations occurred mainly in men in their thirties to forties, and the
majority of them presented within 2.8 years of Behçet disease onset. Brainstem involvement is the
most common presentation. However, the disease can also present with a wide range of symptoms.
CVST pattern of the disease was prevalent in Iraq. Radiologically, brainstem hyperintensity is the most
common finding in parenchymal NBD.

BACKGROUND:
The increasing prevalence of antibiotic-resistant strains of Helicobacter pylori contributed to reduce
the effectiveness of the first-line standard therapy. Consequently, it is necessary to identify
alternative regimens that provide better or comparable efficacy and safety.
OBJECTIVE:
Compare the efficacy and tolerability of 10-days levofloxacin-based triple therapy versus
clarithromycin-based triple therapy as a first-line eradication regimen of Helicobacter pylori.
PATIENTS AND METHODS:
This is an open label observational comparative study. A total of 100 patients with Helicobacter
pylori infection were selected; 50 patients were taking 10-day levofloxacin-based triple therapy and
the other 50 patients were on 14-day clarithromycin based triple therapy. Eradication rate and
adverse effects were evaluated.
RESULTS:
Helicobacter pylori eradication rates were: levofloxacin group 74%, and clarithromycin group 54%.
There were a statistically significant differences in the efficacy between the two regimens (p value
< 0.05). In addition, no relevant differences in adverse effects were demonstrated. There was no
significant relationship between Helicobacter pylori eradication and gender, age, or smoking.
CONCLUSION:
This study showed that levofloxacin-based triple therapy is significantly more effective than
clarithromycin-based therapy in the eradication of Helicobacter pylori infection but it does not
reach the recommended eradication threshold.

BACKGROUND:
Despite the long history of research favoring the left hemisphere is dominant for language processing in
most right-handed subjects. There is accumulating evidence that the right hemisphere contributes to
language.
OBJECTIVE:
To evaluate language deficits in right hemisphere stroke survivors so they will have the opportunity to be
tested for deficits and offered compensatory strategies.
PATIENT AND METHODS:
case control study, right-handed patients from 3 hospitals and a physiotherapy Centre in Iraq, aged (38-75
years), each had either right or left hemispheric stroke, patients with bilateral hemispheric stroke and who
are not sufficiently clinically stable to be approached were excluded, and a control group of
neurologically healthy participant. we used the quick aphasia test for both patients and control groups,
data collected between April 2022 and February 2023.
RESULTS:
We included 40 patients, 20 had right hemispheric stroke and 20 had left hemispheric stroke, and 20
controls who were neurologically healthy. The mean age for patients was 58.2 years, aphasia was found
in 30% of right hemispheric stroke patients and 35 % of left hemispheric stroke patients. Sentence
comprehension was the most often impaired task for both left hemispheric stroke patients with mean
score 7.19(SD = 2.36) and right hemispheric stroke patients with mean score of 8.07 (SD = 1.64). the
difference in mean for word comprehension between right hemispheric stroke patients 9.58 (SD = 0.83)
and control group (10 SD 0) was statistically significant with p value (0.03). grammatical construction
was impaired more for the left hemispheric stroke patients with mean score 8.95(SD = 1.49) than the
right hemispheric stroke patients with mean score 9.41 (SD = 0.6).
CONCLUSION:
Right hemisphere is involved in language which can be affected by stroke so it is vital to be looked for,
so adaptations can be offered for those patients for a better life.

BACKGROUND:
Type 2 diabetes mellitus is a chronic metabolic disorder, characterized by poor glycemic control.
Nutritional education enhances knowledge, attitudes, and practices leading to better glycemic
control.
OBJECTIVE:
To find out the impact of nutritional education program on knowledge, attitudes and practices of
participants regarding the glycemic control in type 2 diabetes mellitus.
METHODOLOGY:
A quasi-experimental study was conducted at Baghdad medical city on 45 patients with Type 2
diabetes mellitus and recruited by non-probability convenience sampling method over three months’
duration. Patients were assessed for knowledge, attitudes and practices with structured questionnaire
that was derived from previous literatures and validated by expert panel at baseline and after
three months during which a five nutritional educational lectures were done.
RESULTS:
After three months of nutritional education there were a significant increase in the mean of
knowledge score from 18.25 to 21.63 (P<0.001), attitudes from 13.65 to 17.28 (P<0.001) and
practices from 14.15 to 20.13 (P<0.001).
CONCLUSION:
Nutritional education program is effective to enhance the knowledge, attitudes and practices toward
diabetes.

BACKGROUND:
The World health organization approximates that >50% of all medications are incorrectly prescribed,
distributed, or sold. In Iraq, several serious issues and challenges arise in this matter, including
minimal professional categorization of drug prescription, inept patient counseling, and finally high
proportion of remedies being misused.
OBJECTIVE:
This study aims to measure the performance of the primary health care centers regarding the use of
medications and if they match what is proposed by the WHO drug use indicators and their prescribing
patterns.
PATIENTS AND METHOD:
A cross sectional study was conducted on prescriptions from the 1st of January to the last of December
2019 in 20 Primary Health Care Centers in Baghdad, Iraq. A sample of 1200 prescriptions that met the
inclusion criteria were included in this study. Data collection was done by prescriptions review and
prescribing indicators were measured in a special form.
RESULTS:
Drug rate per prescription was 2.33 items, antibiotics were prescribed in 76.3% of the 1200 reviewed
prescriptions, while the percentage of injections was 8.9%, prescribing was in generic names in 24.3%
and 100% from essential drug list. The main antibiotic prescribed was amoxicillin. And injectable
diclofenac for adult age group.
CONCLUSIONS:
Prescribing indicators were below optimal (polypharmacy, antibiotics percentage and generic name)
except for encounters with injections prescribed and prescribing from essential drug list.

BACKGROUND:
Stroke is defined as "rapidly clinical symptoms of focal (or global) impairment of brain function,
lasting longer than 24 hours or leading to death, with vascular origin " according to the World Health
Organization. It has been suggested that elevated circulating D-dimer molecule is formed when
plasmin digests the fibrin clot. Values may be associated with acute ischemic stroke (AIS).
OBJECTIVE:
To estimate the level of plasma D-dimer in acute ischemic stroke patients and to study the effect of
sociodemographic data on the level of D-dimer.
METHOD:
It's a cross-sectional study of 300 participants of whom 200 were with acute ischemic stroke AIS
(patients) and the rest were disease free (control), blood samples were taken in sodium citrate tubes
from each participant, and a suitable appropriate kit was used to assess plasma levels of D-dimer after
24 hours after insult. On admission, the National Institutes of Health Stroke Scale (NIHSS) score was
assessed without regard to D-dimer levels.
RESULTS:
Age, Diabetes, hypertension, ischemic Heart disease and score of NIHSS (National Institutes of
Health Stroke Scale ) were statistically significant with D-dimer levels (p>0.05)
CONCLUSION:
Older in age, diabetic, Hypertensive, had ischemic heart disease with total anterior cerebral infarction
or sever NIHSS was positively associated with higher level of D-dimer

BACKGROUND:
patients with epilepsy need long-term anti-seizure medication; several studies found that antiseizure medication affects endocrine function, including the thyroid gland.
OBJECTIVE:
Assess the impact of Oxcarbazepine therapy on thyroid function test outcomes in epilepsy patients
on Oxcarbazepine therapy.
PATIENTS AND METHOD:
A cross-sectional study was conducted at Baghdad Teaching Hospital, including 65 patients with
epilepsy who used oxcarbazepine as a mono-antiepileptic drug. The epidemiological data include
the type of epilepsy (focal), duration of the disease, duration of treatment, dosage of treatment,
thyroid stimulating hormone (TSH), thyroxin (T4), and triiodothyronine (T3) levels were tested.
RESULTS:
The study group showed notable associations between the length and dosage of oxcarbazepine
treatment and thyroid function level.
CONCLUSION:
There is a significant difference in TSH, T3, and T4 levels in patients receiving oxcarbazepine as
monotherapy in correlation to its duration of use and to its dose; in the analysis, the correlation
observed is in duration >5 years and dosage >600mg/day.

BACKGROUND:
Gliomas are tumors deriving from glia cells and cause significant cancer mortality globally. Alphathalassemia/mental retardation syndrome X-linked (ATRX) mutations are frequently distinguished
in gliomas. There are increasing indications to study the ATRX protein immunohistochemically to
enhance knowledge about diagnosis, therapy, and prognosis.
OBJECTIVE:
To determine the association between ATRX expression and different clinicopathological
parameters in gliomas including age, sex, tumor grade and IDH status.
PATIENTS AND METHODS:
This cross-sectional retrospective study was carried out at the Department of Pathology and
Forensic Medicine, Faculty of Medicine, University of Babylon, during the period from January
2023 through December 2023. Fifty formalin-fixed and paraffin-embedded tissue blocks of patients
diagnosed as glioma have been obtained from the laboratory of histopathology in Al-Kafeel
Specialized Hospital, Karbala, for the last five years (2019–2023), and different clinicopathological
parameters have been correlated with ATRX expression.
RESULTS:
Loss of nuclear ATRX expression in tumor cells was observed in 37 cases (74%), while retained
expression was observed in 13 cases (36%). Loss of ATRX was mostly observed in the age group of
31–40 years,while retained expression was mostly observed in age group of 61–70 years, and there
was a significant association between ATRX expression and the age groups. Regarding sex, most of
cases were males (54%), and there was no significant association between ATRX expression and
sex. Concerning tumor grade, loss of ATRX expression was observed mostly (100%) in grade 2
tumors, and there was a significant association. There was a significant association between ATRX
and IDH expression.
CONCLUSIONS:
Loss of nuclear ATRX expression is associated with younger patient age and a lower grade of
glioma, and there is an association between IDH mutation (mutant type) and loss of ATRX
expression.

BACKGROUND:
The hyperdense middle cerebral artery sign (HMCAS), often linked to thrombosis of the M1
MCA segment, is the appearance of increased attenuation of the proximal middle cerebral artery
(MCA). It may be the sole diagnostic feature on computed tomography (CT) in the early stages
following an ischemic stroke.
OBJECTIVE:
To evaluate the CT density number of hyperdense MCA presented with hyperacute and acute
stroke and comparing the measurements with those of non-stroke patients with hyperdense MCA
on the baseline non-enhanced brain CT.
METHODS:
This study is a comparative cross sectional study that included two groups; group A: patients
aged ≥35 years with clinical diagnosis of hyperacute (first 6 hours) or acute (6 hours-4 days)
stroke who were referred to the CT unit and group (B): patients aged ≥35 years referred to the CT
unit for various indication with no clinical evidence of stroke who were labeled by two
radiologists as normal brain CT. The study carried out in the CT unit at Al-Imamein ALKadhimein Medical City through the period 2016-2017.
RESULTS:
This study showed that there is a statistically significant difference between the mean density of
the dense MCA at the site of stroke (48 HU) when compared to the contralateral MCA (39.7 HU)
with average difference in density value of 8.3 HU (p<0.001), the same applies when tested
against the dense MCAS in the non-stroke group (42.2 HU) with average difference of 5.8 HU
(p<0.002). However, no significant difference was found when testing the density in the nonstroke group against that of the contralateral MCAS in stroke group (p=0.2). Moreover,
significant variation was observed between the density ratio of stroke and non-stroke patients
(1.29 vs 1.02, p=0.009). A cutoff MCA density of 41.7 HU was proposed to the predict
pathological state.
CONCLUSION:
Hyperdense MCA is associated with acute ischemic stroke exhibit higher CT attenuation value
that of contralateral normal vessel or dense MCAS in healthy individuals. ACT density value of
>41.7 HU is suggested as the best limit to mark the distinction

BACKGROUND:
Proximal hypospadias with severe ventral curvature represent a challenge to surgeons, to correct
different degrees of curvature whilst reconstructing the urethra with the best possible aesthetic
outcome and least possible number of complications.
OBJECTIVE:
To compare the outcome of straightening and grafting procedure in Straightening and Closure (STAC)
vs Straightening and Graft (STAG), in proximal hypospadias repair surgery in terms of recurrent
curvature, graft take, and graft contracture.
METHODS:
Twenty-two male patients with proximal hypospadias associated with ventral curvature, undergone
staged repair with oral buccal mucosa as a graft, divided randomly into 2 groups; group A, (STAC)
repair (9 patients), and group B, (STAG) repair (13 patients), from November 2019 to November
2021. Ventral penile straightening procedure had been performed in form of urethral plate transection
and 3 ventral corporotomies. Graft inserted at the 2nd stage in STAC group after healing of
corporotomy incisions, while directly inserted over the incisions in STAG group at the 1st stage.
Patients were followed up for 6 months for assessment of graft take, graft contracture, and recurrent
curvature, which evaluated at beginning of second stage by goniometer.
RESULTS:
All patients in (STAC) repair group had straight penis with no recurrent curvature, no graft contracture
was noted, whereas in (STAG) group, (2) patients had minor ventral curvature of 15° which is
corrected at beginning of the 2nd stage, and (1) patient had partial graft contracture which was
managed by local betamethasone. The graft took successfully in all patients of both groups.
CONCLUSION:
STAC and STAG repair for proximal hypospadias achieved successful and adequate straightening of
severe ventral curvature degrees, with a slight advantage for STAC repair in terms of graft contracture
and recurrent curvature, as the graft inserted over a completely healed smooth corpora in comparison
to STAG in which graft inserted over a raw open corporotomies.

BACKGROUND:
Colorectal cancer is the most common gastrointestinal tract cancer worldwide. Cyclin D1 shows
increased expression both in advanced adenomas (Large size (> 1 cm), high dysplasia grade, and/or
villous morphology) and colorectal adenocarcinoma with loss of expression in normal cells.
OBJECTIVE:
To evaluate the immunohistochemical expression of Cyclin D1 in colorectal adenoma and compare
it to adenocarcinoma cases and to correlate it with different clinicopathological parameters.
PATIENTS AND METHOD:
This retrospective study was done on formalin fixed, paraffin embedded tissue blocks of (40) cases
(20) of which are colorectal adenomatous polyps, (20) cases are colorectal adenocarcinoma
collected from archived materials from the gastrointestinal and hepatology teaching hospital in
Baghdad medical city and Baghdad medical city teaching laboratories (covering the period from
November 2018 to March 2020).
RESULTS:
Cyclin D1 expression was lost in normal mucosa and showed variable staining, the adenoma
staining percentage was score 0 in 20%(4), score I 20%(4), score II 40%(8) and score III 20%(4) of
cases, none had score IV While the staining percentage of colorectal adenocarcinoma was score 0
10%(2), score I 35%(7), score II 35%(7), score III 5%(1) and score IV 15%(3) of cases.
The mean immunohistochemical staining score was significantly higher in distal colorectal han
proximal adenoma (p=0.045).
When adenoma cases were evaluated separately for (histopathological type, grade, size) 2 cases
(10%) had villous adenoma morphology and 9 (45%) for tubular and tubulovillous ,11 (55%)
showed high grade dysplasia and 9 (45%) showed low grade dysplasia and colorectal adenoma sizes
ranged between (0.3-2.5) cm 15 (75%) were less than 2 cm, 5 (25%) were equal to or larger than 2
cm.The mean score showed a significant difference according to histopathological type (P value
=0.11), grade of dysplasia (P value <0.001) and size (P value =0.045) in colorectal adenoma.
CONCLUSION:
There was no significant difference in the Cyclin D1 score in colorectal adenoma and
adenocarcinoma and showed a significant difference according to histopathological type, grade of
dysplasia and size in colorectal adenoma.

BACKGROUND:
Colorectal cancer is the most common gastrointestinal tract cancer worldwide. Cyclin D1 shows
increased expression both in advanced adenomas (Large size (> 1 cm), high dysplasia grade, and/or
villous morphology) and colorectal adenocarcinoma with loss of expression in normal cells.
OBJECTIVE:
To evaluate the immunohistochemical expression of Cyclin D1 in colorectal adenoma and compare
it to adenocarcinoma cases and to correlate it with different clinicopathological parameters.
PATIENTS AND METHOD:
This retrospective study was done on formalin fixed, paraffin embedded tissue blocks of (40) cases
(20) of which are colorectal adenomatous polyps, (20) cases are colorectal adenocarcinoma
collected from archived materials from the gastrointestinal and hepatology teaching hospital in
Baghdad medical city and Baghdad medical city teaching laboratories (covering the period from
November 2018 to March 2020).
RESULTS:
Cyclin D1 expression was lost in normal mucosa and showed variable staining, the adenoma
staining percentage was score 0 in 20%(4), score I 20%(4), score II 40%(8) and score III 20%(4) of
cases, none had score IV While the staining percentage of colorectal adenocarcinoma was score 0
10%(2), score I 35%(7), score II 35%(7), score III 5%(1) and score IV 15%(3) of cases.
The mean immunohistochemical staining score was significantly higher in distal colorectal han
proximal adenoma (p=0.045).
When adenoma cases were evaluated separately for (histopathological type, grade, size) 2 cases
(10%) had villous adenoma morphology and 9 (45%) for tubular and tubulovillous ,11 (55%)
showed high grade dysplasia and 9 (45%) showed low grade dysplasia and colorectal adenoma sizes
ranged between (0.3-2.5) cm 15 (75%) were less than 2 cm, 5 (25%) were equal to or larger than 2
cm.The mean score showed a significant difference according to histopathological type (P value
=0.11), grade of dysplasia (P value <0.001) and size (P value =0.045) in colorectal adenoma.
CONCLUSION:
There was no significant difference in the Cyclin D1 score in colorectal adenoma and
adenocarcinoma and showed a significant difference according to histopathological type, grade of
dysplasia and size in colorectal adenoma.