Iraqi Postgraduate Medical Journal

BACKGROUND:
Isolated posterior wall fractures are common injuries of the acetabulum, anatomical reduction and
stable fixation are the goals of operative treatment when indicated, outcomes of surgical treatment
depend on many patient`s and fracture`s factors.
OBJECTIVE:
To evaluate the functional and radiological outcomes of surgically treated isolated posterior wall
fractures of acetabulum and the effect of patient`s and fracture`s variables on the outcomes in a short
term follow up.
MATERIALS AND METHODS:
Prospective study on twenty patient who met the inclusion criteria treated surgically for isolated
posterior wall fractures of acetabulum at Baghdad Medical City Directorate from July 2014 to
December 2016 with at least one year follow up. All patients were evaluated clinically with
Modified Merle d`Aubigne score and Harris hip score, and radiologically with Matta`s radiological
outcome grading. The effect of gender, BMI, associated dislocation, timing of reduction of
dislocation, timing of surgery, and quality of reduction on the outcomes were evaluated.
RESULTS:
The mean final Modified Merle d`Aubigne score was 15.65 (range, 8 to 18) with excellent and good
results in 16 patient (80%), fair and poor results in 4 patients (20%). The mean final Harris hip score
was 89.2 (range, 65 to 100), with excellent and good results in 16 patient (80%), fair and poor
results in 4 patients (20%).The final radiological outcome results were excellent and good in 17
patient (85%), fair and poor in 3 patients (15%). The functional and radiological outcomes were
significantly affected by the quality of fracture reduction ( p=<0.0001, p=0.0009) respectively. In
addition, the functional outcome was significantly affected by the presence of dislocation (p=0.019),
delay in reduction of dislocation (p=0.0026), and delay in surgery more than 2 weeks (p=<0.0001).
However, gender, and BMI did not show clear effects on the functional outcome ( p=0.938,
p=0.172) respectively.
CONCLUSION:
Satisfactory outcomes can be obtained with open reduction and internal fixation of isolated posterior
wall fractures of acetabulum in short term follow up. Anatomical reduction strictly correlated to both
functional and radiological outcomes with favorable results. Early reduction of hip dislocation
within 12 hours and early surgery within two weeks had favorable functional outcome while the
presence of hip dislocation adversely affects the functional outcome. However differences in gender
and body mass index did not clearly affected the functional outcome.

BACKGROUND:
diabetic nephropathy is being recognized as a worldwide public problem with high cost and poor
outcomes, there is increase in the incidence and prevalence of renal failure all over the world.
Functional renal imaging methods such as diffusion- weighted magnetic resonance imaging (DWMRI),
has been shown to be a promising technique in the evaluation of renal function
OBJECTIVE:
To study the value of apparent diffusion coefficient (ADC) in the detection and evaluation of
diabetic nephropathy, correlating these values with the clinical stage of diabetic nephropathy and to
compare these findings with diabetic patient without nephropathy.
PAT IENTS AND METHODS:
A cross sectional analytic study was conducted in MRI unit of Radiology department at Al-Imamein
Al-Kadhimyain medical city through period form 1st oct.2017 to 30 of July 2018, 80 diabetic
patients were classified according to GFR into two groups; group I 40 patients (diabetic patient with
no nephropathy) group II 40 patients (diabetic patients with nephropathy). DWI ( b value ,0 and
1000 s/mm2) was performed in two group of the study . The mean ADC value of renal cortex was
calculated from three regions positioned in the upper, mid and lower third of the kidney.
The Relationship between ADC value and stage of diabetic nephropathy were assessed.
RESULTS:
In comparing diabetic patients (with no nephropathy) with patient with diabetic nephropathy, there
was significant decline in mean ADC value among patients with advanced stages of diabetic
nephropathy(p< 0.001). The mean ADC value with diabetic nephropathy was significantly lower
among patients with type I DM (P<0.001).
CONCLUSION:
The magnetic resonance imaging-apparent diffusion coefficient value is an appropriate method for
assessment and evaluation of diabetic nephropathy and is a reliable diagnostic tool for

BACKGROUND:
Urinary tract infection is the third most common pediatric bacterial infection in developing
countries. Exclusive breastfeeding as World Health Organization recommendations in infants
provides the simplest method that provides protection against infant’s infections including UTI.
OBJECTIVE:
To assess the possible protective effect of exclusive breastfeeding on infant UTI.
PATIENTS AND METHODS:
A case control study was carried out in Children Welfare Teaching Hospital from March to
September 2018. The study group included 300 infants (100 cases and 200 controls). Cases were
selected from Pediatric Nephrology Department when clinically suspected as UTI. Controls were
selected from the patients of other diseases in the hospital. Both cases and controls were divided
according to the type of feeding during first 6 months of life into three groups: Exclusive
breastfeeding, bottle feeding and mixed feeding.
RESULTS:
Infants exclusively breastfed for 6 months, shown to have a lower risk of UTI 12% than partially
breastfed 68% or bottle fed peers 20%. This protective effect after fixation of other variables (P
value=0.0001). The study also showed that lack of circumcision in male infants, having a previous
history of UTI and use of antibiotics inappropriately were significant risk factors for UTI in infants.
CONCLUSION:
This study showed a protective role of breastfeeding on UTI in infancy. Other risk factors for the
UTI were uncircumcised male infants, positive history of UTI and improper use of antibiotics.

BACKGROUND:
A pacemakers is a small device that is placed in the chest to help control abnormal heart rhythms
and prevent bradycardia.
OBJECTIVE:
To evaluate the practice of permanent pacemaker implantation including indications and early
complications.
PAT IENTS AND METHODS:
This is a retrospective study in 90 patients over 2.5 years (from June 2013 to January 2016).
The case sheets of patients were studied carefully including history, clinical examination, ECG
findings, echocardiographic Study and cardiac catheterization. In addition, the reports of the first
follow up visit around two weeks after implantation were studied.
RESULTS:
The females (61.2%) more than males, syncope (44.4%) and dizziness (33.3%) were the most
common presentations, most of patients (87 patients) represented in class I indication for pacemaker
implantation, CHB (72.2%) was the most common ECG finding, the most common causes of heart
block were unspecified (55%) and post MI (27.7%), the most common pacing mode was VVI mode
(43.3%). The complications of pacemaker implantation were 11.1% and the infections represent
3.1%, In older age group and in diabetic patients the infection incidence increased. The indication of
temporary pacemaker prior to permanent pacemaker implantation was (22.2%), and post-acute MI
and hemodynamically unstable patients were the most common causes (8 patients) and (7 patients)
respectively .
CONCLUSION:
implantation of permanent pacemaker is a save and could be life saving in significant bradycardia,
and complete heart block was the most common cause of pacemaker implantation

BACKGROUND:
Skin biopsy is often considered as confirmatory in case of diagnostic dilemma and is the most
common investigation sought by a dermatologist. Hence, a high diagnostic accuracy of this
investigation is pursued.
OBJECTIVE:
The study was planned to determine the consistency between the provisional clinical diagnosis of
skin diseases and the final diagnosis after clinicopathological correlation.
MATERIALS AND METHODS:
The study was carried out from the 1st of April 2017 to the 1st of April 2018 at dermatology center
Medical City Teaching Hospital. During this period, a total of 440 biopsies were performed, and
110 biopsies were reviewed at the clinicopatholgical meeting every Sunday. Interesting and difficult
cases were presented at the meeting and discussed to reach a final diagnosis. A comparison was
made between the provisional clinical diagnosis and the final diagnosis, and between the
histopathological report and the final diagnosis.
RESULTS:
This study included 110 patients; of them, 65 patients were males (60%) and 45 patients (40%) were
females with the mean of age was 41.6±18.6 yrs. The most frequent conditions were tumors in 51
cases (46.36 %), pupulosquamous diseases 20 cases (18.18 %), infections 11 cases (10 %),
connective tissue diseases 7 cases(6.36 %), vescicobullous 7 cases (6.36 %), & miscellaneous
diseases 14 cases (12.72 %). Concerning tumors, 35 cases (68.63%) were malignant, and 16 cases
(31.37%) were benign. Of these tumours the most frequent tumour was mycosis fungoides; 9 cases
(17.6%), followed by squamous cell carcinoma; 5 cases (9.8%). Regarding the consistency
between provisional clinical diagnosis and the final diagnosis, the current study showed that 21
cases (19%) were consistent, 60 cases (55%) were corroborative, and 29 (26%) of the cases were
inconsistent. This study showed that there was a consistency between provisional clinical diagnoses
and histopathological report in 19 biopsies (17%), 75 biopsies (68%) were corroborative, and 16
biopsies (15%) were inconsistent.Concerning the consistency between histopathological report and
final diagnosis, 68 biopsies (62%) were consistent, while 42 biopsies (38 %) were inconsistent.
CONCLUSION:
Clinicopathological

BACKGROUND:
Cryptorchidism is one of the most common congenital urological disease. The prevalence of
cryptorchidism at birth varies from 2 to 5% and the testis mostly descend during the first 6 months
of life. In large clinical series, the majority, 75-80% of undescended testes are palpable and 60-70%
are unilateral involvement of the right side is more common. The recommended age of orchiopexy
progressivley descreased from 10-15 years in the 1950 until the last decade, orchiopexy is
recommended between 6-12 months.
OBJECTIVE:
The aim of this study was to determine the most of favorable age at which orchipexy should be
performed
PATIENTS AND METHODS:
Fifty 50 newborn boys babys with undescended testes was followed up through two years from
February 2015 to February 2017 in a private clinic in Baghdad. Follow up done every 3 months
included examination of the inguinal and scrotal area to palpate the position of the testis, and history
taken for the family history of undescended testis.
RESULTS:
Forty one (82%) babies with unilateral undescended testis, follow up of 1 year, 36.6% of babies,
the testes were descended down to its normal position, and only one case (2.4%) had incomplete
descent. Those with bilateral undescended testes (9 babies; 18%), only 11.1% of them had complete
descent to normal position.
CONCLUSION:
Boys with retractile testes do not need medical or surgical treatment but require close follow up.
Spontaneous descent of testes from inguinal to suprascrotal or scrotal position are observed in
majority of infant boys during first year of life.

BACKGROUND:
According to world health organization, about 15 million people suffer from stroke worldwide each
year. Acute kidney injury complicates 5-7% of acute care hospital admissions and up to 30% of
critical care patients. These in turn lead to increase disability, decreased quality of life and
disproportionate burden on healthcare resources. Patients admitted for diagnosis and treatment
of acute stroke are at high risk of developing acute kidney injury due to comorbid conditions, poor
oral intake and exposure to nephrotoxic agents.
OBJECTIVE:
to determine the incidence of acute kidney injury in patients admitted with acute stroke and
evaluates associated comorbidities and possible risk factors.
PATIENTS AND METHODS:
in a cross-sectional study, a cohort of 436 patients admitted with acute stroke, (327 with ischemic
stroke and 109 with intracerebral hemorrhage) entailed in this study.
Serum creatinine readings using Jaffe method was obtained at first day of insult, after 48 hours and 7
days after onset of stroke, KDIGO criteria was used to define patients who developed acute kidney
injury which include elevation of serum creatinine of 0.3 mgdl or more within 48 hours or 1.5 fold
or more increment of baseline serum creatinine within 7 days.
RESULTS:
Acute kidney injury was a common complication in acute stroke population with total incidence
13.5%, with significantly higher incidence in intracerebral hemorrhage group (22.9%) than in
ischemic group (10.4%) p=0.000919. The study also show significant sex difference with higher
incidence in males than females in ischemic group (13.4% vs 6.7%; p= 0.049) intracerebral
hemorrhage group (31.5% vs 12.3%; p=0.0246).
Study also shows significant relation between developing acute kidney injury and history of
hypertension in both groups with p=0.00229, and significant relation with diabetes mellitus
p=0.009096.
Study shows that there is significant elevation of serum creatinine on consecutive measures between
first day and day 7 with p=0.000.
We found that there is significant direct relation between increasing age and incidence of acute
kidney injury with p=0.040 in ischemic group and p= 0.015 in intracerebral hemorrhage group.
CONCLUSION:
The incidence of acute kidney injury in acute stroke patients was 13.5% with significantly higher
incidence in intracerebral hemorrhage group with significant relation between development of acute
kidney injury and being male, has hypertension, diabetes mellitus or advance age.

BACKGROUND:
Systemic lupus erythematosus (SLE) is a chronic multisystem autoimmune disorder affecting
mainly young women during childbearing years.
OBJECTIVE:
To assess the prevalence of cervical dysplasia in a group of Iraqi women with SLE and
study the relationship between results of Pap smear and HPV DNA test with disease activity,
disease duration and use of immunosuppressant drugs.
PATIENTS AND METHODS:
A case controlled study was conducted on 55 women with SLE and 55 healthy controls. Full
history was taken and complete physical examination including extensive gynecological
evaluation was done for both groups. High vaginal swab and culture, Pap smears and HPV
PCR test were done to them.
RESULTS:
Patients with SLE were more likely to have cervical dysplasia than control (P=0.022) with
2.1 folds increased risk. HPV infection was found to have no statistically significant difference
between both studied groups (P>0.15). The C1N1 changes were significantly associated with
high SLEDAI scores (P=0.030) and longer disease duration (P= 0.027). There was no
significant correlation neither with the dose nor with the duration of use of
immunosuppressant medications and Pap smear findings (P> 0.05).
CONCLUSION:
The prevalence of cervical dysplasia was higher in SLE patients than controls. Patients with SLE
were more likely to have abnormal Pap smear findings which significantly and directly associated
with disease duration and disease activity than controls.

BACKGROUND:
Pneumoperitoneum with CO2 insufflation is used during laparoscopic cholecystectomy to facilitate
surgical access as it is a minimally invasive procedure, and despite its benefits when compared to the
open cholecystectomy, it is known that pneumoperitoneum has some adverse physiological effects
including an abrupt increase in the arterial blood pressure and an increase in the heart rate due to
increased catecholamines release.
OBJECTIVE:
To investigate the effect of magnesium sulfate on attenuating the hemodynamic response to carbon
dioxide pneumoperitoneum in patients undergoing laparoscopic cholecystectomy.
PATIENTS AND METHODS:
This double blind prospective study was conducted in Rizgari Teaching Hospital in Erbil/Iraq on 60
patients whose ages ranges between (20-45) years to assess the effectiveness of magnesium sulfate in
attenuating the hemodynamic response to cholecystectomy, after dividing the patients into two
groups: group I (magnesium group) and group II control group.
RESULTS:
The increase in systolic blood pressure, diastolic blood pressure, mean arterial blood pressure and
heart rate readings were less in group I (Magnesium group) when compared to group II (control
group) with a statistically significant difference (p < 0.05).
CONCLUSION:
It can be concluded that magnesium sulfate attenuates the hemodynamic response to
pneumoperitoneum in laparoscopic cholecystectomy.
KEYWORDS: Magnesium sulfate, Laparoscopic cholecystectomy,

BACKGROUND:
Plane warts represents a common dermatological problem and self-limiting viral infection of the
skin caused by human papilloma viruses type (3,10,28,29) with no uniformly effective treatment
modality.
OBJECTIVE:
To evaluate and compare the effectiveness and side effect of topical trichloroacetic acid solution in
two concentration (35% & 70%) for treatment of plane warts.
PATIENTS AND METHODS
This is a comparative interventional therapeutic study conducted at the dermatology center of
Baghdad Teaching Hospital / Medical City . Sixty consecutive patients with plane warts were
randomly assigned into two groups of thirty patients each; group A received topical trichloroacetic
acid 35% (9 patients defaulted for unknown reasons) and group B received topical trichloroacetic
acid 70% (8 patients defaulted for unknown reasons) once weekly application by doctor at hospital
with wood stick once weekly until complete responce of the lesions or for at least four weeks.
Patients with complete response follow up monthly for 3 months for detecting recurrence.
RESULTS:
In group (A) 9 (42.85 %) patients from showed complete response, with 9 (42.85 %) patients
showed partial response; the remaining 3 (14.28%) patients showed no response (p value ˂ 0.05)
with complete response (7 from 9) need 4-8 weeks of treatment, while in group (B) 13 (59.09 %)
patients showed complete response, with 8 (36.36 %) patients showed partial response; the
remaining one (4.54 %) patients showed no response, (p value < 0.05) with complete response (8
from 13) need two to four weeks of treatment i.e TCA 70% faster response. Most of patient suffer
from burning sensation & itching as a side effects and few patients with erythema &
dyspigmentaion. There are 2 (9.52%) recurrent cases from group 35% with 1 (4.54%) recurrent case
in group 70% .
CONCLUSION:
both concentrations are effective in treatment of plane warts with a faster response in 70%
concentration.

BACKGROUND:
It is important for primary health care (PHC) physicians to possess adequate knowledge and attitude
towards geriatrics to cope with the increasing number of elderly patients care during their daily
practice.
OBJECTIVE:
To assess the knowledge and attitude of PHC physicians towards elderly and to study the relation
between some factors with physicians’ knowledge and attitude.
PATIENTS AND METHODS:
A cross sectional study was conducted in 31 PHC centers in Baghdad/Al-Karkh for a period of 3
months from 1st of March to the end of May 2018.
A self-administered questionnaire was used for data collection which covered some physicians'
characteristics.
RESULTS:
Out of 225 PHC physicians working at the chosen PHC centers, 200 physicians enrolled in
the study, with a response rate of 88.88%. The results showed that only 27.5% of physicians had
good knowledge levels and 117 (58.5%) had positive attitude. Better levels of knowledge and
attitude were achieved by family physicians, females in addition to those who work for less
than 5 years in PHC centers.
CONCLUSION:
Despite positive attitude of physicians towards elderly, better training and continuing medical
education are important to improve the knowledge of physicians to ensure better services.

BACKGROUND:
Histopathological examination in a patient who did tonsillectomy due to various indications reveals
some of a rare but important incidental pathological finding as choriostomatic tissue (cartilage and
fat) and an unusual bacterial colonization (actinomycosis) in tonsillar specimen.
OBJECTIVE:
The aim of this study is to represent of an unusual finding of choriostomatic tissue in resected
tonsils, and to evaluate the incidence of Actinomyces colonization with disclose their relation to
tonsillar diseases.
PATIENTS AND METHODS:
A case series study design is adopted. The sample of the present study included 100 patients who
have done tonsillectomy are carried out in the ENT Department of Al-jamhori Teaching Hospital in
Mosul city during the period from February 2018 to February 2019.
RESULTS:
In the current study, the most frequent indication for tonsillеctomy is recurrent tonsilitis. Also shows
that there is highly significant relation between incidence of actinomycosis with chronic, recurrent
tonsillitis and hypertrophied tonsils (p=0.000, 0.000, 0.003) respectively, there was
a statistically insignificant relationship between the presence of actinomycosis and age furthermore
there is predominance of actinomycosis in tonsillar obstructive hypertrophy 4 (18.2%), moreover
their occurrence in adult patient is more common than in children. The mesenchyme cartilage is seen
only in two adult cases (male 2.3%, female, 2.9%) has recurrent and chronic tonsillitis, respectively.
CONCLUSION:
A histopathological analysis of the tonsillar specimen aids in the diagnosis of actinomycosis
organisms which are difficult defined in culture. Although choristoma in tonsillectomy specimen is
uncommon entity. However, any patient with recurrent or chronic tonsillitis, suspicion for this
condition should be considered.

BACKGROUND:
congenital nephrotic syndrome occurring in the first 3 months of life and infantile presenting after 3
to12 months.It differs from the nephrotic syndrome in older children in terms of histopathological
finding and carries a poor prognosis.
OBJECTIVE:
To study the diagnosis and treatment of nephrotic syndrome cases manifested in the first year of life
and their outcome.
PATIENTS AND METHODS:
A single-center retrospective study was conducted in the nephrology unit in central child teaching
hospital, Baghdad, Iraq. During the study period from the 1st of July to end of December 2017,
the records of all patients who diagnosed as nephrotic syndrome below one year from January 2007
to December 2016 with minimal follow up of six months in the nephrology department reviewed
and analyzed.
RESULTS:
Seventy cases were diagnosed with nephrotic syndrome below one year from a total number of
nephrotic 620 cases (30 of them congenital and 40 were an infantile type), their mean age 5.242
months. Male was higher than female (67.1% versus 32.9%) with a male to female ratio 2.04:1.
In this study, patient represented infantile nephrotic were the higher proportion (57.1%) than
congenital type (42.9%)both types represented (11.29%)of all nephrotic cases .concerning family
history was slightly higher than those with negative history (52. 9%).The higher proportion of
parents without consanguinity (67.1%).
Study patient who suffered from sepsis were of the higher proportion (62. 9%).In regard to
hypertension in this study (92.9%) had no hypertension with a significant association between
hypertension and infantile type. The proportion of those with elevated serum creatinine was (11.4%),
anemic patients (51.4%) in regard to thyroid function all patients with congenital nephrotic had
hypothyroidism while only (6.2%)of 32 cases with infantile had hypothyroidism. According to
biopsy finding in (60) patients, Finnish type representing (91.3%)of patient with congenital
nephrotic while in infantile type focal segmental glomerulosclerosis represent the highest proportion
(54. 1%). regarding the outcome of study cases (80%) of these cases were ended with no remission,
while remission was noticed among only (20%) of cases.
CONCLUSION:
Nephrotic syndrome in the first year constitute a small percentage of nephrotic syndrome and it had
a poor prognosis, Finnish type represent the highest proportion of biopsy in congenital nephrotic
syndrome and focal segmental glomerulosclerosis highest proportion in infantile type.

Intraductaltubulo- papillary neoplasm of bile
duct (IPNB) is a less common variant of
cholngiocarcinoma comparing it to more
common types, sclerosing or nodular types.
IPNB constitute about 12% of all
cholangiocarcinoma(1). IPNB characterized by a
growth within the bile duct wall, showing
papillary proliferatin of the lining epithelium
having fibrovascular stalk protruding to
the lumen of the bile duct. Tubular subtype,
intraductal tubule-papillary neoplasm (ITPN) is
even rarer variant of IPNB (1).
These biliary neoplasms have been drawn
attention, they are characterized by excessive
mucin production, and they show extensive
papillary configuration into lumen of dilated bile
duct and secrets excessive amounts of mucin.
These neoplasms have various names such as
mucin producing cholangiocarcinoma, mucin
hyper secreting bile duct tumors and intraductal
papillary mucinous tumors of bile duct. They
may resemble intrapapillary mucinous
neoplasms of pancrease, as both arise within
a dilated duct system and demonstrate
predominantly intraductal growth (2, 3).
Tumor location varies by a report. Some reports
showed that the majority of IPNB was located at
the intrahepatic bile duct, whereas the other
showed that the most common location of IPNB
was the hepatic hilum (1).
Sometimes multifocal, with or without
macroscopically visible mucin secretion, and can
be of any type of pathological transformation,
from low-grade dysplasia to invasive
carcinoma(4). But few if any report about periampullary IPNB as our case.
College of Medicine / University of Baghdad
IPNB also may affect pancreatic duct, which is
uncommon, accounting for less than 1% of all
pancreatic exocrine tumors and 3% of pancreatic
intraductal neoplasms, most commonly located
at the pancreatic head , and shows less
aggressive behavior than other pancreatic
malignancies(5).