Journal of the Faculty of Medicine Baghdad

Background: Laparoscopic sleeve gastrectomy is becoming one of the most common procedures performed for the treatment of morbidly obese patients in the last few years until now.
Objectives: This type of surgery needs to be evaluated regarding the various techniques used and the possible post-operative complications with the exact methods of treating them.
Patients and methods: A retrospective study was conducted on 240 consecutive morbidly obese patients over a period of 3 years (Feb 2011- Mar 2013) in the Saint Raphael Centre of morbid obesity with an average patient body mass index of 45 (35 - 61). They all underwent LSG, and the decreased weight resulting from surgery was analyzed regarding early and late complications. In 40 of the 240 patients, the gastric band was removed 4 weeks prior to the sleeve operation.
Results: Intraoperative difficulties (difficult endotracheal intubation in 7 patients, difficult ports insertion in 6 patients, opening of the staple line in one patient and a bleeding from short gastric vessels in 2 patients). Only 5 patients developed primary haemorrhages (within the first 24 hours post operatively) from the staple line three of them were treated conservatively and the other 2 patients were returned to the theater, no anastomotic leakage or stricture, and no mortality. During a median follow up of 10.6 months (range of 1-3 months), the excess BMI lost reached 52+-23%, and the BMI decreased from 45 +-5 to 33 +- 5 kg/m2. Patient satisfaction scores (1-4) at least one year after surgery was 3.5 +- 0.7.
Conclusion: The early results achieved by following the above outlined surgical steps in 240 consecutive patients who underwent LSG indicates show that this type of morbid obesity surgery is an effective, safe and worthwhile choice for morbidly obese patients as a first treatment option, although long-term results are still pending.

Background: Inguinal hernias are a common medical problem that can significantly decrease the quality of life.Repair of inguinal hernia is one of the commonest surgical procedures worldwide irrespective of the country, race, or socioeconomic state. The inguinal hernia repair has been a controversial area in surgical practice from the time it has been conceived. Laparoscopic inguinal hernia repair has shown a great deal of promise as a treatment for the condition.
Objectives: To compare the outcome of laparoscopic versus open inguinal hernia mesh repair in terms of operative time , analgesics requirement , postoperative complication , hospital stay and return to daily activities and work.
Patients and methods: A prospective study of 80 patients with inguinal hernia repair, carried out during the period from January 2010 till January 2013, Baghdad Teaching Hospital\Medical City, Iraq, to compare the effectiveness and safety of laparoscopic and conventional open mesh techniques. Those patients were divided into 2 groups (each group of 40 patients); 1st group treated by laparoscopic (TAPP) repair and the 2nd one by open technique (mesh repair).
Results: The mean operating time in laparoscopic repair was 55 minutes (45-120) while in open repair it was 38 minutes (30-110) .The laparoscopic repair was superior to open repair in regard to ; less analgesic requirement post operatively , short hospital stay , and faster return to daily activities and work
There was no statistically significant difference between the two groups regarding complications.
Conclusion: Laparoscopic hernia repair is equally safe and can provide less postoperative morbidity in experienced hands Therefore laparoscopic hernia repair can be safely recommended for most cases of inguinal hernia unless laparoscopy itself is contraindicated.

Background: Changes in the indication for splenectomy in hematology, especially in hematological malignancies, has been observed in the last 10 – 15 years. Yet splenectomy, as a diagnostic tool, is still an option in the management of isolated splenomegaly.
Objectives: to describe the outcome of diagnostic splenectomy in the management of 12 patients presenting with isolated splenomegaly.
Patients and methods: Between August 2005 and July2012, Twelve patients underwent splenectomy for diagnostic purposes in the hematology unit / Baghdad Teaching Hospital. Analysis of these patients was done with a median follow up of 16 months (6 months -4 years).
Results: The median age was 46 years (range 25-68). The median duration of symptoms was 6.8 months (range 3-12) months. The median duration of follow up was 16 months. We had 8 females, and 4 males. Three patients were asymptomatic, but they had progressive enlargement of spleen over one month. The most common symptoms were malaise and abdominal pain, seen in 8 patients. The other less frequent symptoms were fever (5 patients), weight loss (5 patients), arthralgia (4 patients), while the bleeding manifestation was seen in one patient only. Anemia was seen in 5 patients, two had leucopenia, and two had thrombocytopenia. Focal lesions in the spleen were seen in two patients by ultrasound and CT scan. The results of bone marrow aspirate and biopsy, upper gastrointestinal endoscopy and serological tests for collagen vascular diseases all were unrevealing prior to splenectomy. The histopathological results were; Hodgkin disease(1 patient), intermediate grade Non-Hodgkin lymphoma(1 patient) , splenic marginal zone NHL(2 patients),Diffuse Large B Cell Lymphoma(1 patient), Gaucher's disease(1 patient), favor myeloproliferative disorders(1 patients), one patient had tuberculosis, while 4 patients ended with non-diagnostic results. Laproscopic splenectomy was done in one patient only. Postoperative complications were seen in 4 patients which were grade 1-2 bleeding and simple wound infection. During follow up one patient with undiagnostic reports proved to have collagen vascular disease & two patients developed lymphoma, and the last one developed features of myeloproliferative disorder.
Conclusion: splenectomy for isolated splenomegaly has a significant impact on the management of a significant proportion of those 12 patients. Other investigations which help in the diagnosis of collagen vascular diseases, myeloproliferative disorders& lymphoproliferative disorders are needed before proceeding for splenectomy.

Background: Guidelines for blood products transfusion are needed to avoid unnecessary blood transfusion in acute and chronic anaemias to minimize complications.
Objective: To evaluate the practice of blood transfusion in Baghdad Teaching Hospital.
Patients and methods: One hundred and sixty adults Iraqi patients, who had blood transfusion, were selected randomly from different wards of Baghdad Teaching Hospital including General Medicine (GM), General Surgery (GS), Gynecology/Obstetrics (G/O), forty patients from each ward, from October 2011 to October 2012. Collected data included age, gender, type of ward, indication for transfusion, pre-transfusion packed cell volume (PCV) and hemoglobin (Hb), type (whole blood or red blood cells (RBCs)) and number of units transfused.
Results: Pre-transfusion PCV was >30% (Hb >10gm/dl) in 23.1% of the patients, and were highest in G/O (47.5%) and GS (37.5%) wards. Whole blood was given instead of RBCs to 60% of patients (100% in G/O and GS).Single unit blood was given to 22.5% of patients (37.5% in G/O and 35% 1n GS.
Conclusion: There is general unawareness of the risks of blood transfusion in Baghdad Teaching Hospital as shown by the use of whole blood instead of RBCs and single unit transfusion, so a more restrictive strategy is needed by following the international guidelines.

Background: Guidelines for blood products transfusion are needed to avoid unnecessary blood transfusion in acute and chronic anaemias to minimize complications.
Objective: To evaluate the practice of blood transfusion in Baghdad Teaching Hospital.
Patients and methods: One hundred and sixty adults Iraqi patients, who had blood transfusion, were selected randomly from different wards of Baghdad Teaching Hospital including General Medicine (GM), General Surgery (GS), Gynecology/Obstetrics (G/O), forty patients from each ward, from October 2011 to October 2012. Collected data included age, gender, type of ward, indication for transfusion, pre-transfusion packed cell volume (PCV) and hemoglobin (Hb), type (whole blood or red blood cells (RBCs)) and number of units transfused.
Results: Pre-transfusion PCV was >30% (Hb >10gm/dl) in 23.1% of the patients, and were highest in G/O (47.5%) and GS (37.5%) wards. Whole blood was given instead of RBCs to 60% of patients (100% in G/O and GS).Single unit blood was given to 22.5% of patients (37.5% in G/O and 35% 1n GS.
Conclusion: There is general unawareness of the risks of blood transfusion in Baghdad Teaching Hospital as shown by the use of whole blood instead of RBCs and single unit transfusion, so a more restrictive strategy is needed by following the international guidelines

Background: Chronic Obstructive Pulmonary Disease (COPD) represents one of the major causes of chronic morbidity where, airflow limitation is caused by a mixture of small airways disease and parenchyma destruction.
Objective: to correlate the clinical characteristics of patients with COPD with imaging classification into phenotypes.
Patients and Methods: Thirty patients with stable COPD were examined by chest CT. Bronchial wall thickness is evaluated by measuring the wall area percentage by identifying the trunk of the apical bronchus of the right upper lobe, while the extent of emphysema was assessed using the percentage of lung voxels with X-ray attenuation values less than -950 HU {automatically calculated by special software}.
Results: Three phenotypes were found: A phenotype (airway-predominant) , 66.6% of total, E phenotype (emphysema predominant), 20% of total and M phenotype (mixed), 13.3% of total.
Conclusions: Using volumetric chest CT in patients with chronic obstructive pulmonary diseases determine three disease patterns. Airway predominant disease which correlate to patients who have clinical & spirometric pattern of chronic bronchitis rather than emphysema. Emphysema predominant on CT correlated with patients with clinical findings of lung hyperinflation rather than bronchial inflammation. Patients with mixed CT findings combined of both previously mentioned types found to be correlated with those with overlapped clinical patterns of both chronic bronchitis & emphysema.

Background: Obesity is a public health concern worldwide associated with significant health risks and comorbid conditions. Obesity might be a strong factor that can induce left ventricular systolic dysfunction and eventually cause heart failure independent to coronary artery disease or other morbidities. In uncomplicated obese subjects, diastolic dysfunction is caused by hemodynamic and metabolic factors.
Objectives: To assess the left ventricular (systolic and diastolic) function in a sample of overweight and obese subjects using different Echocardiographic tools and exploring the percentage and type of diastolic dysfunction in those people.
Subjects and methods: one hundred seven (107) normal adult males subjects with a mean age of (39.3± 7.5) years were involved in this study. The study was performed during the period from September 2012 until July 2013, at the echo unit of Ibn Al-Bitar hospital for cardiac surgery.
Results: Regarding E/A ratio there were statistically significant decrease in the E/A ratio of Group 1(normal body weight) when compared with that of Group3(obese). Deceleration time(DT), Isovolumetric relaxation time(IVRT) and E/Vp ratio showed a statistically significant increase when comparing Group1 with Group3. Regarding velocity of flow propagation(VP) there were statistically significant decrease when comparing Group1 with Group2 and Group 1 with Group3. Higher percent of subjects in group1 developed normal diastolic function(44%), while higher percent of subjects who found to have impaired relaxation were those in group3(68%), also higher percent of subjects with pseudonormal type were found in group3(57%) when compared to group1& 2.
Conclusion: The relationship between BMI and diastolic function parameters is continuous and independent of cardiovascular risk factors that cluster with obesity, such as hypertension, diabetes, and LV hypertrophy. The overweight status is already associated with an impairment of LV diastolic function, close to that observed in obese persons.

Background: A number of different types of fluid may accumulate in the pleural space, the most common being transudate, exudate (thin or thick), blood and chyle. All types of pleural effusion are radio graphically identical, though historical, clinical and other radiological features may help limit the diagnostic possibilities. Sometimes, also CT and MRI can help to specify the diagnosis.
Objective: To determine the accuracy of computed tomography (CT) in enabling differentiation of pleural exudates from transudates.
Patients and methods: forty three consecutive patients (43 effusions) underwent contrast-enhanced CT. Thoracocentesis was performed to measure pleural and serum total protein values. Effusions were classified as exudates with accepted criteria. CT scans were evaluated for the presence and appearance of: parietal pleural thickening, visceral pleural, thickening, extra pleural fat thickening, measurement of CT attenuation values for each of the pleural fluids.
Results: 34 effusions were exudates and 9 were transudates. Twenty of the 34 exudates (59%) were associated with parietal pleural thickening. 67% of empyema and 86% of the parapneumonic exudative effusions had pleural thickening. The specificity of this finding in diagnosing the presence of an exudate is 88%. The mean value in Hounsfield units of an effusion was determined using a region of interest on the three slices with the greatest quantity of fluid.
Conclusion: Ultrasound is done to detect pleural effusion ,which sometimes cannot be detected by conventional radiography , but characterization of the pleural fluid cannot be done by ultrasound because CT attenuation with additional pleural CT appearance features such as fluid loculation, pleural thickness, and pleural nodules are helpful in differentiating exudates from transudates, because we found that their prevalence is higher among exudative effusions .so ultrasound is done to detect the effusion ,but its characterization is done by CT.

Background: ultrasound offers non-invasive, rapid and simple method for confirming the clinical diagnosis of maxillary sinus pathologies.
Objective: to evaluate the accuracy of real time ultrasound compared with the computed tomography in evaluation of maxillary sinusitis.
Patients and materials: This comparative cross-sectional study was done on 42 patients referred for computed tomography examination of paranasal sinuses in Al-Yarmook Teaching Hospital-Baghdad, from October 2012 to February 2013 with patients clinically suggesting an underlying maxillary sinusitis. Ultrasound and computed tomography examinations were carried out on the same day, the ultrasound being the first investigation. The sample of this study consisted of 26 men and 16 women. The age of patients ranged between 20-60 years, mean age equal to 38 years. Our patients were randomly selected.
Results: The results are based on the data analysis of total forty two [84 sinuses] patients with symptoms and/or signs of maxillary sinus diseases. In this study, real time B-mode ultrasonography of maxillary compared with computed tomography had a 81.8% sensitivity, 100 % specificity and 90.4% accuracy. The present study showed that total opacity of the maxillary sinus on computed tomography frequently gave a positive full sinus scan [77.7%] while the rest shows partial sinus scan [22.3%]. All patients with positive full sinus scan on ultrasound of maxillary sinuses have total opacity on computed tomography. Conclusion: Ultrasound can help as one of primary investigations of maxillary sinusitis. A positive full sinus scan appeared specific for total opacity of the maxillary sinus on computed tomography. A postural adjustment of the patient slightly bent foreword reduces the false negative results.

Background: Epidemic keratoconjunctivitis (EKC) is a viral conjunctivitis caused by a group of adenoviruses. EKC is highly contagious and has a tendency to occur in epidemics.
Objectives: The aim of this study is to evaluate the efficacy of fluorometholone(0.1%) eye drop in the management of viral EKC in Al-Ramadi city .
Patients and methods: 300 patients were examined in the private clinic at Al-Nahrain Eye Specialty center from February 2009 to September 2011 and follow up of the patients extended from 3months to 12 months.Those patients were divided into two groups: first group includes 150 patients(95 males and 55 females, aged from 1 year to 65 years) was treated by cold compresses with lubricant eye drop without the use of fluorometholone eye drop.Second group includes 150 patients(80 males and 70 females, aged from1 year to 65 years) was treated by cold compresses with lubricant eye drop and fluorometholone (0.1%) eye drop.
Results: Regarding the first group, this study showed that recovery without sequelae was noted in 63(42%) patients. Corneal subepithelial opacities were detected in 76(50.6%) patients, while 10(6.6%) patients developed conjunctival scarring, and only one (0.6%) developed conjunctival cyst.
Data from the second group showed that 120(80%) patients recovered without complications, while 30(20%) patients developed subepithelial opacities and no one(0%) develop conjunctival scarring or conjunctival cyst.
Conclusion: Use of fluorometholone eye drop in treatment of EKC : Alleviate the patient's symptoms, decrease the course of the disease and decrease the occurrence of subepithelial opacities.
So it is recommended to use fluorometholone (0.1%) eye drop in the treatment of EKC.

Back ground: Fibromyalgia syndrome (FMS) is a common chronic musculo-skeletal disorder resulting in chronic widespread pain impacting on quality life.
Objectives: To assess the relationship between FMS and knee osteoarthritis (KOA) and to evaluate the predictors of this relationship if present.
Patients and Methods: One hundred Iraqi KOA patients and 100 healthy controls were included in this cross-sectional study. Full history was taken and complete clinical examination was done for all patients. Baseline characteristics [age, sex, duration, body mass index (BMI), waist circumference, family history (Hx) of KOA, smoking history, and drug history.] were also documented. Laboratory analysis included complete blood count, erythrocyte sedimentation rate (ESR), thyroid stimulation hormone, serum calcium, serum alkaline phosphatase, serum phosphate, and anti-nuclear antibody were done for all patients. X-rays of both Knees was taken for patients and was graded according Kellgren and Lawrence scale. The American College of Rheumatology (ACR) criteria for classification and reporting osteoarthritis of the knees were applied on both groups. Individuals in both groups were assessed for FMS and the American College of Rheumatology 1990 Criteria for fibromyalgia were applied for both groups. Comparative statistics were done using Chi square test for categorical variables and students' independent 2 samples (t) test for continuous variables.
Results: FMS was present in 26 of 100(26%) KOA patients compared to 7(75%) of 100 of controls [odd ratio (OR)=4.6(95% CI(1.92-11.35),p=0.001]. Frequencies of associated features (headache, sleep disturbances, fatigue, depression, anxiety, and parasthesia) were significantly more in patients than that of controls (P<0.05). Longer duration of KOA, higher waist circumference, and positive family Hx of FMS were significant associates with FMS in the patient group (P<0.05). However no significant association was found with age, sex, BMI, grade of KOA, drugs taken marital status, and increased ESR.
Conclusions: FMS was significantly increased in Iraqi patients with KOA compared to controls. Longer disease duration of KOA, large waist circumference and family history of FMS were significant predictors

Background: Fibromyalgia syndrome and psoriasis share various soft problems. In addition, patients with psoriasis can experience subjective joint swelling and pain (Fibromyalgia syndrome) and objective swelling (Psoriatic arthritis) with the latter requiring systemic disease modifying antirheumatic drugs while the former requires anti-fibromyalgia measures.
Objective: To assess the rate of fibromyalgia syndrome in a sample of Iraqi patients with psoriasis.
Patients and Method: A sample of one hundred and twenty Iraqi patients with psoriasis and another one hundred and twenty healthy individuals matched for age and sex, serving as control group were studied. Full history was taken and complete clinical examination was done and various laboratory investigations were carried out for all individuals in both groups. The American College of Rheumatology 1990 criteria for Fibromyalgia syndrome were applied for individuals of both groups.
Results: Fibromyalgia was present in 32 (26.7%) psoriatic patients compared to 13 (10.8%) individuals of the control group (P=0.0016). We found that psoriatic arthritis as well as treatment with systemic therapy (chemotherapy) are significant predictors for development of Fibromyalgia in a rate of 17 (14.2%) (p. value =0.001), 20 (16.7%) (p. value =0.0001) respectively.
Conclusion: There is a significant association between Fibromyalgia Syndrome and psoriasis.

Background: Fibromyalgia syndrome and psoriasis share various soft problems. In addition, patients with psoriasis can experience subjective joint swelling and pain (Fibromyalgia syndrome) and objective swelling (Psoriatic arthritis) with the latter requiring systemic disease modifying antirheumatic drugs while the former requires anti-fibromyalgia measures.
Objective: To assess the rate of fibromyalgia syndrome in a sample of Iraqi patients with psoriasis.
Patients and Method: A sample of one hundred and twenty Iraqi patients with psoriasis and another one hundred and twenty healthy individuals matched for age and sex, serving as control group were studied. Full history was taken and complete clinical examination was done and various laboratory investigations were carried out for all individuals in both groups. The American College of Rheumatology 1990 criteria for Fibromyalgia syndrome were applied for individuals of both groups.
Results: Fibromyalgia was present in 32 (26.7%) psoriatic patients compared to 13 (10.8%) individuals of the control group (P=0.0016). We found that psoriatic arthritis as well as treatment with systemic therapy (chemotherapy) are significant predictors for development of Fibromyalgia in a rate of 17 (14.2%) (p. value =0.001), 20 (16.7%) (p. value =0.0001) respectively.
Conclusion: There is a significant association between Fibromyalgia Syndrome and psoriasis.

Back ground: Celiac disease (CD) is an immune–mediated enteropathy induced by gluten with broad spectrum of presentation, many patients with atypical symptoms or clinically silent remain undiagnosed, and are at risk of long-term complications.
Objective: The aim of the present study is to determine the of prevalence celiac disease in children with short stature.
Patient and Methods: In this prospective study, 307 children 181(58.9%)males and 126(41.1%) females ,with ages ranging from 3 to 17.5years ( mean 12.2 ±3.4) with short statures (height below 3rd percentile adjusted for age and sex) attending the consultation room of endocrinology/ Welfare Teaching Hospital/medical city- Baghdad , were enrolled in this study from the first of Oct 2008 to the first of Aug 2010.Full history, thorough physical examination, immune-biochemical tests ; complete blood count ,renal function tests, serum electrolytes, thyroid function tests, immunoglobulin A and G, tissue transglutaminase (tTG) antibodies , and intestinal biopsy for those with positive celiac serological screens, growth hormone estimation, radiological assessment of bone age, genetic counseling for some females (when available) was done . Each celiac disease case once diagnosed was started on gluten free diet and followed up for one year for growth parameters.
Results: celiac disease (CD) was found as the second most common cause of short stature. Unfortunately there was delay in the diagnosis due to asymptomatic status of the disease. Complete catch up in growth had been found in 63.6% after one year of gluten free diet.
Conclusion: Celiac disease is an important cause of short stature in children, and should be an essential part of screening panel and workup of short children, irrespective to the presence or absence of gastrointestinal symptoms.

Background: Pain after amputation is a common squeal, patients often have a phantom limb sensation too, which can be painful or painless.
Objectives: This study describes the sensations and pain reported by patients after traumatic amputation of unilateral lower limb as well as the incidence and epidemiology of those sensations.
Patients and methods: A retrospective study of 118 patients who underwent lower limb amputation due to trauma. Patients scheduled for interview by means of a standard questionnaire and examined, days, weeks, months, years, after surgery about limb pain, phantom limb sensations, stump pain, back and shoulder pain .
Results: Statistical analysis revealed that the incidence of non-painful sensation was the commonest and more frequent than phantom limb pain. Back pain disturbing the amputee more than phantom limb pain. Phantom pain was significantly less common in patients with below knee amputation than above it.
Conclusion: Phantom limb pain and shoulder and back pain problems warranting further clinical attention and analysis.

Background: Every hospital with delivery services should have skilled nurses immediately available for neonatal care, and appropriate equipments should be present at all deliveries. The first hour after birth has a major influence on the survival, future health, and well being of a newly born infant. The nurses have an important role at this time, the care they give during this period is critical in helping to prevent complication.
Objectives: The study aims to evaluate nurses’ practices toward care of the newborn infant immediately after birth in delivery rooms and finds the relationship between the nurses' practices and their demographic characteristics.
Methodology: A descriptive study was carried out in 3 teaching hospitals (Al-Yarmouk Teaching Hospital, Al-Karama General Teaching Hospital, and Al-karkh Maternity Teaching Hospital) in Baghdad City, Iraq, from the 22th May 2013 to 30 July 2013. A purposive (non probability) sample of 40 nurses who are working in the delivery room in these hospital. The data was collected through using constructed questionnaire which comprises 44 items and filled by using interview technique. The reliability of the questionnaire was determined through a pilot study and validity through a panel of experts. The data were analyzed through the application of descriptive statistic frequency, percentage, and the application of inferential statistical procedures, which include Pearson correlation coefficient and chi-square.
Results: The study results shows that (30.0 %) of the study sample were 36-40 years old, (40.0 %) graduated from medical institute, (75.0%) were married, (32.5%) have more than 16 years of employment in nursing, (30.0 %) have more than 16 years of practices in maternal delivery room,(55%) of them have training session and (72.5%) participate in training session inside of Iraq. The Percentages for total nurses' practices scores toward care of the newly born immediately after birth includes 25% for physical examination, 30% for neonatal supplies and equipment, 25% for providing warmth and 20% for preventing injury, infection and provide feeding. The study demonstrated that there was poor nurses' practice about care of the newborn infant immediately after birth in delivery rooms
Conclusions: The study comes to the following conclusions: The nurses were poor practices in caring for the newborn babies immediately after birth in delivery rooms.

Background: Breast cancer is the leading cause of cancer death among women worldwide and in Iraq.
Objectives: To evaluate the reliability of the immunocytochemical method in breast carcinoma aspirates with those obtained by immunohistochemistry of the corresponding excised breast tissue sections.
Patients and methods: This is a prospective study. A total of (41) patient complain from malignant breast lump and (10) cases with benign mass (fibro adenoma) visited the Oncology Teaching Hospital in the Medical City in Baghdad during the period from the first of April 2012 to the end of December 2012. FNA sample taken for routine cytopathological and immuncytological study and the patient where followed up and immunhistological study was done for mastectomy or tissue biopsy samples.
Results: The diagnostic sensitivity, specificity, PPV, and NPV of estrogen receptor ICC staining as Compared to the ER IHC were 92%,62%,50% and 95% respectively. The overall accuracy was 59.2%.The diagnostic sensitivity, specificity, PPV, and NPV of progesterone receptor ICC staining as Compared to the PR IHC were 93%, 62%, 58%, and 94% respectively. The overall accuracy was 73.2%
Conclusion: There was no statistically significant correlation between ER , PR expression in both ICC and IHC

Background: In recent years, bone marrow angiogenesis is indicated to be involved in the pathogenesis and progression of certain hematological malignancies like acute leukemia, lymphomas, and multiple myeloma. Recent studies have suggested that bone marrow angiogenesis plays an important role in the pathogenesis of adult acute lymphoblastic leukemia and also has prognostic value in the disease.
Objectives: at the present study, bone marrow angiogenesis in ALL will be examined using immunohistochemical staining for CD34, and this will be correlated with various pathological, laboratory and clinical parameters.
Patients and methods: A retrospective cross-sectional study was done on 60 patients with acute lymphoblastic leukemia (32 males & 28 females) compared with 20 controls (anemic patients), all recruited at the Medical City Hospital/ Teaching Laboratories/ Baghdad from January 2010 to December 2012. The bone marrow biopsy of each was re-examined histologically. BM angiogenesis was studied by immunohistochemical staining for CD34 to identify microvessels.
Results: The bone marrow microvessel density was markedly and significantly increased in patients with acute lymphoblastic leukemia compared with bone marrow controls (p = 0.0001). There was a significant association between angiogenesis grade III and WBC count more than 30×109/L (P > 0.0001).
Conclusions: Angiogenesis in ALL was significantly higher than control group. Increase angiogenesis confirmed by IHC was significantly correlated with high WBC at diagnosis. These observations suggest that the combination of anti antiangiogenic therapy might apply to leukemia.

Background: Neonatal septicemia is a significant cause of morbidity and mortality worldwide especially so in developing countries. To reduce the mortality caused by neonatal septicemia, it became vital to diagnose it as soon as possible and treat with administration of appropriate antibiotics.
Objective: To study the relationship between themicroorganisms isolated from septicemic neonates with place of delivery.
Patients and Methods: Blood sample was obtained from 76 neonates (50 of them are born in Baghdad teaching hospital (Inborn), 26 of the babies are born at home or in Al-Elwya teaching hospital (out born) ,the laboratory diagnosis for the out born patients done in the same hospital(Al-Elwya teaching hospital .The aged of the neonates ranged from1 hour-28 days. These neonates are diagnosed clinically (poor feeding, respiratory distress, fever, hypothermia, gastrointestinal and/or central nervous system symptoms) and bacteriologically to have neonatal septicemia.
Results:One of the most important neonatal factors predisposing to infection is place of delivery, in our study significant number of babies was had sepsis at inborn group (65.8%) as compared to out born (34.2%). Gram negative bacteria constituted 71% of the total isolates.
(28%) of neonates born in Baghdad teaching hospital (inborn) were infected with K. pneumoniae, (24%) of them were infected with S.aureus, and (10%) of them were infected with E. cloacae and P. aeruginosa equally. On the other hand (26.9%) neonates born at home or in any other hospital (out born) were infected with E. coli followed by Enterobacter species (23%).
Conclusion: inborn babies were at higher risk for infection with K. pneumoniae and S. aureus, whereas out born babies were at risk of E.coli infection.

Background: Urinary tract infection (UTI) is the most common bacterial infection in women in general and in postmenopausal women in particular. Bacteriuria occurs more often in elderly functionally impaired women but in general many of it are asymptomatic.However the risk factors associated with recurrent UTI in elderly women are not widely described.Bacteuria in elderly women is associated with high mortality rates ,however many of thus bacteriuria are asymptomatic (Assel et al.,2009).The belief that diabetes ,a common metabolic disorder is associated with ahigher risk of UTI is widespread,diabetes result in several abnormalities of the host defense system that might result in a higher risk of certain infection.
Patient and Method: The prospectiye study included 200 cases of urinary tract infection with diabetes mellitus type 2 in postmenopausal women visiting Medicine out patients and in patients Clinic of Medical City Teaching Hospital in Baghdad city. This study period was from 15 November 2011 till 15 June 2012. Urine Samples were collacted from women under supervision of the specialist’s physicians. General urine examination was accomplished for each patient. For patients suspected with DM type 2the Glycosylated haemoglobin (HbA1c) level was measured considering also the duration of diabetes. The urine samples were inoculated directly onto enrichment and selective media for the isolation of the causative bacteria. The isolates were identified using different microscopical, culture characteristics and biochemical testes.
Results: Totally in the four studied groups E.coli was the most common isolates bacteria 39(23.0%),followed by Klebsiella 26(15.3%),Candida albicans 25(14.7%),non hemolytic streptococcus 30(6.5%), Moraxilla catarrhalis 28(16.5%) and diaphtheroid 23(13.6%). Wherease Staphylococcus aureus comprised 13(7.7%). There was no significant relation shipe between type of uropathogenes and HbA1c level .However the relation was significant between uropathogenes and kind of diabetes treatment and duration of diabetes. E.coli and klebsiella growth isolated from diabetic cases was heavy rather than moderate growth.
Conclusion: In postmenopausal women the incidence of UTI in age group 50-60 yrs was higher than that of 61-70. However there was no significant difference between diabetic and non diabetic women groups, The risk of UTI was higher with longer duration of diabetes rather than degree of glycemic control (HbA1C), women undergoing pharmacological treatment for diabetes were mainly at higher risk suggesting association between severity of diabetes and risk of UTI, E.coli was the most single isolated organism in all women as well as young women.

Background: Patients on maintenance hemodialysis are at increased risk of infection with parentally transmitted viral agents. In recent years a high prevalence of hepatitis G virus infection among end stage renal diseases and chronic hemodialysis patients has been well documented.
Objectives: To assess the percentage and risk factors of HGV in hemodialysis patients, and to evaluate the clinical consequences of HGV in this population.
Patients and methods: Fifty (50) patients with chronic renal failure who underwent maintenance hemodialysis. Patients were currently attending hemodialysis department of Baghdad teaching hospital during the period of October 2011 to January 2012, compared to forty one (41) healthy blood donors who underwent a full blood screening tests collected from blood bank. Aged matched as a control group. Anti-Hepatitis G antibodies (IgM and IgG) were detected using enzyme linked immunosorbant assay and HGV-RNA was determined by RT-PCR.
Results: Hepatitis G virus -IgM and HGV-IgG were detected in 26 patients (52%) and in 36 patients (72%) respectively. HGV-RNA was detected in 16 patients (32%). Furthermore, nine (18%) patients revealed HGV-RNA bands and gave a positive HGV-IgM. Hepatitis G virus was significantly associated with the history and numbers of blood pints intake among hemodialysis patients, while there were no association with the hemodialysis duration, history of renal transplant nor with raised liver enzymes.
Conclusions: Our results showed that hemodialysis patients carry the risk for HGV infection as a major possibility of parenteral transmission, especially by transfusion of blood and blood components. Decisions to screen blood supplies for a transfusion-transmitted infection agent should be based on sufficient benefits for recipients

Background: Visceral Leishmaniasis( VL ) is a systemic infection of the reticulo- endothelial system that could affect the immune system and biochemical parameters like the concentration of Copper which may be significantly hanged .
Objective: The study aims to evaluate the level of cytokines (INF- γ ,IL-10 ) and trace element (Cu ) in Visceral Leishmaniasis in children after diagnosis .
patients and Methods: A total of 98 children, whose their ages ranged (6 menthes -5 years) were attending the Central Public Health Laboratory and Teaching Laboratories of Medical City, who were suspected to be infected with kala- azar, who were diagnosed by both IFAT technique and Rapid Kala-azar (r-K39) detecting test and trying to evaluate the level of cytokines (INF- γ , IL-10) by ELISA and concentration of ( Cu ) by Atomic Absorption Technique
Results: The dipstick test ( r-K39) showed a high sensitivity of (92.1%) compared to IFAT (73.6%) with a specificity of 100% for both tests. Serum samples of 56 child with positive results in IFAT and rK39 test were used for the investigation of IL-10, IFN-γ. The mean levels of IL-10 (80.207±77.54 Pg/ml) and IFN- γ (5.426±4.599 IU/ml) were highly significant increased in patients compared to healthy controls. The mean level of serum Cu (171.54±10.37 μg/dl) in VL patients.
Conclusions: This study showed that the ( r-K39) dipstick test could be more sensitive than IFAT technique in the diagnosis of VL with a specificity of 100 % for both test according to clinical diagnosis. Both IFN-γ & IL-10 were significantly increased in VL patients as compared to controls group. Copper concentration was significantly higher in VL patients than healthy controls.

Background:-M. pneumoniae is an important human pathogen that produces community-acquired respiratory tract infection. Diagnosis of M. pneumoniae infection is challenging and crucial for the timely initiation of the effective antibiotic therapy.
Objective: This study has been undertaken to detect M. pneumoniae in respiratory samples (throat swabs, throat wash and sputum) in patients with respiratory tract infection qualitatively by conventional polymerase chain reaction (PCR). Also, more advanced one, real time PCR was used to determine mycoplasmal target gene qualitatively and quantitatively.
Patients and methods: The study was performed on Seventy-five patients and thirty healthy subject as control. Genomic DNA was extracted and M. pneumoniae target gene (lipoprotein gene) was amplified using conventional PCR. Negative, positive controls and internal controls were involved in each experimental run. The amplified products were analyzed in 2% agarose gel and visualized using Red safe staining. In real time PCR, specific primer and probe mix depending on TaqMan® principle was used to detect P1 adhesion gene through FAM channel. A fluorogenic probe was included in the same reaction mixture which consists of a DNA probe labeled with a 5`-dye and a 3`-quencher. During PCR amplification Data were analyzed using Smart-cycler software and M. pneumoniae DNA copy number was estimated from the cross point threshold relative to positive standard.
Results: Thirty five patients(45.5%) were positive by PCR and Thirty two (42.6 %) were positive by Real-time PCR. The highest rate of infection by using tow molecular methods were of less than 20 years of age. The quantity of M. pneumoniae DNA target gene in positive Real-time PCR were ranged between 10-2000copies/μl.
Conclusion: The study concluded that both of molecular techniques conventional and real-time PCR are a rapid, reliable and ideal in diagnosis of M. pneumoniae using throat swabs, throat wash and sputum samples.

Background: Cervical spondylotic myelopathy (CSM) is considered the most serious consequence of cervical spondylosis and accounts for the majority of non_traumatic paraparesis and/or quadriparesis. The electrical property of the spinal cord and its susceptibility to injuries renders electrophysiology relevant to the management of CSM. Somatosensory evoked potentials study (SEPs) is an objective assessment of the functional integrity of the neural pathway.
Objective: Utilizing both of the median and the posterior tibial SEPs in evaluating the functional integrity of the cervical spinal cord in patients with CSM and to correlate the SEPs findings with the clinical and MRI findings.
Patients and methods: Twenty two patients with CSM (11 male and 11 female) ranging in age from 29 to 77 years with a mean age of (56 ±11) years and matched with 25 healthy subjects of the control group were enrolled in this study.
Results: In this study, 86.36% of patients had abnormal SEPs study (either tibial or median or both tests abnormal), with 68.2% abnormal tibial and 63.6% abnormal median. There was no difference between right and left side study of neither median nor tibial SEPs studies (P>0.05). Loss of N13, loss or delayed N20 and loss or delayed N13-N20 were the most frequent abnormalities for median SEPs and loss or delayed P37 and LP-P37 were most frequent abnormalities in tibial SEPs. Results showed that normal SEPs findings mostly correlated with mild and early myelopathy (grade-1 and grade-2 Nurick). Abnormal SEPs findings are useful in prediction the progression of myelopathy in patients with mild clinical neurological deficits in the early stages of the disease.
Conclusion: This study concluded that both median and tibial SEPs montages are useful important objective assessment of the spinal cord function to evaluate patients with CSM since MRI and SEPs may evaluate different aspects of the disease process.

Background: Lumbar spinal canal stenosis (LSCS) is a disorder that causes neurologic deficit, pain and disability. It is common in the elderly, and increasingly encountered as the population ages. Because other causes of back pain are common and difficult to prove, it is possible that mechanical backache, in conjunction with coincident neuropathy or other unrelated leg complaint, might lead to inappropriate treatment including surgery. Thus, accurate diagnosis of the clinical syndrome of spinal stenosis using paraspinal mapping technique may be of critical importance.
Objectives: Asses the utility of paraspinal mapping technique in detecting the level of lumbar radiculopathies in patients with lumbar spinal canal stenosis.
Subjects and methods: Ninety seven (97) patients with LSCS with a mean age of (46.3±11.2) years and thirty four (34) healthy control subjects with a mean age of (42.8±8.8) years involved in the study. Needle EMG of lumbar paraspinal muscles in addition to eight lower limbs muscles were performed.
Results: Paraspinal muscles scores greater than 4 significantly differentiate the patients with LSCS from the control groups. The percentages of each level of lumbar radiculopathy by using paraspinal mapping technique differ from those by using lower limbs electromyography (EMG) for example right and left L5 radiculopathy 19.6%, 18.6% using EMG of PSM when compared with 78.2%, 79.4% using EMG of lower limbs muscles, and the percentages will increase by combination of both tests in such a way that RT and LT L5 radiculopathy increase to 84.5%, 82.5%.
Conclusion: Paraspinal mapping technique is a sensitive, useful, quantifiable and quite effective method in the diagnosis of lumbar spinal canal stenosis when compared with lower limbs EMG

Background: Polycystic ovary syndrome (PCOS) is one of the common female endocrine disorders of uncertain etiology, which causes menstrual disorders as well as infertility. Interleukin–33(IL-33) is considered as a strong risk marker of inflammation and may have possible role in pathogenesis of PCOS.
Objectives: The present study is designed to investigate the possible role of IL-33 in pathogenesis of PCOS and its relation with glycated hemoglobin (HbA1C),insulin resistance(IR) and oxidative stress in prediabetic PCOS patients.
Subjects and Methods: The study involved 30 healthy women as control group and sixty six infertile Iraqi women with PCOS which were divided into two groups according to glycated heamoglobin(HbA1c) value and homeostasis model assessment for insulin resistance (HOMA-IR). The first group (G1) consist of 30 women with HbA1c ≤ 6.5% and HOMA –IR<3.8 as PCOS without diabetes and without insulin resistance. The second group(G2) consist of 36 patients with HbA1c ≥ 6.5 % and HOMA-IR ≥ 3.8 as PCOS with pre diabetes type 2 and insulin resistance. Ten milliliters of blood were collected from all subjects by vein puncture during 2nd – 4th day of the menstrual cycle. Two ml of blood were collected in EDTA tube for HbA1c analysis. The serum which obtained from the remained blood were used for determination of (insulin, fasting blood glucose(FBG), Malondialdehyde(MDA) , Total antioxidant capacity(TAC) , uric acid, glutathione(GSH), albumin, and IL-33) .
Results: Results revealed a significant elevation in HbA1c, insulin, HOMA-IR, MDA, TAC, uric acid and IL-33 in the patients group when compared with healthy women. On the other hand, a significant decreased in GSH and albumin were found in patients group when compared with control group. Also there are significant differences in the results between patients in group 1 and group 2. A significant positive correlation between IL-33 and HbA1c levels was noticed in G1 and G2 .A significant positive correlation between IL-33 and HOMA-IR was noticed in group 1 while a negative significant correlation was found in group 2. No correlation founded between IL-33 levels and TAC concentration in group 1, but a positive correlation noticed with group 2. A significant negative correlation was observed between IL-33 and MDA/TAS ratio in G1, while a significant positive correlation in G2 was found.
Conclusion: high levels of IL-33 in patient groups may be considered as a novel cytokine involved in the pathogenesis of PCOS. Also the elevation in oxidative stress in PCOS patients could be a reason for disturbed follicular development and ultimately infertility.

Background: Hyperuricemia represents a major public health problem; approximately most population has hyperuricemia, serum uric acid ≥6.5 mg/dL in women and ≥7.0 mg/dL in men.
Allopurinol has been approved for the treatment of hyperuricemia patients. Epidemiological and experimental studies suggest a linkage between hyperuricemia and type of treatment.
Objective: To assess the effect of allopurinol and uralyt- 4 and mixture of two drugs (allopurinol and uralyt-4) in hyperuricemia patients
Methods: A total of 60 serum patients with history of hyperuricemia, obtained from Baladrus Hospital in Diyala governorate, were included in this study. In addition, ten normal uric acid level persons used as control group. Serum used for uric acid. We used two type of treatment to compare the effective of each one to treat patients with hyperuricemia, patients were divided into three groups first one treated with allopurinol at 300mg/day, second group treated with uralyt-4 at 10 mg/day for three time daily while the third group treated with mixture of allopurinol and uralyt-4. Level of uric acid measured after 4 weeks and 8 weeks by enzymatic colorimetric method
Results: The present study, patients had a mean age of 44.5  0.12 years, significant differences noticed between three age groups. The percentage of males equal to females. Urate concentration was more likely to be lower in patients receiving mixture of allopurinol and uralyt-4 comparing with patients receiving single drug such as allopurinol or uralyt-4. But statistical significant differences were not found among them.
Conclusion: allopurinol was effective in reducing serum urate in hyperuricemic patients with gout but combination 0f Uralyt-4 (10 mg/d) allopurinol were more efficacious compared with allopurinol (300 mg/d). The doses of allopurinol to which Uralyt-4 has been compared, although commonly prescribed, are low in the range of approved doses of allopurinol. The tolerability of Uralyt-4 for the treatment of hyperuricemia is similar to that of allopurinol.

Background: Low hemoglobin levels and lead exposure remain significant health issues in many parts of the world, often occurring together, however most of the researches concentrate on the effect of high levels of lead .This study aimed to demonstrate the effect of blood lead level on hemoglobin and packed cell volume (PCV).
Patients and Methods: Fifty eight adult volunteers were enrolled in this study with age range between 23 and 55 years, working in the different departments in medical college of Baghdad University. Whole blood was withdrawn in EDTA tubes. Hemoglobin and PCV were measured and blood lead level was estimated using blood lead testing system including lead care kit and lead care analyzer.
Results: After measuring blood lead level and correlate it to PCV in all volunteers results revealed a significant negative correlation between them which is obvious in both smokers and non-smokers groups. Age was found to correlate positively and significantly with blood lead level in non smokers group. Comparing the blood levels of lead and PCV in both smokers and non-smokers shows non-significant difference between them although blood lead level was higher in smokers group.
Conclusion: Blood lead levels is increased with age. There is a significant decrease in PCV with the increase in blood lead level which is noticed in both smokers and non smokers. There is a significant increase of blood lead levels in smokers group.

Background: Patients with an Implantable Cardiovertor Defibrillation (ICD) describe psychological problems such as depression, anxiety, and stress. To achieve the full benefits of the device, patient must maintain their psychological status within good levels.
Objectives: The major objectives of this study were to determine the main psychological problems in adult patients with an ICD and to find out the relationship between Psychological problems in patients with ICD and some demographic characteristics of patients with ICD.
Patients and Methods: A Descriptive analytical study was carried out from January 25, 2011 to March 20, 2012 in order to determine Psychological problems of patients with ICD. The sample was selected by A purposive (non-probability) sampling of (100) patients raising ICD during routine checking or programming the device in outpatient at Ibn Abitar Hospital. Data was collected through the use of the Depression Anxiety Stress Scales (DASS) after doing some modifications and the process of the self- administrative report for each patient as a mean of data collection. The questionnaire was constructed by the researcher to achieve the objectives of the study, which consisted of two parts; the first part is concerned with the demographic characteristics of the patients; the second part consists of three domain describe the psychological problems and contain42- item measure of depression, anxiety and stress.
Results: Results of the study indicate that (80%) of the sample are male at age group (40-49) years old, (53.3%) were married, (62 %) are at Bachelor Degree, (39. %) experience with ICD since 6-12 months, (42 %) employee, (7o%) take about (1-5) discharge per last 6 months. Psychological problems (depression, anxiety, and stress) among ICD patients at high levels, and the highest one was stress at MS (3.00) and SD (0.48), and there were significant relationships between depression and gender, educational level, and since ICD implantation at p-value (0.030, 0.011, and 0.037). There were significant relationships between anxiety and age, marital status, educational level, since ICD implantation at p-value (0.008, 0.025,0 .000, 0.007). There were significant relationships between Stress and age, gender, occupations, since ICD implantation at p-value (0.001, 0.000,0 .002, 0.053).
Conclusions: An Implantable Cardioverter Defibrillator patients experience high levels of psychological problems, patients worry about the devices malfunctioning, a afraid from the ICD shocks, They should be granted psychological support from health professionals who are familiar with the specific problems of ICD recipients. As well as psychological interventions is important role of nurse for those patients with ICD.