Iraqi Postgraduate Medical Journal

BACKGROUND:
More dependence on real-time three dimensional echocardiography, is in practice in the assessment of LV
systolic function in coronary and valvular heart disease.
OBJECTIVE:
To investigate the accuracy of linear M-MODE and volumetric (BIPLANE and TRIPLANE)
echocardiographic method versus the REAL-TIME 3DE in assessment of regional and global LV systolic
function (depending on the high agreement of RT -3DE with CMR which is the gold standard in
assessment of LV systolic function) and to start orientation to this issue in our centers.
PATIENTS AND METHOD:
This study included 60 patients with coronary heart disease and valvular heart disease who were
admitted in Iraqi center for cardiac disease, for whom the LV systolic function is assessed by EF% by
using 3 methods which are M-mode, biplane, triplane methods and compare it with RT-3D
echocardiography.
RESULTS:
There is a significant difference between RT-3D echocardiography and old measures, (M-mode ,
sensitivity and specificity was 74.3% , 95.2% respectively) and that of (Biplane was 97.4%, 95.2%
respectively ), while there is no significant difference with triplane method in the assessment of LV
systolic dysfunction by EF% in coronary and valvular heart disease as it was (97.4% , 100% respectively)
CONCLUSION:
Real-time three dimensional echocardiography provides more valuable and accurate clinical information
that empowers echocardiographers with new levels of confidence in the diagnosis of LV systolic
dysfunction in coronary and valvular cardiac disease.

BACKGROUND:
Inter-pregnancy interval is defined as the time in completed months from the reported date of live
birth of the previous child to the self-reported last normal menstrual period.
OBJECTIVE:
To assess the duration of inter-pregnancy interval, and to assess the possible predictors associated
with the duration of inter-pregnancy interval.
PARTICIPANTS & METHODS:
A cross-sectional study was carried out during the period from 1st March to 1st August 2023. A
convenient sample of pregnant women in the reproductive age group (15-49 years) who attended
PHCCS in Al-Shaab sector, Baghdad-Alrusafa Health Directorate. Data was collected by direct
interviews with the target population, the researcher filled out a structured questionnaire that was
adapted from a previous study.
RESULTS:
For the 364 study participants (50.5%) were with optimal interpregnancy interval, (41.2) were with
short interpregnancy interval. Significant predictors of optimal interpregnancy interval were age at
marriage of 20-29 years, middle socioeconomic class, planned pregnancy, contraceptive use, having
2-4 child, good knowledge and encouraging husband about optimal birth spacing.
CONCLUSION:
The predictors of short interpregnancy intervals include marriage at age of 30 years or more, a low
socioeconomic index, unplanned pregnancy, having only one live child, not using contraceptive
method and poor knowledge about optimal interpregnancy interval

BACKGROUND:
Diabetic retinopathy is a common and serious complication of diabetes that can lead to vision loss or
even blindness if not detected and treated early. However, some people may not have any symptoms
until the condition is advanced. Therefore, regular eye exams with dilated pupils are recommended for
people with diabetes to check for signs of diabetic retinopathy and other eye problems regardless of
the symptoms.
OBJECTIVE:
To measure patients’ awareness and practices regarding diabetic retinopathy, to detect the barriers for
eye screening and receiving eye check-up, and to find if there is any association between level of
awareness with sociodemographic and diabetic variables.
PATIENTS AND MMETHODS:
A cross -sectional study was carried out at the Internal Medicine Outpatient Clinic in Baghdad
Teaching Hospital/Medical City Complex, Iraq, from 1st February 2023 to the 30th of July 2023,
among patients with type 2 diabetes mellitus, interview questionnaire was used to measure the
awareness of diabetic retinopathy and practices of periodic eye examination, this questionnaire was
adapted from previous study.
RESULTS:
The overall awareness of participants regarding diabetic retinopathy was good among 249 (61.6%).
There were 336 (83.2%) participants who didn’t practice regular eye examination. The biggest
barriers of not getting regular eye examination was cost 120 (35.7%), there is significant association
between high socioeconomic state, family history of diabetes, long duration of diabetes, type of
treatment for diabetes with good level of awareness, there is significant association between age ,
socioeconomic state with practice of periodic eye examination.
CONCLUSION:
Despite that the overall awareness of diabetic retinopathy is considered good, the practice of regular
eye examination is poor. The biggest barriers for not having periodic eye examination were cost.

BACKGROUND:
Septoplasty is a surgical correction of the deviated nasal septum; it is one of the most common
Otorhinolaryngology operations in adults. Currently the main indication to perform septoplasty is nasal
obstruction. Nasal Obstruction Symptom Evaluation Scale is a tool for assessing nasal obstruction.
OBJECTIVE:
The purpose of this study is to evaluate and compare the outcome of Septoplasty regarding nasal
obstruction, improvement associated headache and Eustachian Tube functions by tympanometry.
Study design: it is a prospective comparative study.
PATIENTS AND METHODS:
This prospective study was done from February 2021 to December 2021 at otorhinolaryngology department in
Rizgary Teaching Hospital in Erbil City/Iraq on Overall (60) patients, (23) of them were female and (37)
were male, their age ranged between (18) and (50) years old, patient undergoing septoplasty because of
Deviated Nasal Septum were included. All participants were informed about the study, and written
informed consents were obtained, Nasal Obstruction Symptom Evaluation Scale was used to evaluate
surgical satisfaction. The preoperative headache intensity was recorded based on Visual Analogue Scale,
Middle ear pressure and Eustachian Tube functions of total (120) ears were assessed by tympanometry
and Functioning divided into those at side of septal deviation and ears to the opposite side of deviation.
The tests were performed the day before Surgery and eight weeks after surgery.
RESULTS:
Regarding Nasal Obstruction Symptom Evaluation Scale decreased after septoplasty (11.48/4.5)(P <
0.05).Comparing the outcome of associated headache, pain Visual Analogue Scale revealed a mean
value of (5.1) preoperatively ; and (3.4) postoperatively, the difference of scores was significant (p <
0.05), There were (27) functional Eustachian Tube (40.9%) in the side of septal deviation preoperatively,
which increased to (46) ears (49.49%) postoperatively)(P < 0.05), while in the contralateral side
increased to (47) (50.53%) from (39) (59.1%) after surgery.
CONCLUSION:
Outcome of septoplasty has a satisfactory result in most of the cases on improvement both nasal
obstruction and associated headache, and this study represents that there is a relation between
septoplasty and Eustachian Tube function.

BACKGROUND:
Breast cancer is the most common woman cancer. Accurate diagnosis of metastatic axillary lymph
node (ALN) have an important role because it controls the clinical therapeutic schedule and
influence overall disease prognosis.
The development of MRI including DWI\ADC sequences improve the detection of axillary lymph
nodes metastasis using the Brownian phenomena this represents an important non-invasive method
with no need for contrast media.
OBJECTIVE:
To evaluate the role of the apparent diffusion coefficient in the differentiation between metastatic
and benign non metastatic axillary lymph nodes.
PATIENTS AND METHODS:
A prospective cohort study was conducted at Oncology teaching hospital in Medical city teaching
compass during a period of 10 months between January 2022 until November 2022.
Our study includes 58 women. MRI was performed using a 1.5 Tesla MRI using a dedicated
bilateral sixteen channel breast coils. The mean ADC value were measured for axillary lymph nodes
and results were compared with histopathological findings.
The optimal ADC cut off values were evaluated using receiver coefficient characteristic (ROC)
curves.
RESULTS:
The histopathological examination reveals that 37.9% of examined lymph nodes were metastatic
and 62.1% was non-metastatic.
The ADC value of the metastatic ALN was significantly lower than that of the non-metastatic ALN
(0.78 x10–3 mm2/s vs 2.39 x10–3 mm2/s, P= 0.009).
The optimal cut-off ADC value for the discrimination between metastatic and non-metastatic lymphnodes was 0.97x10–3mm2/s with sensitivity and specificity of 95.5% and 100% respectively, and
accuracy of 98.3%. Positive predictive value and negative predictive value of ADC were 100% and
97.3% respectively.
CONCLUSION:
The ADC value obtain important role in prediction of axillary lymph nodes metastasis with a
diagnostic accuracy of 98.3% in this study

BACKGROUND:
Prostate cancer (PC) is the second most frequent malignancy in men beyond lung cancer. Modern
radiation therapy techniques employ over 3D conformal radiotherapy has been widely used now a
day.
OBJECTIVE:
The study aimed to compare between hypofractionated radiotherapy with conventional
radiotherapy in prostate cancer using VMAT technique and to investigate the dose delivered to
organs at risk in prostate cancer treated with conventional and hypofractionated VMAT
techniques.
PATIENTS AND METHOD:
A prospective clinical and dosimetric study in radiotherapy, medical physics, and dosimetry.
Forty patients diagnosed with proven PC will be treat with the VMAT technique. Two prescribed
dose methods used for each patient, the first method is the conventional fractionation as VMATSEQ with a prescribed dose of 78 Gy delivered in 39 sessions (2 Gy per session), and the second
method is the hypofractionated dose as VMAT-SIB with a prescribed dose of 60 Gy in 20
sessions (3 Gy per session).
RESULTS:
Forty patients with PC, the mean age (±SD) was 60.45 years (±8.77). The mean dose of rectum in
sequential group was greater than SIB group with no significant difference (p=0.055). Regarding
doses distribution at V80, V60 of rectum, the mean of sequential group was much lower than SIB
group with a high significant difference (p<0.0001), while at V40 of rectum, the mean of
sequential group was greater than SIB group with a high significant difference (p<0.0001).
Regarding dose distribution at V45 of bowel, the mean of sequential group was greater than SIB
group with a high significant difference (p<0.0001).
CONCLUSION:
The SIB deliver lower doses to rectum, bladder, head of femurs, bowel and penile bulb than
sequential planning. Hypofractionated achieve better PTV coverage, improved the dosimetry and
decline the dose delivery time for targets. SIB Hypofractionated RT produce better coverage to
the targets and better protection of OARs.

BACKGROUND:
Beyond pulmonary infection, SARS-CoV can cause dysfunction of multiple organs and systems. Cardiovascular complications after COVID-19 have now been reported very often but the knowledge of neurovascular complications especially Intracerebral Hemorrhage (ICH) is undetermined. Overall it is well-documented complication of COVID-19.
OBJECTIVE:
To describe the natural history of acute Intracranial Hemorrhage (ICH) in COVID-19 patients.
PATIENTS AND METHODS:
A case series study was performed at Al-Imamain Al-Kadhimain medical city and Saad Alwitry Hospital for Neuroscience in 2021.
RESULTS:
Twenty patients with ICH were included in this study, 12 (60%) participants were males while females were 8 (40%) participants with mean age of 54.38±10.51 years; 10 (50%) patients had high systolic and diastolic blood pressure on presentation with preexisted hypertension and /or diabetes. The most prevalent comorbidities were Hypertension and Diabetes mellitus. The maximum duration between initial infection and presentation of ICH was 30 days in both males and females ranging between 5 and 30 days. Regarding the site of involvement (50%) of patients presented with cerebral hemisphere (deep-seated) involvement on CT scan and 3 (15%) of deep-seated developed intraventricular extension and 3 (15%) had lobar presentation. Cerebellar, brainstem, and SAH were the least site of presentation with 10%, 5%, and 5%, respectively. According to lab investigation, 13 out of 20 patients (70%) in the present series had positive PCR with variable IgM and IgG results, but almost all of them had abnormal D-dimer, CRP, and S. ferritin with mean 1208, 27, 453 respectively. Almost all of the patients had normal Hb and platelet levels, with a mean of abnormal neutrophil (77) 109/L, and (16) 109/L lymphocyte count.
CONCLUSION:
This study provides evidence of ICH in the middle-aged patients demographic, a deep-seated predominance, and a marked systemic inflammatory prodrome. SARS-Covid-19 increases the preexistence risk such as HTN, DM, and the ICH cannot be attributed solely to COVID-19 itself.

BACKGROUND:
Uterine corpus tumour is one of the most prevalent gynecological malignancies. 75% of women are
postmenopausal at time of diagnosis. Thus, Postmenopausal bleeding is the most common symptom,
COX2, also known as prostaglandin H synthase, catalyzes the formation of prostaglandin from
arachidonic acid, identified as a potential indicator of the neoplastic transformation of normal cells
into tumours cell.
OBJECTIVE:
To evaluate the Cyclooxygenase-2(COX2) immunohistochemical expression in endometrial
carcinoma and endometrial hyperplasia with and without atypia and its correlation with
clinicopathological parameters.
METHOD:
Cross sectional study carried out in the Department of Pathology, Babylon Center during the
period from December 2022 through December 2023 including (70) cases: (36) endometrial
biopsy (34) hysterectomy specimens; patients age ranges from 31 to77 years. (20) cases as
endometrial hyperplasia without atypia; (20) cases as atypical endometrial hyperplasia; (30) cases
of endometrial carcinoma. Two sections of 5μm thickness were taken from each block, the first
was stained with (H&E) stain for histopathological revision, the other section was stained for
COX2 (IHC) antigen expression .
RESULTS:
Higher COX2 expression with strong cytoplasmic and membranous staining was found in
endometrial carcinoma than endometrial hyperplasia which mostly show weak to negative staining,
this expression increase with advanced stage and grade of endometrial carcinoma which mean that
COX2 have a role in tumour progression from hyperplasia to carcinoma.
CONCLUSION:
●COX2 immunohistochemical expression increased in endometrial carcinoma, associated closely
with parameters of tumour aggressiveness such as advanced tumour stage and grade, this makes
the possibility of the use of COX2 inhibitors as adjunct endometrial carcinoma treatment and to
decrease recurrence after treatment, also the possibility for it use in prevention of endometrial
carcinoma in high risk groups.
●Endometrial carcinoma with strong positivity for COX-2 expression have a poor prognostic
significance.

BACKGROUND:
Sudden death is a significant global public health concern affecting individuals under 40.
Understanding sudden death dynamics is crucial for addressing health and legal implications.
Exploring epidemiology, causes, and risk factors is essential for implementing preventive measures,
healthcare policies, and forensic practices.
OBJECTIVE:
To identify the causes of sudden death among individuals under 40 in Baghdad. Also, to assess the
impact of lifestyle and family history contributions and examine the patterns of age, sex, and gender
in sudden death cases within this particular demographic group.
PATIENTS AND METHODS:
A cross-sectional study was conducted on 69 medico-legal cases involving individuals under the age
of 40 in Baghdad from January 1st to June 30th 2023. Collected data included demographics, cause
of death, social history, family history, chronic illnesses, and consanguinity. Postmortem
examinations and further investigations were conducted, and statistical analysis included
percentages, ratios, Chi-square tests, and t-tests.
RESULTS:
A significant percentage of sudden deaths occurred in individuals aged between 31 and 39.
Myocardial infarction and bronchopneumonia were the primary reasons for sudden death.
Cardiovascular-related causes were predominant. The majority of cases had no history of smoking
exposure, and 24.6% had parents who were consanguineous. The incidence of younger age
mortality was linked to a positive family history.
CONCLUSION:
Myocardial infarction and bronchopneumonia were the most common causes of sudden death.
There is a complex relationship between smoking and sudden death. A significant association exists
between a positive family history and younger age of death.

BACKGROUND:
Baltzer et al. introduced the Kaiser score to aid the interpretation of enhancing breast MRI lesions, the
score ranges from 1 to 11, reflecting an increased probabilities of malignancy.
OBJECTIVE:
To investigate whether the application of the Kaiser score, can improve the diagnostic performance in
contrast enhancing lesions classified as BI-RADS4-5 on breast MRI.
PATIENTS AND METHODS:
Prospectively Data collected at oncology teaching hospital in medical city teaching complex in
Baghdad, the study included 60 female patients with breast lesions classified as BI-RADS4-5 on DCEMRI. The diagnostic efficacy of Kaiser score was evaluated according to the pathological results.
RESULTS:
The study included 60 females with 69 suspicious breast lesions categorized as BI-RADS 4-5 lesions on
DCE-MRI, 45 lesions were malignant, 24 were benign, the results regarding the diagnostic performance
of the Kaiser score, showed that it has high accuracy with AUC= 94.1%, high sensitivity of 92.3%, high
specificity of 86.7%, and it was 88.4% accurate in diagnosis of breast malignancy.
CONCLUSION:
This study provides evidence that the Kaiser score can be used in improving the diagnostic performance
of dynamic enhanced breast MRI in BI-RADS 4-5 lesions.

BACKGROUND:
Genu valgum is a deformity resulting from the separation of ankles when the medial faces of the knees are in
contact while the patella and the hallux turn to the anterior direction.
OBJECTIVE:
To evaluate the features of genu valgum and the associated sociodemographic factors in children and
assess the association between these factors and the type of the genu valgum.
PATIENTS AND METHODS:
A cross-sectional study was conducted at Sader Al-Qanat Center for Prosthetics and Orthotics, a
tertiary referral center in Baghdad/Iraq during the period from January to December 2022. A
convenient sampling method was adopted to enrol 60 patients aged 2-14 years with genu valgum who
attained the Sader Al-Qanat Orthoses and Prostheses Center.
RESULTS:
More than half of the patients 31 (51.7%) were male. About 42 (70%) of the patients were at the age of
≤6 years. Regarding body mass index, 41.7% of the patients had normal weight, 36.7% had overweight,
and 21.6% of them were obese. Most patients were walking at the age of <18 months (83.3%). About
76.7% of the patients presented with the disease at the age of < 6 years. Family history was presented in
11.7%. Most patients did not have pes planus (93.3%), presented with symmetrical deformity (95.0%)
and had an intermalleolar distance of < 8 cm (90%), Genu valgum was physiological in 91.7% of the
patients.
CONCLUSION:
Male patients, patients with an age of < 6 years, obese or overweight, and those without family history
constituted more than half of the sample. The genu valgum was symmetrical and physiological in most
patients. Most patients had an intermalleolar distance of < 8 cm. There was a significant association
between the genu valgum and overweight or obesity and age at walking.

BACKGROUND :
There is increasing interest regarding the health implications of Ramadan fasting in the recent years.
Many reports indicate that fasting during the holy month of Ramadan results in reduced body weight
and improved metabolic parameters like lipid profile in healthy individuals.
OBJECTIVE:
To study the effect of fasting during the holy month of Ramadan on serum lipid profile and body mass
index in healthy adult volunteers.
PATIENTS AND METHODS:
prospective cohort study was done including a total of 50 healthy volunteers. Venous blood samples
were taken from volunteer, 1week before Ramadan, and, on the 28th day of Ramadan. Lipid profile
(total cholesterol, triglyceride and HDL-C) were measured using automated clinical chemistry analyzer
and (LDL-C, VLDL-C and atherogenic index) were calculated mathematically. Body mass index was
also measured for each participant.
RESULTS:
Participants showed no significant difference in mean of BMI , P= 0.11. A significant reduction in the
mean of total cholesterol (P=0.01), triglyceride (P=0.001), VLDL-C (P=0.001) and atherogenic index
(P=0.001) were observed. A significant increase in HDL-C level at the end of Ramadan (P=0.001) was
noted. No significant difference in mean of LDL-C (P=0.13).
CONCLUSION:
Fasting Ramadan may have beneficial health effects in the levels of lipid profile

BACKGROUND:
Discriminating a pathological from osteoporotic vertebral compression fractures is sometimes
challenging.
OBJECTIVE:
To create scoring system using several MRI signs, trying to correctly differentiate osteoporotic from
malignant compression vertebral fractures.
PATIENTS AND METHODS:
A cross sectional study was performed in MRI unit of Al-Imamain Al-Kadhemain Medical City/
Baghdad/Iraq, 68 patients (24 males and 44 females) were included, all patients were presenting with
acute back pain and x-ray evidence of compression fracture of vertebral body. MRI was done within 2
months from onset of symptoms and follow up for at least 4-6 weeks. A total of 9 MRI signs were
evaluated in terms of sensitivity, specificity and accuracy in diagnosis of malignant fractures. A
stepwise analysis of these signs was used to create a scoring system to differentiate malignant from
osteoporotic vertebral compression fractures.
RESULTS:
Malignant vertebral fracture was diagnosed in 13 patients and osteoporotic vertebral fracture was found
in 55 patients. All used MRI signs had a variable specificity and sensitivity for diagnosis of malignant
fractures but all are statistically significant except one. Mean score for patients with malignant vertebral
fractures was 3.5 (range of 3-6), while Mean score in patients with osteoporotic vertebral fractures was
2.1 (range of 0-4). The optimum score cutoff value was 4 with 61.5% sensitivity, 81.8% specificity,
79.4% accuracy and statistically significant (P-value=0.012) for the discrimination of malignant from
osteoporotic vertebral compression fractures.
CONCLUSION:
Convex posterior vertebral border, asymmetrical diffuse or rounded abnormal bone marrow signal,
involvement of the pedicle, and paravertebral soft tissue mass are highly suggestive MRI sign of
malignant fracture. Post contrast enhancement is not a specific sign. Fluid cleft sign is suggestive of
osteoporotic fracture. This simple scoring system could be useful tool for the differentiation of
malignant and osteoporotic vertebral fractures with the best accurate cutoff value is 4.

Breast feeding (BF) provides infants with the most
suitable nutrients from birth tell weaning. The
major part of mother breast milk (MBM) is water
in which the other components dissolve. These
components include nutrients and immune factors.
The concentration of these components varies by
time after delivery. Breast milk even provides
infants with various types of bacterial species that
contribute for development of infant microbiota.
Components that are regarded important for
shaping of infant immune response include
different factors. MBM contains oligosaccharides
which are associated with guts defenses, cytokines
that participate in inflammation and immune cells
activation, immunoglobulins that arm infant’s
intestinal mucosa with defense lines against
microbial infections. Extracellular micro vesicles
(EV) are microparticles with phospholipid bilayer
secreted by maternal cells. These particles are
highly found inside human milk and they regulate
intracellular signaling, inflammation and immune
response. Lactoferrin are protein molecules found
in human breast milk and play a great role in
immune modulation and interaction with different
types of microorganisms.
Childs who are breast fed have less incidence of
being a victim of auto immune diseases as multiple
sclerosis, rheumatoid arthritis or diabetes type.
Breast milk has an important effect in protection of
infants against several types of bacterial, viral,
fungal and parasitic pathogens. MBM stays the
most suitable food to infants in spite of the
progress of infant’s formula industry.

BACKGROUND:
Laparoscopic cholecystectomy is relatively a simple and quick procedure, but it can be difficult,
takes longer time, and needs special instruments and an experienced surgeon. However,
identifying the preoperative patient-related factors, and anticipating the need to convert from
laparoscopic cholecystectomy to open surgery can help identifying high-risk patients and redefine
the surgical strategy needed.
OBJECTIVE:
To Assess laparoscopic cholecystectomies through identifying the preoperative factors that predict
the difficulty of laparoscopic cholecystectomy.
PATIENTS AND METHODS:
A cross-sectional study conducted on patients preparing for laparoscopic cholecystectomy in
during 2023.
RESULTS:
The study involved 221 patients with mean age was 41.3±12.3 years, 51(45.5%) were overweight.
The average time needed for laparoscopic cholecystectomy was 58.9±10.0 minutes. The average
time needed for port installation (porting time) was 8.5± 2.1 minutes. Difficult procedure was
reported in 100 (89.3%), of them 99 (88.4%) patients were classified as having moderate
difficulty, and only one case was considered as very difficult and was converted to open
procedure. The current study showed a significant association between the difficulty level of
laparoscopic cholecystectomy and older age, sex, and high BMI.
CONCLUSION:
Difficult laparoscopic cholecystectomy is common though the conversion rate is low, the current
study presented a significant association between the difficulty level of laparoscopic
cholecystectomy with older age, sex, and high BMI.

BACKGROUND:
Hypothyroidism is a syndrome resulting from deficiency of thyroid hormones leading to general
slowdown of many metabolic processes
OBJECTIVE:
This study was designed for investigating the occurrence of type 2 diabetes mellitus among sample of
patients with hypothyroidism, as well as investigate the relationship between fasting serum glucose
and glycated hemoglobin levels with thyroid stimulating hormone, free triiodothyronine and free
thyroxine
PATIENTS AND METHODS:
This is a comparative cross section study include 80 subjects was taken, 40 of them as patients
diagnosed with clinical hypothyroidism who are on treatment. The remaining 40 apparently healthy
individuals who served as a control group. The diagnosis of clinical hypothyroidism was depending
on serum thyroid stimulating hormone level of more than 4.2 Ulu /ml with low levels of free
thyroxine and free tri-iodothyronine.
RESULTS:
The mean values for the TSH levels of patients group (4.10 ± 3.25 µIU/ml) which was significantly
higher than values of controls (1.74 ± 1.14, p µIU/ml < 0.001). Also, mean values for fasting serum
glucose (103.68 ± 21.06 mg/dl, p < 0.001) and HbA1c (6.27 ± 1.18 %, p < 0.001) of hypothyroidism
patients were significantly increased in comparison to these of control (86.23 ± 9.32 mg/dl, 5.28 ±
0.35 %, respectively).
CONCLUSION:
Overt hypothyroidism is related with an increased risk of type 2 diabetes mellitus and measurement
of glucose indices needed to be included in hypothyroid investigations. Progression the prediabetes to
diabetes seems more prominent in presence of uncontrolled hypothyroidism.

BACKGROUND:
In the last decade, the incidence of renal cell carcinoma (RCC) has been rising, with the greatest
increase observed for solid tumors. Magnetic resonance imaging (MRI) protocols and algorithms have
recently been available for classifying RCC subtypes and benign subtypes.
OBJECTIVE:
To assess the role of multi-parametric magnetic resonance imaging (mpMRI) in differentiation of
different types of solid renal masses.
PATIENTS AND METHODS:
This is a cross-sectional study performed in Al- Imamian Al- Kadhmain medical city and was conducted
on 41 patients having renal masses previously diagnosed with ultrasound and/or computed tomography,
referred to the radiology department. All patients were subjected to full history taking, radiological
examination inform of mpMRI of the upper abdomen and histopathological correlation of surgical
specimens.
RESULTS:
Malignant solid renal mass lesion is commoner than benign masses. Lesions that shows low signal
intensity on T2WI (lipid poor AML and papillary RCC), high to intermediate T2WI seen in other types
of solid renal masses, in phase opposed phase T1WI was very helpful in identifying the fat content of
different types of solid renal masses in which macroscopic fat content seen as India ink artefact on
opposed phase and only seen a lipid rich AML, microscopic fat content was seen in some of the clear
cell RCC and all lipid poor AML. The mean ADC value of malignant lesions was very helpful in this
study it was significantly lower than that of benign lesions of about 1.5 *10 -3 mm2/sec. for malignant solid
renal masses and 2.03 *10 -3 mm2/sec for benign solid renal masses. Dynamic contrast MRI showed three
types of curves: progressive, plateau and washout dynamic curves, progressive type dynamic curve seen
only in papillary RCC, washout type dynamic curve seen in clear cell RCC, oncocytoma, chromophobe
RCC and AML, plateau type dynamic curve seen in both clear cell RCC and chromophobe type RCC.
CONCLUSION:
Multiparametric MR imaging as a noninvasive imaging method provides critical information that can
help in differentiation of the most common solid renal masses, T2WI play an important role in
differentiation between different types of solid renal masses and narrow the differential diagnosis,
macroscopic fat content seen as India ink artefact on opposed phase and seen in lipid rich AML, DWI
play vital role in differentiation between benign and malignant renal masses, in which malignant solid
renal masses show diffusion restriction, while benign masses show no restriction ,DCE MRI play no
significant role in differentiation BETWEEN SOLID RENAL MASSES.

BACKGROUND:
Vitiligo is chronic autoimmune disease characterized by pale white patches developing on the skin
caused by lack of melanin pigment which produced by melanocytes. Most common autoimmune disease
association with vitiligo is autoimmune thyroid disease that characterized by presence of autoantibody
(anti-thyroperoxidase, anti-thyroglobulin) in serum of vitiligo patients.
OBJECTIVE:
Detection of serum anti-thyroperoxidase and anti-thyroglobulin antibodies in patients with nonsegmental vitiligo.
PATIENTS AND METHODS:
Serum level of Anti-thyroperoxidase and anti-thyroglobulin antibodies were assessed in 50 non
segmental vitiligo patients in the dermatology Consultation Clinic of IMAM ALSADIQ Teaching
Hospital / Babil Health Directorate compare with 30 apparently healthy control, their age and sex
matched to the patients’ group, number of males in this study was 46 (57.5%) and female were 34
(42.5%)., using enzyme linked immunosorbent assay (ELISA) technique in the medical city\teaching
laboratories\immunity unit.
RESULTS:
A significant association is found between positive anti –thyroperoxidase antibody and vitiligo patients
p value 0.036, the rate of anti-TPO positive in males (80 %) more than females (20%) p value=0.058
and no significant association between positive anti – thyroglobulin antibody and vitiligo patients p
value 0.0596. Both antibodies were elevated in same patient.
CONCLUSION:
Both antibodies could be used as screening test to autoimmune thyroid diseases in vitiligo patients.