Journal of the Faculty of Medicine Baghdad

Background: Strain imaging assessing regional myocardial deformation and can be used to quantify regional myocardial function and differentiate between ischemic and non ischemic myocardium.
Objectives: to assess sensitivity and specificity of strain imaging in detection of coronary artery disease in comparison with coronary angiography.
Patients and Methods: ninety six patients were referred to Ibn albitar center for cardiac surgery, Baghdad, Iraq with symptoms of coronary artery disease for a period between June 2014 and April 2015, all of whom were evaluated by two dimensional echocardiography and all were found to have good left ventricular systolic function with no regional wall motion abnormalities (RWMA), coronary angiography were done for all patients.
Results: of the 96 patients: 69(71.9%) were males and 27(28.1%) females, with mean age 55.7 ± 9.71 years. Thirty-one (32.3%) patients have no significant coronary artery disease and sixty-five (67.7%) have significant coronary artery disease. The sensitivity and specificity of global longitudinal strain in detection of coronary artery disease are 67.7% and 80.6% respectively. Global longitudinal strain appears to be useful in localization of coronary artery disease.
Conclusions: speckle tracking Strain echocardiography is simple, noninvasive and non-angle dependent with acceptable sensitivity and specificity in early detection of cardiomyopathy including ischemic myopathy.

Background: Hypocalcemia is a well-recognized complication of thyroid surgery. The aim of this study was to determine the incidence of hypocalcemia after thyroid surgery and find out the risk factors involved regarding the patient’s age, gender, muscular build, clinical diagnosis, extent of surgery, ligation of the inferior thyroid artery, and pathology report.
Patients and Methods: This case series study was carried out on 50 patients who have undergone thyroid surgery for various thyroid diseases at the surgical department of Al-Karama Teaching Hospital for the period between January 2016 and July 2017. Serial serum calcium measurements were recorded as well as details of the operation, patient’s age and gender, whether or not inferior thyroid artery was ligated, and the pathological report. Hypocalcemia was considered transient if it resolved within 6 months and permanent if it persisted after 6 months and the patient was maintained on supplementation therapy of calcium and vitamin D.
Results: The study found that the incidence of post-thyroidectomy hypocalcemia was 30% and in the majority of the cases (24%) was transient, while it was permanent in only (6%) of the cases; and had occurred mainly after total thyroidectomy and in cases with ligation of the inferior thyroid artery.
Conclusions: It was concluded that post thyroidectomy hypocalcemia is a relatively common complication but it is transient in the majority of the patients. Its incidence is related to the extent of the surgery and can be reduced by the good preparation of the patient preoperatively.

Background: The most serious problem in burn units is nosocomial infection (NI). In extensive burn
patients, sepsis is considered the main cause of death; infection control program will help to lower NI
and its subsequent high mortality rate.
Objective: To achieve the lowering of NI in burn units, by effect of infection control measures (ICMs).
Patients and methods: This is a prospective study conducted on patients admitted in Burn
Center/Medical City in Baghdad from May 2012 to April 2015. A total of 1977 hospitalized patients
were included in this study. This center receives burn patients with different severity. In around April
2012 an infection control program was started in the center by the infection control team ICT.
Results: The rate of NI was reduced; the mortality rates declined, and mean hospital stay of NI patients
decreased. The number of cases with burn wound infection (BWI), bacteremia sepsis and subsequent
mortality were decreased.
Conclusion: ICMs helped to reduce NIs in the burn center .Rational usage of antibiotic and baths, new
dressing, early excision and grafting are vital and recommended

Background: The prevalence of spinal cord lesions is high in multiple sclerosis particularly in the cervical cord, and their detection can assist in both the diagnosis and follow-up of the patients. For spinal multiple sclerosis, MRI is considered the first line investigation.
Objective: To evaluate the value of sagittal 1.5 Tesla proton density-fast spin echo (PD-FSE) MRI in the detecting and increasing conspicuity of multiple sclerosis lesions in cervical cord in comparison with sagittal T2 fast spin-echo (T2-FSE) MRI.
Patients and Methods: A cross sectional study carried out from 3rd of January 2017 to 1st of January 2018 in the MRI department of Al-Imamein Al-Kadhimein Medical City, and included 60 selected patients with a known diagnosis of multiple sclerosis. All patients were examined with 1.5 T sagittal PD-FSE, T2-FSE and axial gradient recalled-echo (GRE) MRI.
Results: Sixty patients with cervical multiple sclerosis were enrolled in the study, 146 (100%) lesions were detected by PD-FSE imaging, while T2 detected 105 (71.9%), 41 more lesions (28%) were detected by PD-FSE imaging, (P-value <0.001). All extra lesions were confirmed on axial imaging. In 13 patients (21.6%) one lesion or more had been detected on sagittal PD-FSE imaging while on sagittal T2-FSE imaging, no lesion were detected. On PD-FSE imaging, 17 long lesions were detected in 16 patients (26.7%) while 7 long lesions in 7 patients (11.7%) were detected by T2-FSE imaging. So, in 9 patients (16.7%) 10 lesions were detected as long in PD-FSE while short lesion in T2– FSE, the detection of long lesions by PD-FSE was significantly higher than in T2– FSE (100% vs 71.9% with p- value of 0.002). The mean lesion contrast to cord ratio was significantly higher in PD-FSE as compared to T2-FSE (PD-FSE, 79±2.0, against T2-FSE, 61± 2.6; P-value <0.001).
Conclusion: Sagittal proton density was more efficient and more accurate in the detection of cervical cord lesions than sagittal T2-FSE sequence, when used in conjunction with sagittal T2-FSE; it can raise the diagnostic assurance via improving the visualization of the lesions.

Background: Ovarian malignancy is considered to score the highest fatality among women due to lack of significant symptoms. Early diagnosis and treatment lead to good prognosis. Magnetic resonance imaging (MRI) plays a major role in the diagnosis by detecting the lesions and assessing their appearance and consistency.
Objective: To determine the accuracy of MRI in the diagnosis of ovarian malignancy and comparing this to histopathology as a gold standard test.
Patients and methods: A follow up study was conducted in the MRI unit of the Radiology Department in Baghdad Teaching Hospital / Baghdad Medical City Complex during the period from 1st of February to 31st of December, 2017 on a group of thirty women with clinically suspected adnexal mass(es). All patients were examined with MRI including the diffusion-weighted imaging. Surgical specimens were taken for histopathology assessment.
Results: A total of 30 women with adnexal mass were included in this study, with a mean age of 46.8±14.9 years. The MRI T1W image of the cystic part was dark in (60%), while the T2W image of the cystic part was bright (80%), T2W of the solid part was bright in (53.3%), T2W fat saturation of the solid part was bright in the majority (73.3%). T1W fat suppression contrast-enhanced of the solid part was avid in 66.7% of women with an adnexal mass; DWI of the solid part was bright in (76.7%). The mean apparent diffusion coefficient (ADC) value by MRI for women with adnexal mass was 0.9±0.3x103 mm2/sec. Histopathology mainly revealed mucinous cystadenocarcinoma in (10%) and low-grade serous adenocarcinoma in (10%).Validity of the results of MRI regarding malignant adnexal mass were sensitivity (90.9%), specificity (75%), +ve predictive value (90.9%), -ve predictive value (75%) and accuracy (86.6%). The appropriate cutoff value for apparent diffusion coefficient in differentiation between malignant and benign adnexal mass was 0.97 with 100% sensitivity and 90.9% specificity.
Conclusions: MRI and diffusion-weighted imaging is a valid and reliable technique in the diagnosis and characterization of ovarian malignancy.

Background: Cervical cancer ranks the fourth most common cancer among women worldwide and the eighth cancer overall. It is considered as one of the most preventable malignancies, and can be controlled through screening and Pap smears.
Objectives: To explore the demographic and clinical characteristics of a sample of Iraqi patients who were referred to the National Cancer Research Center of the University of Baghdad for Pap smear test.
Patients and methods: The study enrolled 175 female participants who were subjected to clinical examination and Pap smear tests. A questionnaire was filled for each patient on which demographic and clinical variables were recorded. Cellular specimens were collected, fixed, stained by Papanicolaou stain and examined cytologically. The corresponding cytological findings were correlated with the studied variables and tabulated accordingly.
Results: 60% of the 175 women were housewives, 40% got married before the age of 20 years, 35.4% had used contraceptive pills and 10.3% were nulliparous. The mean ages at marriage, pregnancy and first child birth were 20.2, 22.0 and 23.0 years respectively. On clinical examination, cervical erosions were obviously apparent in 41.7% of the cases and genital warts were noted in only one case (0.6%), while koilocytotic cellular atypia was observed in 4.0%. Pap smears revealed infections with Moniliasis and Trichomonas Vaginalis in 16.5% and 1.1% respectively. Atypical metaplastic changes, AGUS (atypical glandular cells of uncertain significance) and ASCUS (atypical squamous cells of undetermined significance) were displayed in 21.1%, 5.7% and 22.3% respectively. Diagnoses of CIN I (LSIL) (cervical squamous intraepithelial neoplasia 1 - low-grade squamous intraepithelial lesion), CIN II and CIN III (HSIL) (high-grade squamous intraepithelial lesion) were reported in 26.8% and 2.3% respectively. Among patients with cervical erosions, the Pap smear findings illustrated more pronounced cellular changes consistent with atypical squamous metaplasia, AGUS and ASCUS (43.8%, 19.2% and 45.2% respectively). On the other hand, LSIL, kiolocytotic atypia and HSIL in these cases were registered in 15.1%, 6.8% and 1.3% respectively.
Conclusions: The demonstrated young ages at marriage, pregnancy and childbirth of the examined patients, reflecting the early onset of sexual reproductive activities, and the associated cellular changes urge the necessity for promoting public awareness on the significance of Pap smear screening among Iraqi females. The Bethesda system facilitates easier interpretation of the results; thus fostering the communications between the examining pathologists and the gynecologists.

Background: Vitamin D has been linked to fertility since its receptors were found in reproductive organs. Nevertheless, its exact role in fertility is yet to be cleared.
Objectives: To analyze follicular fluid (FF) vitamin D in females doing Intracytoplasmic Sperm Injection (ICSI), to compare its level between Polycystic Ovary Syndrome (PCOS) and non-PCOS females, and to explore whether vitamin D correlates with oocytes number, percentage of oocyte maturity, fertilization rate and percentage of high quality embryos.
Patients and methods: This comparative observational study was done, from January to October 2018, at Al Amal IVF Center, Jenin hospital, Baghdad. The study was conducted on 40 women; 18 had PCOS, 15 had blocked fallopian tubes and 7 had idiopathic infertility. FF vitamin D was analyzed by Ichroma kit, Boditech. Deficient, insufficient, and sufficient vitamin D levels were as: <10, 10-29, and 30-100 ng/ml, respectively.
Results: Most participants were deficient (12 women) or insufficient (18 women) of vitamin D, only 10 women had adequate vitamin D levels. FF vitamin D was higher in non-PCOS than PCOS women (P= 0.011). The correlation between vitamin D and oocytes number was not significant. However, it was significant with percentage of oocyte maturity (rho= 0.459, P= 0.003), fertilization rate (rho= 0.471, P= 0.002) and percentage of high quality embryos (rho= 0.316, P= 0.047).
Conclusions: PCOS patients, when compared to non-PCOS, have lower vitamin D levels. FF vitamin D might correlate with percentage of oocyte maturity, fertilization rate and percentage of high quality embryos in patients undergoing ICSI.

Background: Psychiatry is an important branch of medicine and has been an integral part of the academic curriculum in Baghdad College of Medicine since its establishment. Medical students have a different attitude towards it as a medical profession like other specialties of medicine and as future medical career.
Objectives: This study aims to explore the attitudes of medical students towards psychiatry in general and as a future career after their course of clerkship in the Department of Psychiatry in Baghdad Teaching Hospital.
Patients and Methods: During the year 2016, 158 male and female students of fifth and sixth years participated in a brief five-question survey derived from the international questionnaire-Attitude towards Mental Illness (AMI) assessing their perspectives toward importance of psychiatry as medical discipline to study and as their future career choice.
Results: The female to male ratio was 2:1. Of all the respondents, 86.6% indicated the clinical significance of psychiatry as a profession. Only 23% said that they would choose psychiatry as their future career. Nearly half of them attributed improvement of their attitudes to the positive effect of tutoring. Generally, there were no prominent gender differences in the responses
Conclusion: The vast majority of the students had a positive attitude towards psychiatry in general yet it wasn’t preferred as their future career. It is thought that education and training of psychiatry may ameliorate the negative attitude towards the clinical importance but it may not affect their career aspiration.

Background: Fibromyalgia is a functional disorder of growing importance characterized by chronic widespread musculoskeletal pain. It frequently affects women of child bearing age. Infertility is failure to achieve pregnancy within a 12 month period for sexually active individuals under 35 years of age and failure to conceive within a 6 months period for those over 35 years, which can have a major psychosocial impact on the affected person’s life.
Objectives: To estimate the prevalence of fibromyalgia among a sample of infertile women; and to study its relationship with age, length of marriage, duration and type of infertility.
Patients and Methods: A cross-sectional study was conducted in Kamal Al-Samarraee Infertility Center & Infertility Clinic in Baghdad Teaching Hospital on 202 infertile women. Fibromyalgia was diagnosed according to 2012 Canadian Guidelines.
Results: Fibromyalgia was reported in 48 women (23.8%). There was a significant association between fibromyalgia and age (P=0.023), longer duration of marriage (P=0.001) and longer duration of infertility (P=0.04), but no significant association with type of infertility whether primary or secondary (P=0.32).
Conclusions: The prevalence of fibromyalgia among infertile women was higher than reported in the general population and its occurrence was significantly associated with age, longer duration of marriage and infertility.

We present a case of dizygotic diamiontic twin pregnancy in which one fetus was normal with normal placenta, the 2nd fetus was normal appearing with partial molar placenta.
The patient was a 31-year-old presented to Central Private Hospital; her gestational age was 22 weeks +5 days following IVF (after 10 years of primary infertility) of diazygotic diamiontic twin pregnancy as a case of vaginal bleeding from 8 weeks of gestation with uterine contractions.
All required investigation and clinical assessments were carried out and revealing partial molar pregnancy in one fetus and normal placenta of the other one. Maternal BhCG was high for gestational age.
The patient had gestational DM & hyperthyroidism. Appropriate treatment regarding her conditions was implemented
All appropriate management was implemented. The patient continued to bleed. Within few days of admission she had premature uncomplicated labor with normal vaginal delivery (gestational age was23 Wks +3 days), both babies appeared normal, one placenta morphologically &histologically typical of H.mole. The other one completely was normal.
Monitoring of serum BhCG and follow up transvaginal US was done until BhCG level returned to normal after 3 months of delivery without chemotherapy.
Close monitoring of pregnancy from early stages and discussing the possible complications to mother and baby (such as baby may be chromosomally abnormal &may not survive) with parents is important to manage such complications.
It is also necessary to have post-natal close follow up for maternal BhCG levels to assess any possibility of invasive mole or choriocarcinoma.