Journal of the Faculty of Medicine Baghdad

Background: Low back pain is the most common health problem in men and women between the ages of 20
and 50 years. The lumbar disc prolapse has a major role in this condition. Treatment is either conservative or
surgical. The most common surgical interventions are either laminectomy or interlaminar approach.
Objective: To determine which is the best surgical approach for the patient according to his/her type of
disc herniation.
Patients and methods: A comparative clinical study conducted in the Neurosciences Hospital, Baghdad,
Iraq from January 2016 to January 2018. In this paper we evaluated the clinical outcome following both
approaches
Results: We studied sixty cases; thirty-four patients had interlaminar approach for lumbar discectomy while
twenty-six patients had laminectomy with discectomy.
Conclusion: Both methods can manage different types of lumbar disc prolapse, apart from far-lateral disc
which favors laminectomy approach.

Background: Acute pancreatitis is an acute inflammatory condition. It's not an uncommon disease, in
both the developed and developing countries, causes high morbidity and mortality, and inflicts a
heavy economic burden. Severe acute pancreatitis is present in up to 25% of patients with acute
pancreatitis, with considerable mortality. Changes in the management of acute pancreatitis in the last 2
decades contributed to reduce the mortality.
Objective: was to review the diagnosis and management and outcomes of patients with acute
pancreatitis of patients with acute pancreatitis in Al- Karama teaching hospital.
Patients and Methods: This prospective study included 63 patients with acute pancreatitis in surgical
and medical wards in Al- Karma teaching hospital from the 1st October 2014 to 30th September 2017.
Results: 63 patients with acute pancreatitis were included 35 male and 28 female patients with upper
abdominal pain in which the diagnosis was not confirmed by CT or serum amylase or by CRP are not
included in this study. Age and gender had no significant relations to outcome. Medical therapy is the
mainstay, with supportive therapy consisting of controlled volume resuscitation and enteral feeding.
Minimally invasive drainage and debridement play a role in managing infective pancreatic necrosis
but in general should not be used until at least 4weeks after the acute illness.
Conclusions: Acute pancreatitis is a benign abdominal disorder in up to 85% of cases. In the
remaining 10%-15% of cases the disorder is life threatening with management of the disorder
requiring admission to an intensive care unit with cardiovascular, respiratory, and renal monitoring
and support.

Background: Colostomy minimizes the risk of leakage at expense of requiring a second operation. In
Iraq, published on colostomy closure in penetrating abdominal wall injuries is scarce.
Objective: to Study the prognosis of colostomy closure in post-conflict patients in Iraq.
Method: This is a retrospective study of 52 patients subjected to colostomy closure, recruited for the
period 2008 to 2009 from Al-Yarmouk Teaching Hospital and Children Central Teaching Hospital.
Demographic data and information about colostomy (type, methods of preparation … etc.) were
studied.
Results: Trauma was noticed in 57.7% patients. Transverse colon was the commonest site of injuries.
The complications were wound infection (19.2%), fecal fistula (3.8%), anastomotic leak (1.9%) and
abdominal abscess (1.9%). A significant high complication rate was associated with conventional
method of preparation, and double layer anastomosis (p = 0.004 rand 0.003, respectively).
Conclusion: the finding were comparable with other centers in the world.

Background: Breast cancer composed of several biologic subtypes that have response to hormonal
therapy. Tamoxifen is hormonal therapy with tissue- pecific antagonistic or agonist effects, the latter
being responsible for multiple effects on lipid metabolism in women .
Objective: This study was designed to determine the impact of Tamoxifen on the serum lipid profile in
breast cancer women.
Patients and methods: Prospective observation cohort study conducted at Oncology Teaching Hospital,
Medical city complx.starting from October 2015 to October 2016. A total number of 40 premenopausal
women with breast cancer were enrolled in this study according to inclusion criteria . Patients were
followed for three months by the measurements TC, TG, HDL – cholesterol and BMI .
Results: At the end of third months of hormonal therapy, Tamoxifen showed a significant decrease in TG,
VLDL (p< 0.001 for both). On the other side HDL and BMI showed significant increase over three
months duration , (p = 0.001 and 0.006, respectively) .
Conclusion: Beneficial alterations of lipid profiles were seen in pre-menopausal breast cancer patients
treated with Tamoxifen.

Background: The evaluation and staging of renal cell carcinoma (RCC) has dramatically changed with
the introduction of cross-sectional imaging. Nowadays, small renal lesions are easily detected by
computed tomography (CT) examination while missed by other modalities.
Objective: To determine whether ultrasound (US) or CT scan is the optimum imaging modality for the
evaluation of the renal masses.
Patients and methods: This is a comparative study in which 30 patients with hematuria were attending
the urological consulting clinic in Ghazzi Al-Harriry hospital, Baghdad, Iraq from May 2016 to July
2017 were subjected to abdominal US and CT scan.
Results: The patients included in the study were 19 females and 11 males. The results of US,
unenhanced and contrast CT for characterization of the consistency of renal mass were 63.4%,56.7%,
and 60% respectively for the solid, while the cystic were 23.3%,23.3%, and 26.6% and for complex
was 13.3%,20% and 13.4% respectively. The size of the masses was compatible in 60% of cases. Mass
surface regularity was compatible in 93.4%.
Regarding mass position, the US showed that 96.7% to be confined to the kidney and 4.3% extended
outside, while 66.6% were judged to be confined by CT scan, which is nearly similar to the operative
findings which revealed 60% localized masses to kidney and 40% extending outside the kidney.
Conclusion: the US is a good modality to start with in the assessment of renal lesions, but CT scan is
still the main tool to diagnose and stage RCC.

Background: Temperatures and seasons have been suggested as environmental factors that influence
fecundity in mammals. It has been reported that there is a link between human fertility and seasonal
changes.
Objectives: The aim of the study was to assess whether the seassonal changes in tempreture,
humidity, light intensity and light duration do influence fecundity and reproduction in the study group
of Iraqi women who were from Baghdad.
Patients and Methods:This study was conducted on 1638 randomly selected womenn who were from
Baghdad city and were normaly delivered at Al- Elwiyah Maternity Teaching Hospital during 2014. A
detailed questionnaire form was filled through direct interview with the mothers shortly after delivery.
The climate information were taken from the Iraqi Meteriological Department and Research Center of
Solar Energy, Ministry of Science and Technology.
Results: Results obtained confirmed that there was a highly significant seasonal variations in birth
and conception rates at different months of the year, The conception rates were significantly
negatively correlated with mean temperature rates, light intensity and light duration and significantly
but positively correlated with mean percent humidity.
Conclusion: These results confirm that there was a significant seasonal nfluence on human

Background: Self-medication (SM) is a worldwide issue, that has serious adverse effects on
individuals and communities.
Objective: To estimate the prevalence of self- medication among medical student in Anbar and
Falluja Universities and to explore the important reasons for using self-medication. To identify the
common sources and types of self-medication drugs.
Method: A descriptive cross-sectional study was carried out among medical students in Anbar and
Fallujah Universities during the period from February to March 2018. The subjects were asked to fill a
questionnaire that consisted of questions on age, gender and educational level, in addition to questions
for self-medication history.
Results:The results revealed that 73% of medical students had practice of self- medication. A higher
prevalence of self-medication was found among 5th study year students. Antibiotics were the most
frequent self-prescribe medicine that used by 137 (49.6%) of the participants, followed by analgesic
(29%), and supplements by 40 (14.5%). The most frequently given reasons for using self-medication
were previous prescription and of pharmacists’ advice.
Conclusion: A high prevalence of self- medication was found among medical students in Falluja &
Anbar Universities with a statistical significant association between gender and self- medication
practice.

Background: Lipids seem to have a direct influence in women breast cancer (BC) or dyslipidemia may be
a consequence of this cancer.
Objective: the aim of this study is to define serum levels of lipid profile in women with breast cancer
(BC) and to compare that with fibroadenoma benign breast tumor. Also, to assess the role of serum CA
15-3 in early diagnosis of breast cancer (BC).
Patients and Methods: This case study was carried out at Biochemistry Department, College of
Medicine, University of Baghdad, during the period from February 2017 to November 2017. It included
38 Iraqi women diagnosed with primary breast cancer (BC, Group-I) and 25 women with Fibroadenoma
of benign breast tumor (FA, Group-II). Women with BC were sub divided according to their stage of BC
into: stage I (n=12), stage II (n=14), and stage III (n=12). Investigations included serum measurements of
CA 15-3 and lipid profile (Total Cholesterol, Triglyceride, LDL-Cholesterol and HDL-Cholesterol).
Results: The mean value of CA15-3 in breast cancer women was found to be significantly higher
(p<0.001) as compared to benign group. The mean values of serum levels of TC, TG and LDL-C in breast
cancer women were found to be significantly higher as compared to the benign women group (for all,
p=0.001).
Conclusion: This study concluded that breast cancer was more associated with dyslipidemia than FA
benign tumor.

Background: Thiopurines are essential medications in Acute Lymphoblastic Leukemia (ALL)
treatment protocols as anti-cancer agents since long time; however, their use might result in
unexpected toxicities in ALL children due to the low thiopurine S-methyltransferase (TPMT) activity,
a major enzyme involved in 6- mercaptopurine metabolism, which strongly correlates to the genetic
polymorphism of the TPMT gene in those patients.
Objective: To identify the most common TPMT polymorphisms in children with ALL and its
frequencies.
Methods: A cross sectional study enrolling eighty-one ALL children receiving mercaptopurine drug
during their maintenance course of treatment according to UKALL – 2011 protocol, were enrolled in
this study. After DNA extraction from whole blood TPMT genetic polymorphisms were detected by
allele-specific multiplex-PCR analysis.
Results: A total of 51 children with allele frequencies of (62.96%) were homozygous for the wildtype
allele TPMT*1, 30 children with allelic frequency of (37.03%) were heterozygous for one of the
two mutant alleles (TPMT*3A or TPMT*3C) with allele frequencies of 29.62% and 7.4%
respectively, while no result was found homozygous for two mutant alleles or TPMT*3B allele.
Conclusions: This is the first study in Iraq to identify the genetic polymorphism of TPMT in a group
of ALL children being treated for ALL. The study revealed the presence of TPMT*3A and TPMT*3C
genetic polymorphisms among the study sample, no TPMT*3B was identified in the study sample.

The term Amyand’s hernia refers to an incarcerated inguinal hernia containing the vermiform appendix,
which may be completely healthy, inflamed or perforated. (1)
Amyand’s hernia is named after Claudius Amyand, who on December, 6,1735 performed the 1st
successful appendectomy during the treatment of 11 years old boy presented with right inguinal hernia .
During the surgery Amyand found a pin within the appendix which was encrusted with stone the
appendix was found within the inguinal hernia sac. (2) It should not be confused with the incidental
findings of cecal appendix within the femoral hernia sac “ de Garengeot’s hernia” which is first
described by Rene de Garengeot in 1731(3.4)
In almost 1% of all inguinal hernias Amyand’s hernia is detected and acute appendicitis in Amyand’s
hernia cases accounts only for 0.1% “ 0.07-0.13”. (5)
The reported mortality rate of Amyand’s hernia ranges from 5.5%- 30%.
This variation occurs due to the effect of early diagnosis, giving proper treatment, preventing intra
abdominal sepsis, and good postoperative care. (6) It is generally accepted that surgical treatment of
Amyand’s hernia includes both appendectomy and hernia repair. (5,6.7)
However, appendectomy in the absence of an inflamed appendix and the use of mesh in cases of
appendectomy remain to be controversial.
Some authors offer not to perform prophylactic appendectomy when non inflamed appendix is
incidentally found in the hernial sac. (6)
Others believe that appendectomy should be performed in all cases to prevent future reherniation and
appendicitis. (8.9) It has been thought that it is impossible to reach sufficient number of Amyand’s
hernias cases to get evidence- based data due to its rarity. Therefore it is logical to revise the
classification and surgical treatment of Amyand’s hernia based on the case reports from different
institutions. The aim of this study is to review the experience of mesh inguinal hernia repair without
performing appendectomy in patients with Amyand’s hernia with healthy looking vermiform appendix
with close postoperative follow up to detect recurrence or other postoperative complications.