Journal of the Faculty of Medicine Baghdad

Background: liver diseases may not be recognized by clinicians, who can lead to a subsequent delay in the initiation of effective therapies, the commonest presenting signs and symptoms of pediatric liver diseases include hepatomegaly, jaundice, coagulopathy or elevation of the liver enzymes or waste products as ammonia.
Objectives: To highlight the etiologies, pattern of presentations and the route of diagnosis of all liver diseases in children less than 10 years referred to the Gastroenterology and Hepatology Unit in Children Welfare Teaching Hospital over a six months period.
Patients and methods: A prospective study was conducted in the Gastroenterology and Hepatology Unit in the Children Welfare Teaching Hospital / Baghdad Medical City hospital during the period from first of December 2016 to the end of thirty first of May 2017.
Forty patients aged below 10 years were thoroughly assessed for possible causes of liver disease and the severity of liver damage. These patients were subjected to a detailed history, thorough physical examination and a list of investigations
Results: forty patients their age less than 10 years, the most common age group in this study was from 1 year to 5 years was 17(40%), males are more affected than females in the ratio of 1.5:1, it was found that the mean age of onset is the biliary atresia and Galactosemia cases were within the first week of life, congenital infection cases presented earlier than the two above groups. In this study most of the cases were diagnosed clinically and by available investigations and only cases of biliary atresia and glycogen storage diseases were diagnosed by liver biopsy.
Conclusion: All patients presented late with complications, biliary atresia cases were very late in presentation, all with fibrosis. Family history usually very important in hereditary liver diseases as galactosemia and glycogen storage disease a careful physical examination in addition to previous medical history most of the time gives a clue to the final diagnosis.
Keywords: liver diseases, clinical aspects, children less than 10 years.

Background: Pulmonary hypertension (PH) is a hemodynamic and pathophysiological condition defined as an increase in mean pulmonary arterial pressure (PAP) ≥25 mmHg at rest as assessed by right heart catheterization (RHC). Although there is some underestimation and overestimation of PAP between transthoracic Doppler echo (DE) and RHC, Doppler echo remains an indispensable screening tool for the assessment of PH.
Objective: clinical evaluation of patients with primary pulmonary hypertension (PPH) and assess vasoreactivity testing to identify patients who may benefit from long term therapy with calcium channel blockers (CCBs).
Patients and methods: This prospective study was performed in the cardiac catheterization division in Al-Zahraa teaching hospital in Al-Kut. We studied the prevalence of certain variables among forty two patients with PPH from "March 2014 to Nov 2016" including the clinical triggers, electrocardiographic (ECG) changes, Echocardiographic variables , RHC and vasoreactivity test with intravenous adenosine to identify acute positive responders and long term responders to CCB.
Results: A total of forty two patients, female to male ratio were 2.8:1 with a mean age of 38±10(years). Dyspnea is a common clinical trigger (85%). Abnormal ECG was found in (90.5%) of patients, the majority had right ventricular hypertrophy (RVH) (76.2%). Echocardiographically all patients had RVH. There was some differences in mean PAP (36±4.9mmhg) derived by DE from that obtained by RHC (47±4.78mmhg). RHC reveal that 6 patients (15.78%) were acute positive responders to intravenous adenosine and about 4 patients (66%) were long term responders to CCB during 3months follow up echocardiography.
Conclusions: There is some discrepancy in the mean PAP between Doppler echo and RHC within ±10 mm Hg for pulmonary artery pressure estimates. 15.7% of patients at RHC were acute positive responder to intravenous adenosine and half of them were long term responder to CCB.
Keywords: Clinical, pulmonary, hypertension

Background: Renal disease results in significant disorder of hemostasis (bleeding diathesis or hypercoagulable state).
Objectives: This study is to determine the changes in some hemostasis parameters in patients with chronic renal failure and identify the effect of dialysis on these changes.
Patients and Methods: seventy five patients with end stage chronic renal failure were collected from Baghdad hospital, a full detailed history and clinical examination were performed, 50 patients were on maintenance weekly hemodialysis, and 25 patients were without dialysis.
Result: Bleeding time was significantly higher in patients with chronic renal failure who didn’t need any type of dialysis, positive D-Dimer test. In some patients, Platelet count, prothrombin time, thrombin time, fibrinogene level, activated partial thromboplastin time; all did not reach significant level between both groups of patients.
Conclusion: hemostatic changes are not uncommon in patients with chronic renal failure, affecting the different parameter hemostasis so it should be consider in the management of these patients.
Keywords: chronic renal failure, prothrombin time, Thrombin time, bleeding time, activated partial thromboplastin time.

Background: Myelomeningocele is the single most common congenital anomaly that affects the CNS and vertebral column. The third world countries having a higher incidence. The management is usually surgical with relative high incidence of complications.
Objectives: to evaluate the possible risk factors that may predispose to early wound complications of myelomeningocele.
Methods: This prospective study was carried out in the Surgical Specialization Hospital in Medical City Complex - Baghdad from 2009-2012. 147 cases were included in the study. Requested data were gestational age, type of delivery, gender, age at operation, type of suturing of the wound, tension of suturing, duration of operation, site of the lesion, ruptured vs non ruptured myelomeningocele, associated shunting, peri-operative stay in hospital and associated jaundice.
Result: Forty four (44 %) of the total developed complications. All premature infants developed complications. Hydrocephalic cases was associated with higher rate of complication (86%). Type of delivery, age at operation, duration of operation, ruptured cases and site of the lesion were not associated with complications.
Conclusion: Myelomeningocele was predominantly affecting female. Most of the complications were wound infection with or without dehiscence, CSF leakage or seroma.
Keywords: Neural tube defect, Hydrocephalus, Cerebrospinal fluid, Myelomeningocele.

Background: Polycystic ovary syndrome (PCOS) is a common endocrinopathy in women of reproductive age with primary features of infertility, menstrual irregularity, and clinical or biochemical evidence of hyperandrogenism (hirsutism, acne and high androgen level). Vitamin D has a role in the development of metabolic and endocrine abnormalities in PCOS mediated by insulin resistance.
Objective: Measure serum 25-hydroxy vitamin D levels in women with polycystic ovary syndrome and compare their levels with age and body mass index matched healthy controls. Also, assess the correlation between insulin resistance and 25-hydroxy vitamin D among women with PCOS.
Subjects and Methods: Eighty eight women were involved in this study with age range (18-34 years). Subjects were divided into two groups: Group 1- forty five women with PCOS and Group 2- forty three women without PCOS (as controls).
Serum 25-hydroxy vitamin D, insulin, free testosterone, Luteinizing hormone (LH), Follicle stimulating hormone (FSH) were measured by enzyme linked immunosorbent assay (ELISA), while serum calcium and fasting serum glucose were measured by spectrophotometer.
Results: Significant increase in mean value of fasting serum glucose, insulin, homeostatic model assessment of insulin resistance (HOMA-IR), LH, LH/FSH ratio, and free testosterone with significant decrease in mean value of serum FSH, 25-hydroxy vitamin D, and calcium for patients with PCOS comparing to age and body mass index match controls. Additionally, significant negative correlations were found between serum 25-hydroxy vitamin D levels with fasting serum glucose (r= -0.484, p=0.01), fasting serum insulin (r= -0.422, p=0.04), and HOMA-IR (r= -0.542, p=0.0001) in women with PCOS.
Conclusion: Vitamin D has a role in metabolic and hormonal disturbance seen in PCOS through impact of vitamin D on insulin releasing and function.
Keywords: Polycystic ovary syndrome, vitamin D, insulin resistance.

Background: The prevalence of thrombocytopenia in most studies ranges from 7 to 10% of all pregnant females. Although pregnancy is associated with physiological changes that may affect platelet count, several pathological conditions can cause thrombocytopenia which have a significant impact on both the mother and her baby.
Objective: The aim of this study was to determine the prevalence of thrombocytopenia in pregnant women attending an out-patient clinic in Al-Yarmouk Teaching hospital in Baghdad.
Material and Methods: A cross sectional study conducted at Al-Yarmouk Teaching Hospital from 1st October 2016 to 1st July 2017. Five hundred sixty pregnant women randomly selected as the study group and another 100 non-pregnant women as the control group were enrolled in this study. A complete blood count and blood film were done for both the selected groups.
Results: Thrombocytopenia was found in 7.1% of the cases. The most common cause of thrombocytopenia was gestational thrombocytopenia seen in 19(47.5%) patients and PE & HELLP syndrome 9 (22.5%) patients. Most of our cases were asymptomatic and only one case developed heavy vaginal bleeding while there were 2 cases who had platelets below 50,000 considered as severe thrombocytopenia without significant bleeding.
Conclusion: Thrombocytopenia is not a rare condition in pregnancy. Accurate etiological diagnosis is essential for effective management. Most of the cases are mild, self-limiting and rarely cause with complications
Keywords: prevalence, Thrombocytopenia, Pregnancy,

Abstract:
Background: Papillary thyroid carcinoma (PTC) is the commonest thyroid cancer. Cases in category-5a of Bethesda system (suspicious for papillary carcinoma) are treated by surgical lobectomy followed by total thyroidectomy if histopathology confirms papillary carcinoma. In order to reduce surgical procedures to one this was conducted.
Objectives: evaluation of role of immunohistochemistry in pre-operative diagnosis of papillary thyroid carcinoma on cell blocks.
Materials and Method: Cell blocks were taken from cases labelled category-5a for histopathology and immunohistochemistry using three markers (CK-19, Thyro-peroxidase, and BRAFv600E mutation).
Results: were highly sensitive, and specific. The use of more than markers increases sensitivity of the procedure.
Conclusion: immunohistochemical stains on cell blocks is a reliable method for pre-operative diagnosis of papillary thyroid carcinoma.
Keywords: Papillary thyroid carcinoma, FNAC, Cell blocks, IHC.

Abstract:
Background: obesity is a serious public health problem. Literatures in Iraq explained that obesity due to change in economy and Lifestyles.
Objective: To report on prevalence of obesity among women in Al- sader
City, Baghdad. 2017.
Method: A total of 440 females were included in this study. They were
Selected randomly from relatives to patients accompanied them In attending to primary health care centers. BMI (body mass index) to assess the Weight. Demo-graphic data were requested too.
Result: The prevalence of obesity was 35.2%. Age , education, divorced
Widows were determinants of obesity. Employment and crowding Index (socioeconomic status) were not obvious determinants of obesity.
Conclusion: High prevalence of obesity was observed.
Keywords: obesity, Al-sader city, Iraq.

Abstract:
Background: It was found that the occurrence of Guillain-Barre Syndrome (GBS) varies in respect to the month and season; this variation has not been adequately studied.
Objective: To determine the month and seasonal variation of GBS in children in the Khuzestan province, south west Iran, during a 10-year period (2006-2015).
Patients and methods: We extracted data retrospectively from acute flaccid paralysis committee from healthcare centers in all cities of the province, over a 10-year period (from January 1, 2006 to December 31, 2015). In this study all children under 15 years of age with Guillain-Barre syndrome were surveyed. In order to compare the frequency of GBS in different seasons and months we used the Chi Square test.
Results: From 187 cases of GBS, 101 (54%) were males, 86 (46%) females with sex ratio 1.17:1. The mean age of the children was 5.39 ± 4.02 years. The highest occurrence of GBS was observed in autumn (32.1%) followed by winter (27.3%). The highest number of cases (28; 15%) occurred in December and the lowest (8; 4.3%) in September. There was seasonal (P=0.006) and monthly (P=0.036) variation in occurrence of GBS throughout the year with more prevalence in autumn and September.
Conclusion: Our study showed that there is a significant monthly and seasonal variation in children with GBS in Khuzestan province.
Keywords: Guillain-Barre syndrome, seasonal variation, children, South-West Iran

Abstract:
Background: Irritable Bowel Syndrome (IBS) is a common chronic functional gastrointestinal disorder characterized by abdominal pain or discomfort and alteration in bowel habits. It is more common among adolescents and young age groups.
Objectives: to estimate the prevalence and identify potential determinants of IBS among high school students in Baghdad, Iraq, 2017.
Methods: This cross-sectional study was conducted by using multi-staging cluster probability sampling technique. All students in the sixth grade were considered eligible. Students with "red flag" symptoms were excluded. Rome III criteria questionnaire of IBS was considered to define IBS. A self-administered questionnaire used to compile socio-demographics, personal habits and certain potential determinants. IBS was further classified as mixed type (M-IBS), diarrhea predominant type (D-IBS) and constipation predominant type (C-IBS).
Result: Among 657 eligible high school students, 592 (90.1%) were enrolled. The prevalence of IBS was 29.7% (95% C.I: 29.4- 30.1%). The most common type of IBS was M-IBS (42.6%) followed by D-IBS (33.5%). Binary and logistic regression analyses revealed the following significant factors: exposure to stressful life event (OR: 3.93; 95% CI: 2.64 – 4.85), food hypersensitivity (OR: 2.89; 95% CI: 1.59 – 3.27), chronic diseases (OR: 2.22; 95% CI: 1.24 – 3.95), family history of IBS (OR: 2.04; 95% CI: 1.30 – 3.01) and female sex (OR: 1.84; 95% CI: 1.25 – 2.73). C-IBS was significantly more common among females (P=0.02)
Conclusion: IBS is a common health problem among high school students. Among the hereditary, environmental and psycho-social factors, stress was the most important determinant.
Keyword: Irritable Bowel Syndrome, High School students, Prevalence, Risk factors, Iraq.

Abstract:
Background: Breast cancer is the most common cancer among women and ranked number two after lung cancer in the world. According to the World Health Organization, breast cancer accounts for 22.9% among cancers in women in 2012.
Objective: This study was designed to evaluate the dietary pattern particularly dairy products consumption and the role of lifestyle on women with breast cancer in Baghdad city and its suburbs.
Subjects and Methods: The study was conducted on 100 women with breast cancer, as a case group, compared with a control group comprised of 100 healthy women. Demographic data were collected from both groups. A food frequency questionnaire was used of 33 items of foods for reporting the dietary pattern and modes of life style of the participants. The statistical Chi-square test / SPSS V.22 was used to analyze the data.
Results: Our data show that 71% of the women in the two groups were found to be overweight
with body mass index (BMI 25-29.9). 90% of obese women represented in case group (BMI ≥30), while 82% of normal weight women (BMI 18.5-24.9) were in control group. Approximately 61% of women in both groups were in post-menopausal age. Intake of high fatty dairy products by the participants showed a statistically significant increase in breast cancer risk (OR=1.625, CIs 95%=0.686-3.847). Consumption of vegetables and fruits was significantly lower (P˂0.01) in case group than in the control group. Furthermore, roughly 68% women in the case group used to smoke cigarettes. In addition, lack or decreased regular physical exercises (never with ≥1 practice per wk) was statistically significant (OR= 44. 809; CIs= 5.889 –340.963). Other parameters, including long period of breastfeeding, early age at first birth and consumption of white meat, beans and eggs were all reported to have significance. On the other hand, there was no correlation with the marital status, occupation, living area, class of dairy products, and passive smoking.
Conclusion: Unhealthy dietary habits especially high-fat dairy intake and wrong lifestyle may be risk factors and predispose Iraqi women for breast cancer development. Therefore, eating healthy food and following correct lifestyle are highly recommended as a suitable program for the prevention of breast cancer.
Keywords: Breast cancer, Dairy products, Dietary patterns, lifestyle, Food frequency questionnaire (FFQ)