Iraqi Postgraduate Medical Journal

BACKGROUND:
Obesity is a medical condition in which excess body fat has accumulated to the extent that it may have a negative effect on health. Obesity increase the likelihood of various diseases and conditions, particularly cardiovascular diseases, type 2 diabetes, obstructive sleep apnea, certain types of cancer, osteoarthritis and depression
OBJECTIVE:
To clarify the effect of work place stress , physical activity and eating behavior as determinants of obesity.
SUBJECTS AND METHOD:
A cross-sectional study with an analytic element, was conducted in eight hospitals and primary health care centers in al-Najaf city selected by a convenient non randomized sampling technique during the period from 1st of April 2018 through 31 December 2018. The total sample of study was 350 medical and paramedical staff .a self rated questionnaire was filled by participants regarding their work place stress , physical activity and eating behavior, weight and height was measured and BMI was calculated .
RESULT :
the rate of obesity was 10.3% and the rate of overweight was 42.3% . The study show that there is no significant association between workplace stress and eating behavior with obesity while significant association found between obesity and physical activity
CONCLUSION:
Physical activity has an important role in the prevention of obesity , greater percentage of participants have normal BMI, greater percentage of participants have controlled eating. greater percentage of participants have low physical activity.

BACKGROUND:
Time consuming, scar contracture, web creeping is risks with reconstruction by skin graft. dorsal metacarpal flaps minimize these complications however they still occur. This study is based on a plane-shaped advancement flap on the dorsum of the hand and a traction device for webspace to prevent contraction and creeping.
THE AIMS:
To evaluate the primary closure after releasing of tight syndactyly and minimizing creeping and contracture of Webspace
PATIENTS AND METHODS:
From January 2018 to May 2019 ten patients (10 Webspaces), 3 females and 7 males, age ranged (1-19) have congenital tight hand syndactyly (3 complexes, 5 simple incomplete,2 simple complete) .
RESULTS:
Average time of operation was 60 min , primary closing of all incisions was done . one of the ten patients had hypertrophic scar at donor site of the flap. furthermore , four patients had web creeping ,one of them had epidermal sloughing of the flap, the others had creeping .
CONCLUSION:
Dorsal advancement plane-shaped flap is helpful in reconstruction tight syndactyly However, it needs precise dissection . Some patient haven’t compliance with traction devices so it isn’t corresponding for every patient

BACKGROUND:
The facial nerve is characterized by the long bony canal that makes it vulnerable to injury during otologic surgery. Facial canal defect could be found as an anatomic variant or due to longstanding inflammation that causes bone erosion.
AIMS OF THE STUDY:
Determination of the incidence and location of facial canal defect and identification of association between facial canal defect and other intraoperative pathological findings.
PATIENTS AND METHODS:
A case series study of eighty-four patients with chronic suppurative otitis media who underwent mastoidectomy in Al-Yarmouk Teaching Hospital through a period from October 2017 till October 2018. Data were collected regarding the intraoperative finding of facial canal defect, its location and associated pathological findings which include lateral semicircular canal erosion, dural exposure and ossicular erosion.
RESULTS:
This study included (38) males and (46) females, their ages ranged from five to fifty-eight years. The incidence of facial canal defects was (20.2%). The tympanic segment was predominantly involved (82.4%).There was a statistically significant correlation between facial canal defect and lateral semicircular canal erosion (p<0.006).
CONCLUSION:
The incidence of facial canal defect was 20.2%, mostly located in the tympanic segment. The presence of lateral semicircular canal erosion was significantly correlated with facial canal defects.

BACKGROUND:
Laparoscopic as a minimally invasive treatment is continuosly gaining place in the treatment of urinary stones,mainly replacing open surgery,it is mostly recommended ror large impacted stones.
OBJECTIVE:
To compare the safety, efficacy, operative time, postoperative hospital stay, and complications rate of transperitoneal laparoscopic ureterolithotomy and ureteroscopic holmium laser lithotripsy for treatment of upper ureteral stones, equal to or larger than 15 mm in longest diameter.
PATIENT AND METHODS:
Forty-two patients with upper ureteral stones of 15 mm or larger in longest diameter were included in this study. Eighteen patients were treated by transperitoneal laparoscopic ureterolithotomy and 24 patients by ureteroscopy using semi-rigid ureteroscope with Holmium laser lithotripsy. Operative time, intraoperative complications, stone-free rate, postoperative complications, postoperative hospital stay and post-operative auxiliary treatment were compared in both groups.
RESULTS:
The mean stones size was comparable in both groups, it was 20.5 ± 6.8 mm in Ureteroscopy group and 20.3 ± 6.7 mm in laparoscopic group, (P. value > 0.05).The mean operative time was significantly shorter in ureteroscopy group, 46.3 ± 27.3 minutes compared to 66.4± 19.1 minutes in laparoscopic group. Regarding the Patients in laparoscopic group needed longer hospital stay with a mean time of 2.2 ± 0.4 days, while in ureteroscopy group, the meantime of hospitalization was 1.1 ± 0.45 days. The stone free rate in laparoscopic group was 100%, compared to 62.5% in ureteroscopy group giving a statistically significant difference, (P. value = 0.003), and the ancillary treatment was needed in 37.5% of patients treated by ureteroscope. Postoperatively in ureteroscopic group, three patients had gross hematuria, while only one Patients in laparoscopic group had pyelonephritis, however, no significant difference in frequency of post-operative complications between both groups, (P. value> 0.05).
CONCLUSION:
Transperitoneal laparoscopic ureterolithotomy has a higher stone-free rate, but longer operative time and hospital stay compared to ureteroscopic laser lithotripsy for the treatment of upper ureteral stone 15 mm or larger in longest diameter.

BACKGROUND:
Patient-controlled epidural analgesia has been considered as superior to continuous epidural infusion for labor pain control.
AIM OF STUDY:
The aim was to establish the efficacy of Patient Controlled Epidural Analgesia for control of labor pain and improve the quality of analgesia.
METHODS:
This study was done on 20 patients; they were given bolus of 10 ml of 0.125% bupivacaine +2 Mg /ml fentanyl then divided into: Group A can put the device to deliver 5ml of 0.125% bupivacaine +2Mg /ml fentanyl with lockout interval 20 min; Group B had the PCA system to deliver continuous infusion of 10 ml /hr. In each group if patient still suffer from pain, patients were received additional dose of 5ml of same solution.
RESULTS:
Data showed that total amount of LA in group A was lower than group B (18.44ml versus 20ml in 1st hr., 2.5ml versus 10ml in 2nd hr.). Regarding additional boluses, CIEA group needed more extra boluses of LA at 20, and 60 mints (5.0ml versus 1.0ml, 4.0 ml versus 0.5ml). CONCLUSION:
The use of PCEA associated with lower doses of local anesthetic with better quality of analgesia and maternal satisfaction.

BACKGROUND:
Tattoo is the introduction of colored ink into the skin, and considered a form of body art for centuries. Its prevalence is rising among adolescents and young adults, mainly in western societies despite being linked to certain health risks.
AIM OF THE STUDY:
To assess the characteristics of tattoo practice among college students, and to highlight its association with certain characteristics of the students.
METHODS:
The study is a cross-sectional study conducted on college students in Babylon University from January 2019 through June 2019. Data were collected using an anonymous self-administered questionnaire based on Armstrong Team Tattoo Attitude Survey (ATTAS).
RESULTS:
The study included (1932) students with a mean age of (21.05 ± 1.69) years, majority being females (70.3%). Tattoo practice was present in (8.3%) of them, with significantly higher proportion among males (P<0.001). Tattoo was significantly more prevalent among students with tattooed family members and friends (P<0.001), odds ratio=3.09 for family members with tattoos and 5.19 for friends with tattoo.
CONCLUSION:
The study demonstrated the significant role of friends and families in the practice of tattoos, with friends having the highest role. Majority of students performed their first tattoo before college.

BACKGROUND:
Adjuvant hormonal treatment with aromatase inhibitors for postmenopausal women with early-stage breast cancer is associated with relatively few side effects but it may cause bone mass loss which can be detected with a dual-energy x-ray absorptiometry scan.
AIM:
In this study, we evaluate the skeletal effects of aromatase inhibitors in postmenopausal women with early-stage breast cancer.
PATIENTS AND METHODS:
This is an observational retrospective case-control study enrolled 70 postmenopausal women with early-stage breast cancer on adjuvant aromatase inhibitors and 70 postmenopausal control women, the two groups were compared regarding the prevalence and severity of bone mass loss by using the DXA scan of their lumbar spine.
RESULTS:
Bone mineral density was significantly lower in breast cancer cases (mean T score was (-2.50 ± 1.01) compared to the control group (mean T score was (-2.12 ± 0.79) with significant (p-value =0.014), also 60%of breast cancer cases were osteoporotic compared to 32% in the control group (p-value =0.005). Based on univariate analysis, breast cancer was associated with 2.79 folds increased probability of osteoporosis
CONCLUSION:
A significant proportion of our breast cancer patients who used aromatase inhibitors were osteoporotic.

BACKGROUND:
The use of immediately loaded basal dental implants in the treatment of partial or completely edentulous patients is one of the new methods; this method was invented to avoid pre-implant surgical procedures to decrease treatment time, cost, and surgical morbidity.
AIM OF THE STUDY:
This study aimed to evaluate the primary stability of basal and compressive dental implants by the use of periotest M and the evaluation of complications of these implants.
MATERIAL AND METHODS:
A total of (158) dental implants were used in (31) patients, basal and compressive DI was sued and the primary stability of each implant was determined by the use of periotest M. the entire DI was loaded immediately and followed up for six months.
RESULTS:
There was a significant correlation between the primary stability and DI dimension, (p>0.05), a significant increase in bone resorption in correlation to time of implant insertion.
CONCLUSION:
Within the limitation of this study, the use of a greater dimension of basal DI increases the primary stability, and the survival of basal and compressive immediately loaded DI was accepted (98.11%).

BACKGROUND:
Ovarian functional hemorrhagic and endometriotic cysts are frequently seen on ultrasound examinations. Magnetic resonance imaging plays a major role in their differentiation based on different imaging characteristics.
OBJECTIVE:
Investigating magnetic resonance imaging signs to differentiate endometriotic from functional hemorrhagic cysts.
PATIENTS AND METHODS:
A prospective descriptive study of 66 cystic hemorrhagic ovarian lesions, conducted in X-ray Institute, Medical City, Bab Al-Mua’dam, Baghdad/Iraq from September 2018 to December 2019. Lesions were inspected for the presence of T2 shading, dark spot, and dark rim signs. Standard of reference was either histopathological analysis or follow-up ultrasound imaging.
RESULTS:
Of 66 hemorrhagic lesions, 39 were endometriotic cysts and 27 were functional hemorrhagic cysts. T2 dark spots were only seen in 19 of 39 endometriomas. T2 shading was seen in 34 of 39 endometriotic cysts and 8 of 27 functional hemorrhagic cysts. Twenty-four of 39 endometriotic cysts and 12 of 27 hemorrhagic cysts showed the dark rim sign.
CONCLUSION:
High sensitivity of the shading sign for diagnosing endometriomas. Identification of dark spots within endometriomas increases specificity and accuracy for their diagnosis. Dark rim sign is also useful for differentiation between endometriomas and functional hemorrhagic cysts.

BACKGROUND:
Hirschsprung’s disease is a developmental abnormality of enteric nervous system characterized by lack of ganglion cell and neural hypertrophy in the Meissner and Auerbach’s plexuses within variable length of the colon, the Calretinin Immunohistochemistry is one of the newer methods overcome difficulties in diagnosis of Hirschsprung’s disease especially immature ganglia in neonates in submucosal plexus.
AIM OF STUDY:
This study was performed to evaluate the diagnostic value of Calretinin immunohistochemistry in the Hirschsprung’s Disease diagnosis.
MATERIALS AND METHOD:
A retrospective and prospective case series study at the period from (Jan2018-Jan2020) included a total 50 formalin-fixed paraffin-embedded blocks of distal colonic and rectal incisional biopsies from infant and young children patient who suspected with Hirschsprung’s disease, The study was undertaken in the department of pathology, collage of medicine/ University of Mosul, a clinicopathological data including (age, gender, site, type of surgical procedure) were obtained from patients' files This study was performed by using the primary antibody of Calretinin.
RESULTS:
The study done on 50 cases their age from 1 day to 14 years. The universal sensitivity in this study to diagnose presence or loss of enteric ganglia by calretinin immunostaining was 90% and the specificity is 100% with positive and negative predictive value of 100% and 97 % respectively.
CONCLUSION:
Calretinin marker considered as a reliable, valuable marker in Hirschsprung disease diagnosis and carry high sensitivity and specificity.

BACKGROUND:
Pathological stage of urothelial carcinoma is the most important factor in determining the prognosis and the mode of therapy. Desmin antibody is used to stage urothelial carcinoma by distinguishing the muscular invasion from desmoplasia and differentiating muscularis mucosa from muscularis proprial invasion.
AIM OF THE STUDY:
To evaluate the usefulness of Desmin expression in differentiation muscularis mucosa from propria invasion and assess muscular invasion in urothelial carcinoma.
MATERIAL AND METHODS:
A retrospective study was done on 40 cases with urothelial carcinoma from the histopathology department of Teaching Hospitals and private laboratories in Mosul city, starting in January 2018 till July 2020. Their mean age was 62.1 years. All cases stained by desmin antibody.
RESULTS:
It was found that the high-grade Urothelial carcinoma is predominant, which is composed of 80%. Desmin can distinguish the muscularis mucosa from propria by at least one level of difference in the strength of the staining intensity.
CONCLUSION:
Desmin marker helps assess the stage of urothelial carcinoma by the differentiation between muscular layer of the bladder wall.

BACKGROUND:
Isolated systolic hypertension is defined as Systolic blood pressure ≥140 and a Diastolic blood pressure <90mm Hg. The rate of isolated systolic hypertension increased with increasing age in both sexes, isolated systolic hypertension, more than any other hypertension subtype, increases the risk for stroke and coronary heart diseases and is associated with many complications.
OBJECTIVE:
To assess the prevalence of isolated systolic hypertension among the adult population in Baghdad.
METHODS:
A cross-sectional study using a convenient sample from the outpatient clinic in Baghdad aged (18-60) year. Data was collected using a questionnaire as a direct interview, with measurements of weight, height and blood pressure.
RESULTS:
A total of 800 adults, were included in the final analysis. Males constituted about 52.1% of the study population. The prevalence of undiagnosed isolated systolic hypertension was 11.4%. Four factors were found to be significant independent risk factors. Age (increasing one year will increase the risk of isolated systolic hypertension by (OR=1.03), illiteracy (OR=1.4), BMI (OR=1.08), and male gender (OR=1.77).
CONCLUSION:
Undiagnosed Isolated systolic hypertension is common and increased with age in both men and women. And more common among males with association with low education and BMI.

BACKGROUND:
Hypertension is a challenge for public health professionals all over the world and it is often poorly controlled in clinical practice and to achieve control, hypertensive patients should actively participate in the plan of management through being educated and monitored at follow-up appointments.
AIM OF THE STUDY:
To shine a light on a sample of hypertensive patients, tracing knowledge about follow-up visits practicing, and identifying the factors that influence their practice.
PATIENTS & METHODS:
A cross-sectional study was carried out on 300 outpatient hypertensive patients aged eighteen years and above of both sexes who were known to be hypertensive for not less than one year and on antihypertensive treatment, attended Al- Imamein Kadhimien Medical City and interviewed face to face by using a detailed questionnaire.
RESULTS:
The majority of the participants had hypertension for less than 5 years (43%), family history in (69%), and (57.3%) had knowledge about hypertensive complications. Patients with regular visits constituted (65.7%) whom the private sector represented the main health care provider (65.5%) of the sample. Diabetes mellitus, cardiovascular diseases, knowledge of hypertension complications and educational level were statistically significantly associated w follow-up w up visits.
CONCLUSION:
the private health sector providers were the preferred side follow-up for 2/3 of the patients. Educational level was inversely associated with regularity of visits, while diabetes and cardiovascular diseases were proportionally associated with the follow-up visit of the patient’s family and friends comprised the main source of information about hypertensive complications rather than health care providers.

BACKGROUND:
The lower extremities defects considered one of the most challenging, lack of tissue, exposure of vital structure(bones, tendons, blood vessles, and nevers) make flap coverage is a must,Venous congestion is one of the common consequences in lower extremities flaps,Phlebotomy is one of the method to reduce venous congestion
OBJECTIVE:
To discuss the role of intravenous catheterization as a method of decreasing venous congestion in reverse flow Sural artery flap used for the reconstruction of lower limb defects.
METHOD:
Eight patients were treated at Alshadeed Ghazi Alharirie hospital for variable defects in lower limb during the period from January 2018 to April 2019 all treated with reverse Sural flap , the venous drainage of these flaps was enhanced by the addition of phlebotomy tube that was removed after the blood flow through it stops
RESULTS:
A total of eight patients were included in this study with ages ranging from 30-62 years ( 7 males – 1 female ) cause of defects was trauma ( 5 cases ) , diabetic foot ulcer ( 2 cases ) , and post burn contracture release in one patient .
the site of the defect was heel (3 cases ) , ankle ( 2 cases ) , lower leg ( 2 cases ) and lateral malleolus (1 case ) . the size of the defect was ranging from 7*8 cm to 10*9 cm .all the flaps survived with no reported case of complete or partial flap necrosis , only one patient had mild skin necrosis of about 1 cm in width of distal margin of the flap which was held with secondary intention .
CONCLUSION:
Intravenous catheterization of lesser saphenous is a simple and safe method for prevention of venous congestion of distally based Sural artery flap , intensive nursing care is needed and it is associated with less complications.

BACKGROUND:
Diarrhea is the leading cause of morbidity and mortality in children in developing countries. Acute-onset diarrhea is usually a self-limited disease; however, acute infection can have a protracted course. Zinc is an essential nutritional element, with a broad spectrum of biological activities in humans; this element plays an important and vital role in the physical development of digestive and immune systems. Zinc deficiency is common in children from developing countries due to lack of intake of animal foods, high dietary phytate content, inadequate food intake, and increased fecal losses during diarrhea.
OBJECTIVE:
To assess serum zinc level in children with acute gastroenteritis.
PATIENTS AND METHODS:
We conducted a cross-sectional study on 53 patients who presented with acute gastroenteritis for less than 14 days duration admitted to casualty and general ward units at Children Welfare Teaching Hospital, their age ranged (6months-15years) from 1st of April 2018 to 31st of October 2018. A detailed history and examination were done for all cases. A special questionnaire was designed for the purpose of the study. Blood samples for complete blood count, C-Reactive Protein, total serum protein and serum zinc level measurement were obtained from patients at admission Serum samples of the patients for measurement of zinc levels were collected in tubes free of trace elements and stored at (−20°C) until measurement. Zinc concentrations were determined by atomic absorption spectrophotometer.
RESULTS:
Fifty-three children with acute gastroenteritis were included in the study (40 males and 13females), their age was between 6 months-15 years. The median duration of diarrhea (4 ± 2.7) days and mean serum zinc (86.2± 26.6). A total of 18 (34%) children had low serum zinc levels.
The mean serum zinc seen was lower in patients with duration of diarrhea < 5 days than patients with duration of diarrhea ≤ 5 days; the result is statistically significant in both groups p-value > 0.05. There were no significant differences in demographic and clinical characteristics between patients with normal zinc levels and those with zinc deficiency.
CONCLUSION:
The serum zinc in children with gastroenteritis has revealed a significantly decreased level.

Minimally invasive surgery (MIS) has seen large uptake in recent decades, with increasing numbers of such procedures being performed. Laser technology is widely used in the management of urological diseases, including urolithiasis, benign prostatic enlargement (BPE), and urinary tract malignancies.(1,2)
Laser lithotripsy was first adopted by urologists in the 1980s, with Holmium:Yttrium- Aluminium-Garnet (Ho:YAG) becoming the laser of choice in the mid 1990s( 3,4)
Compared to other lithotripsy techniques, the Holmium:YAG laser presents several important advantages:
(1) suitability for fragmentation of all known urinary stone types into small stone particles (3,4);
(2) ability to operate with thin and flexible delivery fibers with limited energy losses and with core diameters as small as 200 μm (5,6);
(3) favorable safety profile with minimal tissue penetration depth and low risk of undesirable tissue damage due to the relatively high absorption coefficient of the Holmium:YAG laser wavelength in water(7)
In recent years, there has been a surge of interest in Thulium Fiber Laser (TFL) which has a 4x higher absorption coefficient in water-containing tissue, smaller operating fibers (50–150 μm core diameter), lower energy pulses (0.025 J), and higher pulse rate capability (up to 2 KHz).(2)
One advantage of TFL is its higher water-absorption coefficient compared with Ho:YAG, which means that water absorbs TFL energy around four times higher than it does with Ho:YAG laser energy. Using water absorption as a model for cell absorption, the implication of this is that more energy from TFL is absorbed by cells and therefore they are better ablated (8,9)