Mustansiriya Medical Journal

Background: Otitis media with effusion is a common disease and causes hearing disability that necessitates early and accurate management. Objectives: Comparison of standard otoscopic tympanic membrane finding, pneumatic otoscopy and tympanometric results with myringotomy finding. Patients and Methods: A prospective study of 60 children (120) ears with a suspicion to have otitis media with effusion that have been done from 1st of Jan 2014 to the 1st of Jan 2015, at Otolaryngology Department in AlYarmouk Teaching Hospital-Baghdad, all patients were underwent a clinical assessment by standard otoscopy, pneumatic otoscopy and audiological assessment by tympanometry, then we compared all results with myringotomy finding as a reference standard for predicting the presence or absence of fluid within the middle ear. Results: there were 53% males and 47% females. Among them 63% were in age group 5-8 years. The main presenting symptom was hearing impairment (90%). Retraction of the tympanic membrane was the main otoscopic findings in 83.5%, from which fluid at myringotomy found in 72%. Type B tympanogram in 47.5% of which 88% revealed fluid in taping. The Sensitivity, specificity and accuracy of tympanogram (A and B) were 89%, 63% and 83% respectively, and for type C1 and C2 tympanograms the results was variable, while for clinical assessment (otoscopy) they were 85.7%, 60.5% and 76.7% respectively, and in (pneumatic otoscopy) the results was 97%, 30% and 73% respectively, and in cases of a combined clinical and tympanometric assessment, the results was 97%, 52% and 86% respectively. Conclusion: Conjunction of tympanometry and pneumatic otoscopy examination increase accuracy.

Background: Diarrheal disease still one of the important problems among children in our governorate (Sulaymani) and ORS is an effective treatment for where they get mild to moderate dehydrations. Objective: To assess the knowledge and attitudes of mothers regarding ORS. Patients and methods: From July 1st 2012 to march 31st 2013, total of 200 mothers enrolled in this study. We collected information regarding their children's age, sex, residence, maternal education, water supply. Their knowledge and attitude evaluated on their awareness about ORS, using, source of education, procedure of preparation and giving it to their children. Those information collected by direct interview of those mothers. Results: 99.5% of mothers were aware about ORS. Only 0.5% (1 mother) was not aware of it. There was significant correlation between both educational level of the mothers and water supply, and persons who gave advice to them on using ORS and drug use. But no significant correlation between mothers knowledge and source of information about ORS. Conclusion: ORS is a very effective treatment for diarrhea in children. Mothers knowledge and attitude to be improved about it.

Background: Polycystic ovarian syndrome was first described in1935 by Stein and Leventhal as classical triad of amenorrhea, obesity and hirsutism Aims of the study: Assessment of oral health status including gingival inflammation by (GI), periodontal situation by (PI), dental status by (DMFT), and salivary flow rate (SFR) and their relationship with the severity of symptoms, and evidence of metabolic syndrome in PCOS patients and assessing the serum and salivary levels of leptin, CRP, and fibrinogen in PCOS patients and find out the associations with the oral health and metabolic syndrome. Patients and Methods: Clinical examination had been done for (42) PCOS women and (30), age and BMI, matched control subjects for blood pressure (systolic and diastolic) and anthropometric measurements (BMI, waist to hip, and waist to height ratios). Oral clinical examination including an assessment of gingival inflammation (GI), periodontal situation (PI), dental status (DMFT), and salivary flow (SFR) had also been done. Samples of blood and whole unstimulated (resting) saliva were collected from all participants then investigated for the level of leptin, CRP, and fibrinogen, lipids (HDL and triglyceride), and FBG had also been measured. Results: Oral health measurements including: GI, PI, and DMFT were significantly higher in PCOS patients, while SFR were less in PCOS compared to controls. Leptin and fibrinogen (in blood and saliva) of the PCOS women were higher than that of controls. Whereas (26.19%) serum and (40.47%) salivary CRP levels >6mg/L, but no one of the controls exhibited high CRP levels. Significant correlation between serum and salivary leptin were resulted in both PCOS and controls, and the same story for CRP and fibrinogen. Elevated levels of the rest variables in both blood and saliva were significantly correlated with MS. GI, PI, and SFR were also significantly correlated with MS, while DMFT was not. GI, PI, and DMFT had significant correlation with BMI in PCOS and controls. Severe gingival inflammation and established destructive periodontitis were significantly correlated with salivary: CRP and leptin, but it were non-significant with salivary fibrinogen and SFR. Conclusion: Saliva was found to be a useful alternative to serum for the determination of leptin, CRP, and fibrinogen in PCOS. The susceptibility for dental carries, gingivitis, and periodontitis may significantly increase in PCOS that gingivitis and periodontitis are common finding in patients with PCOS, and that was supported by significant decrease in salivary flow rate. Salivary leptin and CRP have become important markers for inflammation related to oral health and in assessing the risk of developing cardiovascular disease

Background: Breast imaging modalities potentiates the detection of early, clinically occult breast masses thus allowing early treatment & reduces the mortality rate from breast cancer. Objective: (i) To evaluate the diagnostic value of breast imaging modalities (mammography and / or ultrasonography) for the characterization of nonpalpable breast masses in conjunction with cytology / histopathology. (ii)To assess the relation between the non-palpable breast mass & the breast density, Body mass index & the location of the mass within the breast. Patients and method: The results of mammographic, sonographic & cytologic/ histopathologic examination performed in 50 patients with non-palpable breast mass were assessed to determine the diagnostic value of imaging in characterization of breast mass.The BMI of each patient was calculated & the breast density at mammography was assessed, 10 patients were <35 years old &thus had sonographic examination only,40 patients had both mammography and ultrasonography. All the patients underwent guided FNA & only 23 patients had excisional biopsy. Results :Seven out of 40 mammographically detected masses were malignant (17.5%)and 33 cases (82.5%) were benign ,9 cases out of 50 sonographically detected masses were malignant (18%) and 41cases were benign (82%).These results were correlated with FNAC and /or histopathology. The sensitivity , specificity, positive predictive value negative predictive value & accuracy of mammography was 100%,91.6%,57.1%,100% & 92.5% respectively and for ultrasonography was 100% ,91.1% ,55.5% , 100% & 92% respectively .Most of mammographically detected lesions were in breast of category 2 breast density(72.5%) & the majority of patients were overweight or obese(72%).Most of the lesions were found at the upper outer quadrant of the breast. Conclusions: Ultrasonography & mammography are both sensitive & specific in the diagnosis & characterization of benign and malignant non-palpable breast masses. Patients with high BMI are more prone to have non palpable breast masses particularly at the upper outer quadrants

Background: During pregnancy, certain infections in the mother can be more severe than usual like hepatitis or latent viruses such as herpes simplex virus (HSV) and cytomegalovirus (CMV) can reactivate and infect the fetus. Disseminated herpes simplex (HSV) virus infection during pregnancy is rare, but important to recognize, as disseminated disease can have a serious outcome for both the mother and neonate. Aim of the study: The aim of this study was to identify seroprevalence of HSV-2 in pregnant women in Tikrit city and its relation with abortion. Methods: The current study included 135 pregnant women who attended to Tikrit Teaching Hospital for the period from beginning of October/2013 to the end of April/2014. Blood samples were collected from each woman for laboratory diagnosis of HSV-2 IgG and HSV-2 IgM antibodies. Results: The research revealed that HSV-2 IgG and HSV-2 IgM antibodies were found in 37 (27.4%) and 13(9.62%) respectively out of 135 pregnant women. There was significant correlation between HSV-2 IgG seropositive and age of pregnant women, while no such relation was found between HSV-2 IgM and age. There is no-significant relation between both HSV-2 IgG and HSV-2 IgM antibodies with gestational time of pregnancy. Antibodies of HSV-2/ IgG and IgM were detected in 40.54% and 53.85 % respectively of pregnant women with history of abortion and the result was significant at P< 0.05. There was nonsignificant relation between HSV-2 IgG antibodies and HSV-2 IgM antibodies and No. of abortions. Conclusions: Herpes simplex virus type 2 (HSV-2) infection is one of the important infections in pregnant women. The current study revealed a significant role of HSV-2 in abortion and since the first time infection of the mother associate with risk of transmission of infection to the fetus or newborn and its sequelae it is necessary to screen all pregnant women for HSV-2 infection for proper management.

Background: Placental growth factor (PlGF) is an angiogenic factor, a secondary marker of placental dysfunction in preeclampsia, with known low plasma levels in the disease. Objectives: to evaluate the diagnostic accuracy of plasma PlGF concentrations in women presenting with suspected preeclampsia before 35 weeks’ gestation in determining the need for delivery. Patients & Methods: A prospective study was done at Al Yarmouk Teaching hospital at the Department of Obstetrics and Gynecology, Between the 15th of March 2014 to 14th of January 2015 all pregnant women with gestational age of (20 weeks-37 weeks), who were admitted because of suspected preeclampsia were included in the study. Detailed history and examination was done. Two blood samples were obtained, first sample was for biochemical markers The other for Placental Growth Factor assay. Results: The outcome was delivery of confirmed preeclampsia within 14 days. Of 100women, 47(47%) developed confirmed preeclampsia. PlGF <5th centile had high sensitivity (0.95; 95% confidence interval, 0.87–0.99) and negative predictive value (0.88; 0.83–0.97) for preeclampsia within 14 days; specificity was lower (0.59; 0.41–0.74). Area under the receiver operating characteristic curve for low PlGF (0.87, standard error 0.03) for predicting preeclampsia within 14 days was greater than all other commonly used tests in women presenting with suspected preeclampsia (P<0.001 for all comparisons ). Conclusion: Women presenting before 37 weeks’ gestation with suspected preeclampsia, low PlGF has high sensitivity and negative predictive value for preeclampsia within 14 days.

Background: Mitral stenosis (MS) is a disabling and eventually lethal disease unless treated with valvotomy or valve replacement .It has been proposed recently that measuring the flow convergence region proximal to an orifice by Doppler flow mapping can provide a means of calculating regurgitant flow rate. However, this method also can be used to derive cardiac output or flow rate proximal to stenotic orifices and therefore to calculate their areas by the continuityEquation (area=flow rate/velocity) .Applying this method in mitral stenosis would provide a important way to elicited the underlying concept because the predicted areas could be compared with those measured directly by planimetry. Objectives: To validate the proximal isovelocity surface area (PISA) method in measuring mitral valve area (MVA) in patients with mitral valve stenosis by transthoracic echocardiography. Methods: This is a cross sectional study conducted in Ibn-Al Bitar center for cardiac surgery for a duration from March 2010 to March 2011 We studied patients with mitral stenosis using 2D imaging and Doppler echocardiography. Doppler color flow recordings of mitral inflow were obtained from the apex, and the radius of the proximal flow convergence region was measured at its peak diastolic value from the orifice to the first color alias along the axis of flow. Flow rate was calculated assuming uniform radial flow convergence toward the orifice, modified by a factor that accounted for the inflow funnel angle formed by the mitral leaflets. Mitral valve area was then calculated as peak flow rate divided by peak velocity by continuous-wave Doppler. A=(6.28r2 X aliasing velocity /peak MS velocity)Xα 1/180 Results: In the 60 patients studied, mitral valve area by planimetry ranged from 0.5 to 2.2 cm2 with a mean of (1.15±43 ) . Mitral valve area by the proximal isovelocity surface area (PISA) method agreed well with direct planimetry with no significant p value (p 0.30 ) with no significant effect of mitral regurgitation (P 0.6) or atrial fibrillation (P 0.12) on the relation between calculated and plan metered Area -Proximal isovelocity surface area (PISA) method also agreed well with mitral valve area calculated from the Dopplerderived pressure half-time in sinus rhythm (p 0.7) and in aterial fibrillation (p 0.9),but not correlate well in presence of mitral valve regurgitation with significant p value (p 0.05). CONCLUSION: that PISA is a useful method in the measurement of MVA and can be used as third echocardiographic method in patients with unreliable results with classical echocardiographic methods.

Background: thoracolumbar area of the spine is the most common site for injuries and the surgical treatment of fixation for treatment of unstable burst fracture remain controversy. Objectives: to compare the effect of long and short segment posterior pedicular fixation on vertebral burst fracture without neurological deficit since the subject is controversy. Methods: 14 patients had been taken and divided into two categories A and B, each category consists of 7 patient (5 males and 2 females) whom undergo burst fracture at thoracolumbar region (D12, L1 or L2) which is type B according to “Dennis classification” and all the patient were intact neurologically but had local kyphosis angle more than 15 degree according to Cobb method of measuring. Category A was operated by short segment posterior fixation while category B was operated by long segment posterior fixation. The result was based on the correction of kyphosis angle (immediately and at 18-24 months period follow up), operation’s time, the amount of blood loss and instrumental failure. Result: the long segment fixation was significantly (p<0.05) better than short segment in correction of the angle of kyphosis in long follow up period (more than 18 months) rather than immediate post-operative period. The short segment fixation had instrumental complications (fracture of screws and dislodgement) while there was no instrumental failure in long segment fixation. According to the blood loss and operation time there was also significant differences. Conclusion: the long segment fixation had better result in long term follow up on the angle of kyphosis; there was no instrumental complication (fractures of screws or dislodgment) due to distribution of the weight load on more levels in spite of increase in the time of operation and blood loss which are significant.

Metformin is one of the most common used anti-diabetes drugs for treatment of T2DM. Metformin is considered as anti-hyperglycemic drug, it lowers blood glucose levels in T2DM without producing significant hypoglycemia. Plasma omentin-1 concentrations and expression of its mRNA in human omental adipose tissue were significantly lower in patients with impaired glucose tolerance and T2DM. The objectives of the present study were to establishing and elucidation of omentin-1 serum levels in metformin treated T2DM patients. The selected subjects patients were divided into two groups: Group A: includes thirty of a newly diagnosed T2DM patients with (mean age 49.32± 11.18 years), were initially treatment with metformin at time diagnosis according to ADA criteria. Group B: includes thirty healthy volunteers. The duration of treatment was three consecutive months. After a period of 12 hrs fasting, the blood samples (10ml) were withdrawn from all subjects by vein puncture before starting the study (before starting metformin) and after three months of metformin treatment. There was a significant difference in the baseline serum omentin-1 levels between metformin and control groups (p=0.023) and significant rising in serum omentin-1 levels after three month s duration of treatment with metformin. Conclusions: In newly diagnosed T2DM patients, omentin-1 levels were lower compared to control subjects. Three months of treatment with metformin lead to in a significant elevation in omentin-1 serum levels compared with baseline values.

Objective: Acute coronary syndrome (ACS) is an insufficient supply of the myocardium with oxygenated blood in which atherosclerosis is an essential cause of myocardial ischemia. Adipokine biomarkers plays an essential role in the atherosclerosis and hence coronary artery disease. Serum Omentin-1 is the biomarker that believed to be independently associated with acute coronary syndrome. The present study was carried out to evaluate: serum Omentin-1 in patients with acute coronary syndrome [ST- Elevation Myocardial Infarction (STEMI), Non-ST-segment Elevation Myocardial Infarction (NSTEMI), and Unstable Angina pectoris (UA)], that may help in guiding the diagnosis and treatment. Methods: The study included a total (100) individuals; (75) patients with acute coronary syndrome (ACS) and (25) healthy control. A total number of 75 patients with acute coronary syndrome (ACS) (50 male ,25 female ) as: 25 patients with STEMI (22 male and 3 female) 25 patients NSTEMI(16 male and 9 female ) and 25 patients with unstable angina UA(12 male and13 female)were enrolled in this study all taken from Coronary Care Unit (CCU)at AL-Yarmouk Teaching Hospital periods of study . Each patient was clinically examined by the consultant cardiologist and the diagnosis was achieved by electrocardiograph (ECG), and cardiac enzyme levels. Venous blood used for measuring serum omentin-1, total cholesterol, triglyceride, High density lipoprotein cholesterol and low- density lipoprotein cholesterol, fasting blood sugar, serum creatinine and. Body mass index was calculated according to the following equation: BMI=weight/height2, also blood pressure was measured. Results: Serum omentin-1 levels were significantly lower in patients groups in comparison with control group, while total cholesterol, and low- density lipoprotein cholesterol levels were significantly higher in patients with coronary artery disease than controls. Negatively significant correlation was found between serum omentin-1 with (BMI and total cholesterol). Conclusion: Serum Omentin-1 levels were lower in acute coronary syndrome patients in comparison with control group , serum omentin-1 showed significant changes with the development and progression of acute coronary syndrome and would be valuable in the assessment of patients with acute coronary syndrome. Omentin-1 may be used as a predictor of ACS.

Background In Vitro fertilization IVF can be a very effective fertility treatment. However, we need to have sufficient eggs of sufficient quality in order to make it successful. Both egg quantity and egg quality are very much related to female age A woman’s ability to conceive a child reduces with age, on average, the younger the women have the higher chances of success. Objectives This work is intended to study the impact of maternal age on the outcome of IVF resulting in biochemical pregnancy in Sulaimani region. Methods This retrospective study has being done in Dwarozh IVF private center in Sulaimani, between December 2008 and January 2011 on 125 women. All of these women had undergone thorough IVF treatment according to established protocols. According to maternal age the women were divided in to group 1 below 35 years and group 2 from 36 years and above. For each cycle number of retrieved oocyte, injected oocyte, fertilization, number of embryo transfer, quality and grading of the embryo with the result of biochemical pregnancy has been studied. Then comparison between the two maternal age groups has been done to show the significance of maternal age on the outcome of IVF. Results For the Group 1(G1), the effect of maternal age on Fertilizes oocytes is significant, as the T-value is 37.035577. The P-Value is < .00001. The result is significant at p < .05.and the percentage of positive biochemical pregnancies was 45.83%. While for Group 2 (G2) the effect of maternal age on fertilized oocyte is significant, as the T-value is 58.997473. The P-Value is < .00001. The result is significant at p < .05 and the percentage of biochemical pregnancies were 33.96% Conclusion Maternal age has significant effect on the number of fertilized oocytes and percentage of biochemical pregnancy for the IVF process. The percentage of biochemical pregnancy is more in age group less than 35 years. ABBREVIATIONS: IVF: In vitro fertilization, Oocyte R: oocyte retrieval, MI: Meiosis I, MII: Meiosis II, GV: Germinal vesicle, ET: embryo transfer, Bhcg: Beta human chorionic gonadotropin.

Background: Systemic arterial hypertension and dyslipidemia are major risk factors for cardiovascular disease, and have been shown to be associated with oral diseases. Objective: The objective of this study was to estimate apolipoproteins and lipid profile in patients with oral diseases and systemic arterial hypertension. Methods: This study was conducted at Medical City Hospital during the period from October 2014 until the end of April 2015. Sixty arterial hypertensive patients were enrolled in this study; their age range was (38-50) years and they were compared with 30 healthy subjects as control group. Apolipoproteins A1, B, and lipid profile were estimated for each subject. Results: The serum levels of apolipoprotein B, total cholesterol, triacylglycerol, and low density lipoprotein cholesterol were higher while apolipoprotein A1 and high density lipoprotein cholesterol levels were lower in hypertensive patients with oral diseases as compared to the control, which was statistically significant (P < 0.05). Conclusion: Hypertensive patients with oral diseases had dyslipidemia and need measurement of blood pressure and lipid profile at regular intervals to prevent comorbidities.

Background: ; Inflammation has been found to correlate with endothelial dysfunction and relate to renin-angiotensin system, as a result it has hypothesized that hypertension may be in part an inflammatory disorder.Highsensitivity C- reactive protein( Hs-CRP) is an independent predictor of future cardiovascular events and it predicts risk of incident hypertension. Objectives: of this study is to determine the relationship of the Hs-CRP, a marker of systemic inflammation , with hypertension in hypertensive patients living in United Arabic Emirates. Patients & Methods: This study was conducted in,Dubai between May 2008 and April 2009. 86 patients with hypertension and 84 healthy individuals were included in this study. Hs-CRP and lipid profile;Total cholesterol(TC).Triglyceride(TG),Low density lipoprotein(LDL),and High density lipoprotein (HDL) were measured for both groups. Results: Hs-CRP levels were higher in hypertensive patients than in control, but this difference was not statistically significant (p=0.217).Frequency of low and high risk levels was significantly higher in hypertensive patients than in control (p=0.003),while at average risk levels frequency was higher in control individuals than in patients (p=0.003).Overall there was positive association between increasing levels of Hs-CRP and risk of developing hypertension. There was no significant correlation between Hs-CRP and BMI, (r=0.6,p=0.447).SBP(r=0.0.197;p=0.139) and DBP(r=0.112,p=0.455). ConclusionIn: High s-CRP is an independent risk factor for hypertension ,so it is recommended to be done as part of strategies of global risk assessment.

Background: Nodal osteoarthritis is a type of osteoarthritis and its common worldwide, the etiology is unknown but there are a biochemical markers recognized. Many studies have explain that adiponectin have an important role in the pathogenesis of osteoarthritis, but little is studied about the relation between serum Interleukin-6 , body mass index and bone minerals density with nodal osteoarthritis. Objectives: To evaluate serum level of Interleukin-6 , body mass index and bone minerals density in nodal osteoarthritis patients. Methods: Sixty patients with nodal osteoarthritis and sixty controls were included in the study; serum Interleukin-6, body mass index and bone mineral density were measured in all subjects. Student t-test was applied to find out the significant difference between two means. Result: This study shows a significant increase in body mass index (BMI) in those patients with nodal osteoarthritis ( mean + SD) (31.6 + 8.7 ) , Pvalue < 0.05. the mean of serum IL-6 is significantly increased in patients ( mean + SD) ( 3.2 + 2.2 ) P-value < 0.05 . but not in control group and there’s an obvious decrease in the bone mineral density between nodal osteoarthritis patients and control group( mean + SD)(-2.2+ -1.1) P-value < 0.05. Conclusion: This study shows the role of Interleukin-6 as inflammatory mediator in nodal osteoarthritis and osteoporosis. The BMI has a role in Interleukin-6 level and it\'s increased in nodal osteoarthritis patients.

Background: The surgical treatment of long bone non-union always represents a critical situation for the orthopedic surgeon than treatment of the primary fractures, especially those complicated fractures that were previously treated more than one time by different methods. As it is necessary not only to refresh & “revitalize” the nonunion area, but in need to replace the bone fixation devices and to place a new good amount of autogenous bone graft in the bone gap. Patients & method: This prospective Study was conducted in orthopaedic department of Al-YARMOOK TEACHING HOSPITAL & IRAQI RED CREASCENT SURGICAL HOSPITAL from ( January 2000 till December 2009) on 66 patient (38 tibia,16 feumer,12 humors) ,(23 femal & 53 male) with age range between (18-48 years ), presented with (40%hypertrophic non –union , 32%oligotrophic & 28% atrophic nonunion) were treated with surgical exploration & refreshing of the sclerotic end of the fracture , removing of soft tissue interposition , opening of the closed intra medullary canal, used of copious autogenous cortico-canllous bone graft from iliac bone, after fixation of the fractures by unilateral frame double barr external fixation. Results: management by bone graft & external fixatior used in the treatment of hypertrophic ,oligotrophic & atrophic non united long bone result in (86% excellent result) ,(12 % good result) ,(3%fair result) ,(1% poor result). Conclusion: usage of external fixation + refreshing the fractures end + opening the intramedullary canal +removing of the soft tissue interposition+ used of copious autogenously cortico-canllous bone graft from iliac bone, is an excellent methods for management of long bone non united complicated i.e with previous one or more trial for fixation & treatment but of disastrous effect