Journal of the Faculty of Medicine Baghdad

Background: Accumulation of fluid in the pleural space, which is malignant in nature, is secondary to lung,
breast or ovarian tumors. Malignant effusion secondary to metastatic Adeno Ca is most commonly seen in
males and breast Ca is most commonly seen in females. It indicates advanced disease and reduced survival.
Objectives: Is to study prospectively the outcome of pleurodesis in thirty patients with malignant pleural
effusion by using two different agents Bleomycin and Talc.
Patient and methods: Data of thirty patients with malignant pleural effusion collected and analyzed using a
form to categorize them according to their age, gender, presenting features, imaging studies and procedure
performed to drain the fluid and to arrange chemical pleurodesis.
Results: Eighteen patients were male; twelve patients were female in a ratio of 1.5:1. The youngest was 52
years old while the oldest was 81 years old. The mean age was 65.8 ±7.34. Cough and dyspnea were the most
frequent presenting features. Imaging studies showed that eleven patients had left sided effusion with an
underlying mass. Eight patients had right sided effusion with an underlying mass while the remaining eleven
patients had effusion only. Twenty patients received (Talc) and ten patients received (Bleomycin) with
comparable recurrence rate of the effusion, in seven patients out of 20 in Talc (35%) and in three out of 10
patients receiving Bleomycin (30%).
Conclusion: .Both (Talc and Bleomycin) can be used with comparable results and recurrence

Background: The prevalence of congenital anomalies at birth is underestimated in developing countries
due to the unavailability of perinatal diagnostic tests or accurate medical records. The prevalence of
congenital defects may help to establish a baseline, track changes over time, and uncover etiological clues.
Objectives: This study aims to explore the prevalence and types of major congenital anomalies in one of
the main referral tertiary centers in Baghdad, highlighting the parents’ and neonatal characteristics and
assessing the mortality rate in this group of patients.
Patients and Methods: A case series study was conducted in Baghdad Teaching Hospital during the period
between May 2017 and May 2018. Total deliveries were 6553, all live neonates with congenital anomalies
were included regardless of their gestational age or birth weight. The patient's hospital notes were reviewed
for the patient's characteristics, parentage, maternal chronic disease, drug history, and other study
parameters. The early neonatal outcome was assessed within 7 days of the delivery.
Results: The prevalence of congenital malformations was 21.5 per 1000 birth with the most frequent
anomaly affecting the nervous system (41.8%) followed by multiple syndromic malformations (12.8%) and
digestive system (12.1%). The mean maternal age was 27.8 (±7.8) ranging from 14-47. The rate of diseased
mothers was 18.4%, only half of them were on regular medications. Out of a total of 399 early neonatal
death during the study period, death due to congenital malformations constituted 19.8%. Congenitally
deformed patients died at a rate of 56%, which was significantly associated with low gestational age and
birth weight.
Conclusion: The mortality rate for patients with congenital anomalies was high and associated with low
gestational age and low birth weight. It is critical to test for congenital malformations early in pregnancy,
particularly for high-risk parents with advanced age, consanguinity, and history of congenital anomalies.

Background: The prevalence of deep veins thrombosis, complicating total knee replacement in Asian
countries, has not been fully appreciated in comparison to western countries as there are few studies on that.
There is an important correlation between the evidence of deep veins thrombosis in the lower extremity and
likelihood of pulmonary embolism later one . Because of its noninvasive nature, duplex ultrasound has
become one of the initial dependable modality for the cheek out of deep veins thrombosis after total knee
replacement. Therefore, this study was designed to evaluate the outcome of asymptomatic after total knee
replacement by duplex ultrasound among Iraqi patients.
Methods: This prospective study was conducted at AL-Shaheed Gazi AL-Hariri specialized Surgical
Hospital, Radiology department, Ultrasound unit form from October 2009 to October 2010. Duplex
ultrasound surveillance for asymptomatic deep venous thrombosis was done on 30 patients (13 females and
17 males ) who had underwent total knee replacement at day 5-7 postoperatively to investigate the evidence
of deep venous thrombosis after total knee joint replacement among Iraqi patients.
Results: The percentage of deep veins thrombosis in this study was found to be 23.33%. Of these, 14%
occurred in the popliteal and 86% occurred in the calf vein. Patients’ gender was not associated with
significant higher incidence of deep veins thrombosis .Although the incidence of deep veins thrombosis in
patients aged more than 50 years was higher than in patients aged 30-50 years, it did not reach a statistically
significant level. There was statistically significant relationship between obesity and the development of
deep veins thrombosis. Patients with sedentary lifestyle showed higher incidence of deep veins thrombosis
than patients with non-sedentary lifestyle and the difference reached a statistically significant level. The
duration of the operation showed a significant correlation with the incidence of deep veins thrombosis when
the operation lasted more than 2 hours. In addition, there was higher incidence of deep veins thrombosis
among smokers compered to non-smokers.
Conclusion: The evidence of deep veins thrombosis was 22.33% in spite of anticoagulation coverage. Also,
duplex ultrasonography is suggested after total knee replacement, especially in patients who have other risk
factors.

Background: Lung cancer is a disease in which cells in the lung grow out of control and may spread to
lymph nodes or other organs including the brain. Cancer from other organs may also spread to the lungs.
The chance that a man will develop lung cancer in his lifetime is about 1 in 15; for a woman, the risk is
about 1 in 17. These numbers include both, those who smoke and those who don't, but for those who
smoke the risk is much higher. Worldwide, the prevalence of lung cancer has decreased during the past
decade.
Objectives: To determine the prevalence of lung cancer in Al Najaf Governorate as registered in the
Middle Euphrates Oncology Center (MEOC) during 2019 and 2020
Patients and Methods:
A registry-based cross-sectional study was conducted at the (MEOC) in Al Najaf city from October 2021
to February 2022. The target population was patients diagnosed with lung cancer and registered during
the past two years (2019 and 2020. The data was collected from this center and from the Iraqi National
Cancer Registry (INCR) annual reports. The student t- test and the Chi Square test were used, with a
significance level of P < 0.05. The approvals of the committee of Arab Board of Health Specializations
and Al Najaf Directorate of Health were obtained.
Results: A total of 183 cases were registered during the study period, 98 (53.6%) in 2019 and 85 (46.4%)
in 2020. Fifty-nine (32.2%) patients were between 60-69 years of age and another 59 (32.2%) between
70-79 years. There were 125 (68.3%) males, 58 (31.7%) females, 138 (75.4%) smokers, and 59 (32.2%)
were overweight. Ninety-eight patients (53.6%) had right lung CA, 103 (56.3%) patients had squamous
cell carcinoma (SCC), 43 (23.5%) had adenocarcinoma, and 32 (17.5%) had small cell CA. Cancer
metastasis was found in 108 (59%) patients. Bone metastasis was diagnosed in 35 (19.1%) patients and
liver metastasis in 30 (16.4%) patients. The prevalence of lung CA in 2019 was 6.5/105 (8.72/105 in males
and 4.25/105 in females). During 2020, there were 59 males and 26 females diagnosed with lung cancer,
with a prevalence of 5.5/105
(6.7/105 in males and 3.4/105 in females). Small cell CA was significantly
associated with patients aged 60-69 years, smokers, diagnosis with biopsy, metastasis to the
supraclavicular lymph nodes and to the liver.
Conclusions: In Al Najaf, the prevalence of lung CA in 2019 was higher than that in 2020 with a male
predominance, and metastasis in more than half of the patients, most common in the bones and liver. The
most common types of cancer were squamous Cell CA, adenocarcinoma, and small cell CA.

Background: Atrial fibrillation is a common arrhythmia in daily practice and one of the heart disorders
with the highest morbidity and death rates, as it is responsible for a huge number and negative
consequences. In our country, there is limited information on the prevalence of natural history of the less
well-defined clinical types.
Objective: To assess the clinical profile and coronary artery findings in atrial fibrillation patients.
Patients and Methods: This cross-sectional study was conducted during the period from the first of
October 2019 to the end of July 2021 at the Iraqi Center for heart diseases at Baghdad Medical City. It
included 32 Iraqi patients with atrial fibrillation of both genders. Angiography was performed by the
femoral artery approach, Data were collected by history, thorough clinical examination, and
investigations, using a data collection sheet
Results: The main type of atrial fibrillation was the chronic one, (62.5%), Echocardiography findings
revealed systolic dysfunction in 31.1% of patients, diastolic dysfunction in 37.5%, and both dysfunctions
in 6.2%. The left atrium was dilated in 13 patients (40.6%). Angiographic findings revealed RCA lesions
in 13 (40.6%) patients, left circurnflex artery in 9 (28.1%) while both RCA and LCA lesions were present
in 3 (9.4%) patients. LAD lesions were reported in 10 (31.2%) patients, LCX in 27.8%, and LMS in
16.8%.
Conclusion: Chronic AF was the more frequent type, Systolic and diastolic dysfunction are frequent
among AF patients. RCA was more frequently affected than LCA, LAD was the more affected branch

Background: Dietary supplementation is a common additional strategy to achieve a specific health status or
performance benefit. This is the first study to describe the use of dietary supplement in Iraq.
Patients and Methods: In 2021, in Baghdad, a total of 359 individuals (112 males and 247 females) aged
35–74 years have responded randomly to a questionnaire about dietary supplement use and have indicated
reported supplement use frequency and prevalence by sex and supplement type.
Results: The percentage of people who reported taking dietary supplements differed between men and women
with women being more likely to use them than men. The most common supplements reported were vitamins
and minerals, but there were significant disparities between genders. Vitamins, especially D and C, were the
most popular among both genders. Herbal use was higher in females than males.
Conclusions: This study found that supplement use varies widely in the study group, potentially affecting
individual and societal nutrient intakes. The findings highlight the importance of closely monitoring dietary
supplement use

Background: Urinary tract infection is a highly prevalent disease all over the world and affects females
more than males. In the former, it may complicate pregnancy to potentially lethal septicaemia.
Therefore, the aim of the current case report was to show how misinterpretation of symptoms of
septicaemia can lead to inadequate, and probably inappropriate, management with subsequent medicolegal consequences.
Methods: A case study of a young pregnant female who developed urinary tract infection and was
treated with parenteral cephalosporins. The infection developed into septicaemia with subsequent
miscarriage and death of the patient.
Conclusion: Urinary tract infection during pregnancy may progress to septicaemia. Therefore, early
diagnosis and effective treatment may reduce potentially fatal outcomes.

Background: Colorectal cancer (CRC) is the fourth common gastrointestinal cancers. (BRAFV600E) is a
member of RAF family of serine/threonine protein kinases that function to regulate the (MAPK) / (ERK)
pathway. BRAFV600E mutated CRC are associated with right-sided primary tumors, older women, highgrade tumors and poor prognosis
Objectives : Detection of BRAFV600E mutation in a sample of Iraqi patients with CRC using
immunohistochemical techniques and study the correlation of BRAFV600E biomarker with other
clinicopathological variables such as patient's age and tumor grade.
Materials and Methods :In this case series study a total of 90 colorectal cases of Iraqi patients
were collected from teaching labs of Al-Yarmouk Teaching Hospital during the period of 20
September 2019 to 20 May 2020 including 60 cases of CRC and 30 cases of colorectal adenoma ,
The samples were studied regarding the expression of BRAFV600E biomarker and its relationship to
certain clinico-pathological parameters including : Patient'
s age, sex, tumor site, tumor size,
histological type, pathological grade and pathological stage.
Results: Regarding the carcinoma group, BRAFV600E biomarker was positive in 10 (16.6%) cases of
CRC group and all adenoma cases showed negative expression of BRAFV600E.
Conclusions: BRAF expression was higher in older patient's ages and higher tumor stages and there is
no expression of BRAFV600E in adenoma cases.