Journal of the Faculty of Medicine Baghdad

Background: Fibromyalgia has been associated with physical and emotional trauma including invasive medical procedures. Both Fibromyalgia and ischemic heart disease have been linked with depression. The aim of the study is to assess the prevalence of fibromyalgia syndrome in patients with ischemic heart disease.Patients and Methods: A cross-sectional comparative study was done in the Iraqi Center for Heart Disease. One hundred patients, angiographically proved to have ischemic heart disease, were subjected to rheumatologic examination by another physician, and compared to hundred healthy individuals as a control group. Diagnosis of fibromyalgia was based on 1990 American College of Rheumatology Classification criteria for the diagnosis of fibromyalgia.Results: Eighteen (18%) patients with ischemic heart disease fulfilled the American College of Rheumatology criteria for fibromyalgia syndrome in comparison to only 6(6%) of the controls, and this difference is statistically significant (P-value = 0.009).There were statistical significant effects of gender, age, and number of coronary vessels on the prevalence of fibromyalgia syndrome. Conclusion: fibromyalgia occurs with high frequency (18%) in patients with ischemic heart disease.

Background: since the occurrence of transient bacteraemia is fatal following different dental procedures in patients at-risk of bacterial endocarditis, the purpose of this research was to estimate the percentage and nature of bacteraemia following four orthodontic treatment procedures which were: an upper alginate impression, separator placement, band fitting or placement, and arch wire adjustment on a fixed appliance.Materials and methods: the study group consisted of 40 patients (25 females and 15 males) ranging from 17-25 years of age attending Orthodontic Department in the College of Dentistry/Baghdad University, and out patients department from private clinic. The 40 patients were divided into four groups (10 patients each). A cannula was inserted into either the left or right antecubital fossa using an aseptic technique. A 5ml of blood was taken immediately before orthodontic treatment procedure and a second 5ml sample was taken 1-2 minutes after the procedure.Results: the blood samples showed a percentage of bacteraemia of 50%, 40%, 30%, and 20% in cases of post-band placement, post-separator placement, post-arch wire adjustment, and post-alginate impression procedures respectively.Conclusion: this investigation demonstrated that the placement of separator and fitting of band procedures could cause a significant bacteraemia, thus these procedures for patients at–risk of bacterial endocarditis should be placed in consideration, and prescribe the necessarily antibiotic coverage.

Background: Bone disease of hyperthyroidism is a type of high-turnover osteoporosis. In many patients with hyperthyroidism, there is excessive bone resorption, occasionally marked in degree and far exceeding that in the usual patient with osteoporosis. The purpose of this study was to evaluate the bone mineral density (BMD) in hyperthyroid patients in a controlled study.
Patients and Methods. The study group consists of 48 patients with hyperthyroidism who were seen at Specialized Centre for Endocrinology and Diabetes, and at Rheumatology Clinic and Osteoporosis Clinic in Baghdad Teaching Hospital. In all patients, measurement of BMD at the lumbar spine (L1-L4) using dual-energy x-ray absorptiometry (DXA) machine was done.
Results: The BMD was reduced in 40 patients (83.33%). Seventeen postmenopausal women, 2 premenopausal, and 2 men have osteopenia. Fourteen postmenopausal women and 2 premenopausal women have osteoporosis. Osteoporosis was not reported in men.
Conclusion: When compared with control group, the prevalence of osteopenia in hyperthyroid patients was statistically significant in postmenopausal women only (p = 0.013).
Key words: Bone Mineral Density, Iraqi, Hyperthyroid

Background: cerebellar astrocytroma is the commonest paediatric posterior fossa tumor.Patients and method: 54 patients taken from the neuro-surgical unit in the specialized surgical hospital from Aug 1995 till March 2003, all patients studied thoroughly age, gender, Presentation, Radiological diagnoses, surgery, additive therapy & final outcome including 5 years survival & conclusion is reached.Results and discussion: the results show that more than half of the patients were at age 5-7 years with very slight male predominance, most cases diagnosed by CT, some with MRI or MRI alone.Surgery was done for all cases & 16 patients' preceeded by VP shunt. The final out come is compared with other similar studies.Conclusion: cerebellar astrocytoma acommon post fossa pediatric tumor if diagnosed early & proper surgery is done early, good prognosis can be gained.

Back ground: This study was conducted to estimate the relation ship of the incisive papilla to the antero posterior arrangement of the maxillary anterior teeth in a two different groups (Iraqi and Yemenian groups), because incisive papilla is considered as a reliable and relatively stable anatomic land mark.Materials and Methods: Maxillary and mandibular stone casts were collected from 100 dental students, (50) of Iraqi dental students in Baghdad university and (50) of Yemenian dental students in Ibb university at the 3rd and 4th classes. Age ranged from 21-25 years. Alginate impression, dental stone, stock trays were used. Photographic technique was used to measure anatomic land marks located on dental casts. A computerized digital caliper (CDC) tool was used in the measurements which were made on scanned images of dental casts .The distances from midpoint and posterior point of incisive papilla were measured .The area on the incisive papilla where the inter canine distance passed was noted , paired t- test and chi-square test were used to analyze the data.Result: the data obtained suggested that the distance from the labial surface of maxillary central incisors was ranged from 8.9 to 9.92 mm from the midpoint of incisive papilla, this measurement was 8.9 mm in Iraqi sample and 9.92 mm in Yemenian sample. Also the distance from the from the labial surface of maxillary central incisors was ranged from 11.33 to 12.34 mm from the posterior border of incisive papilla , this measurement was 11.33 mm in Iraqi sample and 12.34 mm in Yemenian sample The mean distance of the inter canine line joining the canine cusp tips was 31.9 mm in Iraqi sample and 35.66 mm in Yemenian sample. The differences between Iraqi and Yemenian scores (distance from the labial surface of maxillary central incisors to the mid point and posterior border of incisive papilla in addition to the scores of inter canine distance) were statistically significant (p<0.05). Gender had no significant effect on the relationship of the incisive papilla to the maxillary anterior teeth in both Iraqi and Yemenian samples.Conclusion: These results suggested that there is a relation ship between the maxillary central incisors, canines and incisive papilla aiding in their antero posterior position. Gender did not affect the measurements. Furthermore, these measurements showed a statistically significant difference between Iraqi and Yemenian samples .The clinical revelance of this study lies in application of incisive papilla as a starting point in the preliminary location of maxillary incisors and canine teeth during construction of dentures.

Background: This study was done to assist bond strength of glass ionomer cement reinforced by different amount of Hydroxyapatite Materials and methods: In this study a hydroxyapatite materials were added to glass ionomer cement at different ratios; 10%, 15%, 20%, 25% and 30% (by weight) and the bond strength was detected by construction a cylinders from these mixed materials, constructed on exposed dentine of human extracted premolar teeth and by Zwick’s universal testing machine the bond strength were detected for these mixed materials.Results: Results showed that the glass ionomer cement reinforced by hydroxyapatite has higher bond strength than conventional glass ionomer cement and the hydroyapatite powder to glass ionomer cement powder ratio by weight best to be 25%. Conclusion: The addition of hydroxyapatite to conventional glass ionomer cement increased its bond strength to dentine.

Background: Ministry of Health, since its establishment, adopted the policy of central financing system and free medical services in all health facilities. The sanction and the decline in per capita spending affect the health financing system, thus in 1997 a new financing policy was adopted as pilot in seven specialized hospital called “self–finance” system in which the cost of care was shifted to the patients, i.e. the funds obtained came from user charges at the health facilities. This system was extended (with some modifications) to all hospitals in 1999 and PHC centers in 2001 and implemented until 2003 when it was discontinued.Materials and Methods: During the second half of 2004, a review of hospital records was performed to compare some hospital utilization indicators for a five months period before and after implementing the Self Finance System (October 1998 – February 1999 and October 1999 – February 2000 respectively).A convenient sample of eleven hospitals from the three Health Directorates in Baghdad city were chosen, excluding seven hospitals in which a special form of self finance system was adopted, and the indictors (Bed Occupancy Rate, Hospital Stay Rate, Inpatient Fatality Rate) among each directorate were measured from the hospitals of each directorate before and after implementing the self finance system.Results: The study showed that after implementing the self finance system, the Bed Occupancy Rate in the general wards of both the Medical City and AL-Yarmouk Health Directorates were increased, and decreased in the private wards, the opposite was true for Baghdad Health Directorate, where as the Hospital Stay Rate in the private wards of all Health Directorates and the general ward of Baghdad Health Directorate were higher after implementing the self finance system. Inpatient Fatality Rate increased in all Health Directorates.Conclusions: The implementation of the self finance system affects the utilization of hospitals in many ways, and it has both positive and negative impacts on both the patients and the health professionals.

Background: There is a need for a periodic review of acute bacterial meningitis (ABM) since the pathogens responsible for infection vary with time, geography and patient's age. This study was carried out to describe the epidemiology of different types of meningitis and variables affecting the outcome (improvement, complication and death) Patients and Methods: All the cases of meningitis diagnosed and treated at Ibn- Al-Khateeb Teaching Hospital for the period Jan. 1993 to Dec. 1998 were included in this study. The collected data were age, sex, occupation, date of admission, date of discharge, type of meningitis and outcome of the disease.Results: Out of the total cases, 73.3% were ABM. High rate of ABM was among children < 5 years of age and a significant (p = 0.01) high rate was observed among male (60%) (p = 0.01). Predictors of outcome of meningitis were age, sex, residence, duration of hospitalization and type of meningitis.Conclusion: ABM was predominantly observed in children. The high case fatality rate reported in this study was attributed to the deterioration of health services due to wars and sanctions in 1990s.

ascular injury is still common in countries such as Iraq where both military and urban violence are endemic.
This is a report of a thirty eight year old civilian patient who had been inflicted with shrapnel injury during the 3rd. Gulf war, which had caused two different types of vascular injury with minimal evidence of vascular injury with evidence of only two small wounds in the neck and upper chest at the time of injury but presented few months later with a pulsatile neck mass and palpable thrill across the right supraclavicular area and upper chest.
Preoperative investigations were done including Doppler study and angiography which confirmed the presence of right common carotid artery aneurysm and right subclavian arterio- venous fistula.
Surgical treatment performed sixteen months later by combined trap-door approach and cervical incisions and by the use of scrubner's shunt (which is used for emergency haemodialysis in renal failure patients) as a carotid shunt due to the unavailability of carotid shunt in Iraq to maintain cerebral perfusion during common carotid artery clamping .
Excellent recovery occurred without any neurological sequel.
The report will include also a review of literatures about these rare vascular injuries.