Iraqi Postgraduate Medical Journal

BACKGROUND:
Infantile hemangioma, although often small after birth, it tends to follow a proliferative phase in which the growth may be rapid and unpredictable. Besides, its involution often takes many years to happen causing psychological problems and embarrassment to the parents as well as their child.
OBJECTIVE:
To evaluate the efficacy of intralesional bleomycin in the management of infantile cutaneous hemangiomas and to assess the possible side effects and complications of this treatment modality.
PATIENTS AND METHODS:
A prospective study done in Iraq over the period from October 2014 to December 2015, were 28 patients with cutaneous infantile hemangiomas had been treated by intralesional bleomycin injection, 0.25-0.5 unit/kg/dose, administered subcutaneously. The enrolled patients were divided depending on lesion size at time of presentation into two groups; those with hemangiomas less than 12 cm2 and others with lesions greater than 12 cm2. The lesions were measured serially and monitored with photos for follow up and documentation. Side effects were also recorded. Lesion’s response was graded into five grades according to the final size after treatment.
RESULTS:
The mean age of the studied patients was 13.5±11.2 months (3 months to 4 years). The mean number of injections given was 3.7±0.7(3 to 5), and the mean total dose administered was 3.8±1.5 units/patient(2.5 to 9). Complete involution (>90% reduction in the size of the hemangioma) was recorded in 9(32.1%) children. Twelve (42.9%) children were reported to achieve 75-90% reduction in the size of the hemangioma. In 6(21.4%) children, there was a 50-75% reduction in the size of the lesion, and only 1 patient had <25% reduction in the size of the lesion. The mean follow up period was 5.8±2.1 months (3 to 10 months).Hyperpigmentation was the most common complication and was reported in 11(42.3%)patients.
CONCLUSION:
Intralesional bleomycin is an effective option in the treatment of cutaneous infantile hemangioma
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BACK GROUND:
Breastfeeding is of great benefits to the baby and mother in so many ways. Breastfeeding has been found to provide a measure of protection against the attacks of ear infections, upper respiratory infections, and gastrointestinal disorders. Breastfeeding has an emotional benefit by initiation of bonding between mother and baby .Knowledge of when and why women discontinue breastfeeding is of great important when make a plan aimed at increasing both the initiation and duration of breastfeeding.
OBJECTIVE :
This study was conducted to, 1. detect Patterns of breastfeeding practice during the first 6 months of life, 2.identify the age at when bottle feeding started, and 3.to verify the causes to start bottle feeding .
METHODS:
Parents of 1000 infants seen during a routine visit at the Breastfeeding consultation Clinic (BCC), in the outpatient department in Fatema Al Zahra hospital were interviewed by the researchers from 1st of July 2016 to 30th of June 2017 . The mothers were asked about , the mother's age ,job, and education, infant`s age, Sex, birth order, type of feeding, when to start formula, and why. Inclusion criteria were: women, between 16-40 years who came with their infants for vaccination, and had delivered during the last 12 months.
RESULTS:
It was observed that breast feeding was maintained at a high level (more than 64.6%) throughout infancy while exclusive breast feeding showed a rapid decline. The rate of exclusive breast feeding at 6th month was 28.3%. The birth order of the infant, and mother`s age, job, and education were important factors determining exclusive breast feeding rate.
The most common causes for adding bottle feeding were, milk insufficiency in 25.2 % of cases, Mother`s pregnancy in 19.9 %, and Infant`s crying after feeding in 14.2%.
The advice of starting bottle feeding were recommended by family in 18.9% of cases , by Pediatrician in 29.1 %, by Gynecologist in 3.2 % of cases , and in 48.6 % of cases the mothers start bottle feeding by her opinion.
CONCLUION:
Breast feeding as such was maintained at a high level for the first 12 months of life while the practice of exclusive breast feeding(EBF) was much lower . Mother's age, job, and education have an impacts on exclusive breastfeeding rate. Medical personnel and family have great role in continuation of EBF and breastfeeding.
The most common causes for adding bottle feeding, were, milk insufficiency , Mother`s pregnancy and infant`s crying after feeding.
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BACKGROUND:
Endotracheal intubation is an important step in airway control in pediatric age group, the drugs used for this purpose are ultra-short acting hypnotic agents plus neuromuscular blocking agents (NMBA). NMBA have many serious side effects.
OBJECTIVE :
To evaluate endotracheal intubation without using NMBA, and assess the intubation conditions and hemodynamic response to this method of intubation in pediatric age group
PATIENTS AND METHOD:
This is a prospective randomized double blind study done in Rizgary teaching general hospital from 1/ October to 1/ December 2012 included 60 patients age 4-8 years,American society of anesthesiologist (ASA) I or II.
Patients were allotted to one of these two groups randomly 30 patients per each group. Group (F): those patients that receive Fentanyl 4 μg/kg I.V +Propofol 3 mg/kg I.V. Group (S): those patients that receivePropofol 3 mg/kg +suxamethonium 1 mg/kg I.V. Intubation conditions and hemodynamic changes have been measured and compared between both groups.
RESULTS:
In group F acceptable intubation conditions were obtained in 27 (89%) patients.whileFair intubation conditions occurred in only 3 (11%) patients. In group S acceptable intubation conditionsoccurred in 30 (100%) of patients.In S group there was a significant rise in systolic arterial pressure(SAP) and heart rate (HR) in 0, 1, 3 minute after intubation (P<0.001).
In F group there was significant decrease in SAP (P<0.001) in post induction reading. In F group there was non-significant decrease in HR in post intubation time 1, 3 minutes (P>0.05).
CONCLUSION:
Endotracheal intubation can be accomplished in pediatric age group using Fentanyl and Propofol without the need to use muscle relaxant with acceptable hemodynamic response.
KEY WORDS: endotracheal intubation, fentanyl, Propofol, suxamethonium.

BACKGROUND:
Rotavirus is the most common cause of acute gastroenteritis in children.
OBJECTIVE :
To find out the efficasy of rotavirus vaccine in prevention or reduce the number of cases and hospital admission of gastroenteritis among children under two years of age.
PATIENTS AND METHODS:
A cross-sectional study was conducted in Central Teaching Hospital of Pediatric in Baghdad,from the first of February to 31st of May 2016,on a total of(524) child under two years of age, grouped into two groups,first group(260)vaccinated with rotavirus vaccine,second group(264)non-vaccinated.
RESULTS:
According to development of gastroenteritis and vaccination state of rotavirus vaccine,the acute gastroenteritis in non-vaccinated group was more compared with vaccinated group,192out of264(72.8 %)and128 out of 260(49.2%) respectively,and this association statistically significant.The number of cases that is admitted to hospital is48(37.5%)in vaccinated group with acute gastroenteritis which is significantly lower as compared to148(77.1%)in non-vaccinated group with acute gastroenteritis.This study showed that males and females were found to be equally affected of gastroenteritis.
CONCLUSION:
Rotavirus vaccine have reduced the number of cases and hospital admission of gastroenteritis among children under two years of age in Central Teaching Hospital of Pediatric in Baghdad.

BACKGROUND:
Although the cause of recurrent pregnancy loss is unknown in the majority of cases; advanced maternal age, chromosomal abnormalities, uterine abnormalities and infections could all be potential causes of miscarriage. Miscarriage is a common problem and could affect the women’s psychological wellbeing in the short term and possibly in the long term.
OBJECTIVE:
To describe the awareness of women age (15-45) years old regarding beliefs and emotional impact of miscarriage.
SUBJECTS AND METHOD:
A descriptive cross-sectional study was carried out on the total of 393 women with age from 15-45 years old attending gynecology, obstetrics and family planning departments in Baghdad Teaching Hospital in Baghdad/Iraq during the period from 14th of January 2016 to 15th of April 2016.
RESULTS:
393 women have been or still pregnant, 171 of those 393 women had a history of miscarriage; giving the prevalence of (43.5%) for women reporting a history of miscarriage. The prevalence of miscarriage in women age 40-45 years old was (38.0%). In this study (63.7%) of women satisfied about the medical care they received after abortion. The beliefs of the respondent about the causes of miscarriage showed that a large number agreed that sexual intercourse during pregnancy (36.4%) and past use of oral contraception (33%) may all be causes for miscarriage, (81%) believed that stressful event was a cause of miscarriage, (58%) knew that pregnancy loss was the result of genetic abnormalities, (46.4%) believed that having had a sexually transmitted disease in the past was the cause of miscarriage, and (68.4%) of women who had experienced a miscarriage reported that they would find a miscarriage to be extremely upsetting, equivalent to the loss of a child.
CONCLUSION:
There are some misperceptions about the factors associated with miscarriage. Many women had emotional distress after miscarriage which was perceived as a loss of a child.

BACKGROUND:
Uterine leiomyomas are the most common benign tumours of the female genital tract. They are a major source of morbidity for women and a frequent indication of gynecological surgery. Understanding the etiology of uterine fibroids remains incomplete. Vitamin D may be an unrecognized risk factor for their development.
OBJECTIVE:
To assess serum vitamin D3 levels in women with and without uterine fibroids and to identify whether serum vitamin D3 levels correlate with the severity of uterine fibroids disease.
METHODS:
This prospective case- control study involved 150 women in their premenopausal state who presented at the outpatient gynecology clinic at AL-Yarmook Teaching Hospital, Baghdad-Iraq. They were arranged into two groups; the control group consisted of 75 healthy women without uterine fibroids confirmed by ultrasound examination. The remaining 75 women, had at least one fibroid lesion of 2cm3 in volume or larger confirmed by transvaginal/ transabdominal ultrasound examination, represented the study group. All women enrolled in the study had similar demographic background. For each case woman, total uterine volume, and total volume of all existing fibroids were measured. Serum vitamin D3 levels were measured for all participants by ELISA method. Statistical analysis was performed to compare serum vitamin D3 levels across groups of women with and without uterine fibroids and to assess the correlation of serum vitamin D3 levels with uterine fibroids burden.
RESULTS:
Serum vitamin D3 levels were significantly (p=0.0001) lower among women with uterine fibroids compared to the control group with a mean value (15.81±8.64) ng/ml in women with uterine fibroid and (34.25±8.07) ng/ml in the control group. A significant negative correlation was found between serum vitamin D3 levels and the increase in number of uterine fibroids (r=-0.623, p=0.0001) and the increase in total uterine fibroids volume (r=-0.742, p=0.0001).
CONCLUSION:
According to the present study, lower serum vitamin D3 levels are significantly associated with the occurrence of uterine fibroids and serum vitamin D3 levels inversely correlate with both uterine fibroids number and total uterine fibroids volume.

BACKGROUND:‎ ‎
The term cavity is a gas-filled space that appears on imaging as ‎an area of low attenuation surrounded by a variously thickened wall within a pulmonary consolidation, mass, or nodule. ‎Multidetector computed tomography (CT) of the chest is the current technique ‎of choice for evaluating lung cavities.‎
OBJECTIVE:
To assess the role of some computed tomography criteria in ‎differentiating benign ‎from malignant solitary cavitary lung lesion.‎
PATIENT AND METHODS:
This was a cross sectional study done in the Computed Tomography ‎unit of Al-Immamain Al-‎Kadhmain Medical city in Baghdad, Iraq between ‎October, ‎‎2016 and June, 2017. All patients presented with solitary pulmonary cavitary lesions ‎‎detected by chest x-ray referred for different reasons. ‎‎Examination of ‎the chest was ‎performed by multi-detector CT (Somatom definition edge, SIEMENS ‎‎medical system, Germany (256 slices)) with 2 sets of CT examination one ‎before and another ‎after giving IV nonionic iodinated contrast ‎medium (Ultravist 370 mg /ml), 1.5 ml/kg Body ‎weight. ‎The final diagnosis was obtained depending on the sputum ‎culture for AFB, ‎bronchoscopy and biopsy, bronchoscopy and brush ‎cytology and true cut biopsy. ‎
RESULTS:
The study included 50 patients with solitary pulmonary ‎cavitary lesions, 54% were male and 46% were females. Final diagnosis was 80% diagnosed as ‎benign and 20% as malignant lesions. Enhancement was ‎significant among 20% of studied patients. The common associated CT scan ‎features were pleural effusion (24%), consolidation (12%), consolidation and tree ‎in Bud (10%), pleural effusion and mediastinal lymph nodes (8%), tree in bud ‎‎(10%), mediastinal lymph node and consolidation (8%), ground glass opacification, ‎honeycombing and tree in bud (6%), pleural effusion and tree in bud (4%), fibrosis ‎‎(2%) and encysted hydro-pneumothorax (2%). There was a highly significant association of significant enhancement and ‎ Pleural effusion ‎ with malignant solitary cavitary lesions (p<0.001 and p=0.003‎). A highly significant ‎association was observed between increased mean thickness of lesion and ‎malignant solitary cavitary lesion (p<0.001) ‎
CONCLUSION: ‎
The common computerized tomography characteristics of malignant solitary ‎pulmonary cavitary lesions were significant enhancement, pleural effusion and ‎increased diameter and thickness of pulmonary cavities.‎

BACKGROUND:
The diagnosis of acute appendicitis carries significant difficulties, particularly in very young ages on which the history and physical examination are difficult. The clinical challenge is to diagnose appendicitis early enough to prevent perforation, while minimizing the number of negative appendicitis that are performed. The diagnosis of acute appendicitis is primarily clinical and the clinical scoring systems have been investigated as alternatives or adjuncts to diagnostic imaging.
OBJECTIVE:
Is to establish the accuracy and applicability of using pediatric appendicitis scoring system (PAS) in evaluating acute appendicitis in pediatric age group.
METHODS:
A prospective cohort study was conducted in Al-Khansaa Teaching Hospital and Children Welfare Teaching Hospital, from January 2014 till November 2015. The study includes 143 patients aged from (3-13) years old referred from pediatric emergency unit or outpatient clinic with suspicion of acute appendicitis. All the obtained data were analyzed using pediatric appendicitis score (PAS) system which classifies the patients into 3 groups: Group (1): Patients with scoring (1-3) includes 38 patients, Group (2): Patients with scoring (4-6) includes 20 patients, while Group (3): Patients with scoring (7-10) includes 85 patients. Surgery was done to all patients of group 3 and thirteen patients of group 2. All removed appendices were sent for histopathological study.
RESULTS:
The median age of the 98 operated on patients was (8.9 years ± 2.6). The histopathological results of appendicitis were confirmed in 89 patients underwent surgery (five patients of group 2 and 84 patients of group 3), while negative histopathological result of appendicitis is seen in nine (9.2%) patients. There is significant association of positive histopathological findings with high PAS (≥7) scoring (p<0.0001). The 8 parameters of PAS system shows accuracy as following: the right lower quadrant tenderness, anorexia and hop tenderness shows accuracy of 90.8%, 87.8% and 86.7% respectively, while leukocytosis, fever and nausea/vomiting shows accuracy of 83.7%, 80.6% and 63.3% respectively. Migration of pain and PMN neutrophilia shows the lowest accuracy rate. The sensitivity of PAS system was 94.4%, the specificity was 88.9%, the PPV was 98.8%, the NPV was 61.5% with overall accuracy of PAS system was 93.9%.
CONCLUSION:
PAS system is easy, simple and useful tool in pre-operative diagnosis of acute appendicitis and can be used by pediatricians to reduce the number of admission to the hospital. Patients with scores of ≥ 7 show high probability of appendicitis and early operation is indicated, while patients with score of ≤3 rule out this disease. The CT scan and diagnostic laparoscopy is advocated for patients with score of (4-6).

BACKGROUND:
HLA-B27 can effect clinical presentation and course of ankylosing spondylitis. Different detection techniques of HLA-B27 are available with variable sensitivities and specificities.
OBJECTIVE:
To compare serologic and molecular diagnostic techniques of detecting HLA-B27 status and to correlate it with some clinical variables among ankylosing spondylitis patients.
PATIENTS AND METHODS:
A cross-sectional study was conducted on 83 Iraqi patients with ankylosing spondylitis. Clinical and laboratory evaluations were reported. HLA-B27 status was determined in all patients by real-time PCR using HLA-B27 RealFast™ kit; ELISA method was used as well to detect soluble serum HLA-B27 antigens using Human Leukocyte Antigen® kit.
RESULTS:
The mean age of patients ± SD was (38.4±9.8) years. Male to female ratio was 9:1. Disease onset occurred <30 years in 78% of cases. All (100%) cases had lower back pain, 44 (54%) patients had enthesitis, 14 (16.9%) had peripheral arthritis, 12 (14.5%) had eye involvement, while cardiovascular disease and psoriasis were present in one patient (1.2%) each. HLA-B27 was detected in 55 (66.3%) patients by real-time PCR. The disease onset was earlier and disease duration was longer in HLA-B27-positive patients (p-value<0.05 for both). Uveitis was significantly associated with HLA-B27 positivity (p=0.032). HLA-B27 positive cases by ELISA test were 32 (38.6%) patients. Comparing HLA-B27 gene detection by real-time PCR with sHLA-B27 detection by ELISA revealed that the sensitivity of ELISA was 38.18%, specificity was 60.71% and positive predictive value (PPV) was 61.8%.
HLA-B27 typing by microlymphocytotoxicity (MLCT) test from initial old serologic typing was available for a subgroup of 28 (33.7%) cases. Comparison of ELISA and MLCT results with real-time PCR in this subgroup of 28 cases revealed that ELISA method showed a sensitivity of 60.6%, specificity of 72.72% and PPV of 86.95%, while MLCT showed a sensitivity of 68.96%, specificity of 80%, and PPV of 90.9%
CONCLUSION:
Real-time PCR detection of HLA-B27 status is superior to serological techniques (ELISA and MLCT) as the latter two yielded high false results, with MLCT being relatively better than ELISA.

BACKGROUND:
Multiple sclerosis (MS) is a chronic inflammatory, demyelinating and neurodegenerative disease of the brain and spinal cord. The cervical spinal cord is commonly affected in multiple sclerosis ,as many as 90% of MS patients which is often associated with an increase in clinical disability. Though rarely seen in other diseases, asymptomatic lesions of the spinal cord can be present in MS and may help lead to the correct diagnosis. Since the integration of MR imaging into the International Panel (McDonald) criteria in 2001,there is increasing international effort to standardize MR imaging protocols.
OBJECTIVE:
To evaluate MRI imaging protocols for detection of cervical spinal cord multiple sclerosis lesions using 1.5 T MRI scanner.
PATIENTS AND METHODS:
A cross sectional analytical study was conducted at Al-Yarmouk Teaching hospital in Baghdad city. Thirty-one known as MS Patients were examined. from October 2016 till December 2017 by Phillips Achieva Nova Dual 1.5T using a SENSE Neurovascular coil .All patients. underwent sagitta1 T2-turbo spin echo(T2-TSE), Sagittal proton density-turbo spin echo(PD-TSE), sagittal short tau inversion recovery-turbo-spin echo(STIR-TSE )and axial T2-fast field echo(T2-FFE).Comparison was done between the sequences in the means of detectability, conspicuity and number of lesions.
RESULTS:
Total patients were (31),22 were females and 9 were males .The female to male ratio was (2.4:1). The patient ages ranges between 20-61 years with a mean of age of about 38 years.
Mean Lesion to Cord Contrast Ratio (mean LCCR) of STIR and T2WI MR imaging was lower than PD imaging [p value < 0.01].Despite of STIR and T2WI had comparable LCCR (mean= 0.39), STIR imaging had expressively better Lesion Contrast to Noise Ratio (LCNR) [P value < 0.01]. PD had better LCNR (mean=48.8) as compared to T2 and STIR [p value<0.001].
PD-TSE sequence detected a large number of spinal cord lesions as compared to T2-TSE and STIR-TSE sequences [110 vs. 76 , 76; respectively . P value < 0.001].
CONCLUSION:
PD-TSE improves overall lesion detection ,delineation, conspicuity and edge definition, however it cannot give precise cord morphological data, but it prove to be the sequence of choice in cervical MS plaque detection as it has the higher lesion contrast ,and it is beneficial in overcoming artifacts seen in both STIR and T2-TSE.
STIR-TSE have good signal to noise ratio, although have higher CSF flow artifacts.
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BACKGROUND:
Epidemiological studies indicate a higher incidence of intracerebral hemorrhage among persons with low total serum cholesterol level.
OBJECTIVE:
To examine the prospective relationship of total serum cholesterol with a subsequent intracerebral hemorrhage in an Iraqi population sample.
PATIENTS AND METHODS:
A case-control study was performed to assess the relationship between spontaneous intracerebral hemorrhage (ICH) and low serum cholesterol. Eighty patients were admitted, from April 2007 to April 2008, to both Baghdad Teaching Hospital and Sulaimaniyah General Teaching Hospital with a diagnosis of spontaneous ICH. All the patients aged 50 or more years. After the initial review for exclusion criteria, 62 patients were enrolled. The other patients were excluded because of secondary causes of hemorrhages. Brain CT scan was done at the radiology department of both hospitals and read by radiologists. Fasting serum lipid profile was evaluated by the laboratory staff of the hospitals.
RESULTS:
It was noticed that the cholesterol values fall acutely after hemorrhage. Mean total cholesterol was significantly lower within 48 h (total cholesterol 1TC1) and 1-2 weeks (total cholesterol 2TC2) than in 3 months (total cholesterol 3TC3), following hemorrhage. In addition, no significant change between TC1 and TC2 groups was noticed, though TC1 values proved to be somewhat higher. A significantly increased proportion (42%) of hemorrhage cases had TC3 values that were in the sex specific lowest quintile of the control group (20%). Dividing the cases according to likely etiology demonstrated similar overrepresentations within the hypertensive and non-hypertensive subgroups.
CONCLUSION:
Our data in patients with proved spontaneous ICH confirm the population based observation that individuals with the lowest cholesterol levels are at increased risk of ICH.

BACKGROUND:
Unstable angina (UA) is a type of acute coronary syndrome. It has been recognized as a distinct syndrome intermediate between stable exertional angina and myocardial infarction. It includes many types according to the onset, duration, intensity and frequency of pain.
OBJECTIVE :
The objective of this study to estimate the frequency of risk factors of ischemic heart disease, influence of age and gender, also to predict the in-hospital outcome.
METHODS:
One hundred patients with unstable angina of all ages and both gender were enrolled in a cross-sectional study from October 2010 – June 2011 who were admitted to coronary care unit of Baghdad Teaching Hospital / Medical City.
Descriptive analyses were performed to assess the relationship between unstable angina and risk factors and influence of age and gender and in-hospital outcome.
RESULTS:
This study showed a highest incidence of unstable angina among males and females in the age of 50-54years.Hypertension was the major risk factor (58%) while, smoking (48%), diabetes (38%), family history of ischemic heart disease (35%), hypercholesterolemia (34%) and obesity (22%).There were significant differences between both gender with unstable angina and the following risk factors: hypertension, smoking, hypercholesterolemia and obesity. There were 22% of patients with persistent chest pain who developed non- fatal acute myocardial infarction and 6% died in the hospital.
CONCLUSION:
The following risk factors; hypertension, smoking, diabetes, family history of ischemic heart disease, hypercholesterolemia and obesity play an important role in occurrence of unstable angina and prognosis. The incidence of UA was higher among ages of (50 -54) years of both gender. Persistence of chest pain at rest was greatly associated with unfavorable outcome.

BACKGROUND:
Congenital anomalies of the kidney and urinary tract comprise a wide range of structural malformations that result from defects in the morphogenesis of the kidney and/or urinary tract
OBJECTIVE :
Study the types of renal anomalies. Study their clinical presentations, age of presentation, way of diagnosis, and complications.
PATIENTS AND METHODS:
A descriptive study was conducted from 1st January 2015 till 1st January 2016. Patients were collected from 4 pediatric nephrology centers. Data included: age of diagnosis, type of renal anomaly, radiological methods of diagnosis, clinical presentation and associated complications, family history of congenital anomalies and consanguinity.
Thorough physical examination was done to all children. Investigations send were Blood urea, Serum creatinine , urinalysis, urine culture, imaging study were documented.
RESULTS:
In this study 160 patients were included. Males were more affected than females 1.54:1. Most of the patients diagnosed at >1- ≤ 5 age group, 78 patients (48.8%). Most of the patients had negative family history, 124 (77.5%), and most of their parents were not consanguine (58.1%). Vesicoureteral reflux (VUR) was the commonest anomaly detected in 67 patients (41.9%), followed by Renal agenesis in 24 patients (15.0%).
Abdominal Ultrasound was the commonest radiological method used for diagnosis in 152patients (95.0%), followed by voiding cystourethrogram (VCUG) in 80 patients (50.0%).
Urinary symptoms were most common presentation in 93patients (58.1%). A higher complication was UTI (62.5%).
CONCLUSION:
The commonest renal anomaly was VUR, followed by Renal agenesis, then PUJ, These renal anomalies were mostly diagnosed at >1-≤ 5 age group. Males exceeded the number of females, and the majority of patients were diagnosed initially by ultrasound
Most common presentation was urinary symptoms. The most prominent complication was UTI
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BACKGROUND:
Anterior cruciate ligament reconstruction is widely done orthopedic procedure, during this procedure there is potential risk for development of complications, which need to be dealt with or better to be prevented by specific measures.
OBJECTIVE:
To avoid intra operative complications during anterior cruciate ligament reconstruction using hamstring muscles graft in order to reduce incidence of the graft failure due to technical error.
PATIENT AND METHOD:
prospective cohort study for patient who has undergone primary anterior cruciate ligament reconstruction surgery using hamstring graft by same surgical team during the period from 2016-2017. History, examination and investigations were done for all patients and surgery was done under general anesthesia or spinal anesthesia. Specific rehabilitation program was instructed to all patients. Intra operative complications might be encountered during anterior cruciate ligament reconstruction surgery which includes: cartilage injury, Bleeding, Screw breakage, Screw mal direction and graft harvest complications. Identification of the measures to avoid these complications was crucial in this study.
RESULTS:
Fifty four patients who underwent primary anterior cruciate ligament reconstruction with mean age 27.7. Fourteen patients (26%) developed complications. Seven patients had cartilage injury (13)% , (2/54) patients had bleeding (3.7)% , (2/54) patients had developed screw breakage (3.7)% , screw mal direction (1.9)% was encountered in (1/54) patient and (2/54) patients had sustained premature graft cutoff short (3.7)%.
CONCLUSION:
Complications of anterior cruciate ligament reconstruction may occure at any stage of operation, avoidness of these complications is important step in improving the functional outcome and the surgeon need to be aware about it and how to avoid them.

BACKGROUND:
A major goal of quality assurance is the minimization of error rates in order to augment patient safety, six sigma or sigma metrics were used to assess the analytical quality of automated clinical chemistry, six sigma metrics is used in combination with total allowable error, method imprecision and bias. The goal is to achieve the highest possible sigma scale within the acceptable limits of total allowable error.
OBJECTIVE :
For assessment of sigma metrics results of serum parameters of liver and kidney function test tested by automated chemistry analyzer in Medical City Hospital.
METHODS:
In the current study, internal quality control (IQC) and external quality assessment (EQA) data were analyzed for the period from May 2017 to July 2017 using chemistry auto analyzer (Siemens Dimension RxL Max) at the Teaching Laboratories of the Medical City Hospital. Mean, standard deviation, coefficient of variation %, bias %, total error and sigma metrics were calculated for serum urea, creatinine, total serum bilirubin(TSB), alkaline phosphatase (ALP), aspartate aminotransferase(AST) and alanine aminotransferase (ALT).
RESULTS:
Excellent sigma values (≥6) were elicited for TSB (14) and AST (7.7), Satisfactory sigma values (≥3) were elicited for ALT (6) and ALP (4.6), while serum urea and creatinine performed poorly (2.5), (2.8) respectively on the sigma scale.
CONCLUSION:
Total serum bilirubin was the best performer on six sigma scale, for AST, ALT and ALP the sigma results was accepted. While serum urea and creatinine had poor performance, so there is need for improvement of their methods which should be controlled with greater attention to ensure quality.
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