Iraqi Postgraduate Medical Journal

BACKGROUND:
Polycystic ovary syndrome(PCOS) is one of the most common endocrine disorder affecting women
in reproductive age. No single etiologic factor fully accounts for the spectrum of abnormalities in the
polycystic ovary syndrome. Different changes in hormonal, metabolism and the inflammatory
markers as squealy of PCOS with adverse effect on the women life.
OBJECTIVE:
To study the relationship between polycystic ovary syndrome and levels of C-reactive protein, human
interleukin and hormonal and metabolic alteration in women with PCOS
PATIENTS AND METHODS:
Thirty women with Polycystic Ovary syndrome (PCOS) and other thirty women without PCOS were
included. Venous blood samples were taken in early follicular phase of menstrual cycle [day 2-6] for
luteinizing hormone (LH), follicle-stimulating hormone (FSH), and testosterone. Serum level of
Human Interleukin 1B (IL-1B) was quantitatively determined. Blood samples were also tested for
detection of CRP (C-reactive protein, in addition to levels of cholesterol, triglycerides.
RESULTS:
The mean cholesterol level was significantly higher in PCOS group rather than controls; (188.3 ±
7.2) vs. (168.7 ± 6.1) respectively. Mean LH level was higher in PCOS women than control (13.3 ±
2.4 IU/L) vs. (5.85 ± 1.47) IU/L, while in contrary mean FSH level was lower in PCOS cases. The
mean serum testosterone in PCOS group was significantly higher than in controls, with no significant
difference regarding IL-1B, but again it was significant in cases of CRP.
CONCLUSION:
PCOS was associated with higher levels of cholesterol, LH, and serum testosterone with lower levels
of FSH. Positive C-Reactive Protein was more frequent in PCOS cases. Still serum level of Human
Interleukin 1B (IL-1B) was not significantly affected by PCOS.

BACKGROUND:
Regardless of the accessibility of more up to date and more modern methods of investigations,
urinary cytology still remains the most regularly utilized non-invasive investigation for the
diagnosis of cancer of the bladder.
OBJECTIVE:
To assess the helpfulness of urine cytology in assessment of patients with hematuria for the
presence of malignancy.
PATIENTS AND METHODS:
A total of 1560 recently voided urine samples got at private clinics from patients with hematuria,
whether gross or microscopic, over a time of three years were incorporated in the study. Physical
and microscopical (cytological) examination done for all samples.
RESULTS:
Among these cases of hematuria incorporated in the study, 23.7% (370 cases) were found to have
positive finding of atypical cells. In these cases with atypia, 48.7% (180 cases) were proved to have
malignancy both with cystoscopic findings and the histopathological biopsy. The remaining cases
of atypia were found to be reactive, either due to instrumentation or foreign body. In an extensive
number of cases of hematuria, that is, 1190 cases (76.3%) no atypical cells were identified.
CONCLUSION:
Urine cytology can distinguish urothelial cells changes and high grade bladder tumor so it is a good
tool particularly with coordinated effort amongst clinician and cytopathologist. Urine cytology can
be utilized as an adjunct test in assessment of patients with hematuria.

BACKGROUND:
Skin diseases may affect daily lives of individuals and their psychological and social relationships.
Appropriate measurement systems are required to evaluate the impact of the disease on the quality
of life. The Dermatology Life Quality Index (DLQI) is an important and commonly used
dermatology specific quality of life instrument.
OBJECTIVE:
To assess the quality of life in 2 common dermatological disorders (acne and psoriasis) in Iraqi
patients attending dermatological outpatient clinic, Baghdad Teaching Hospital.
PATIENTS AND METHODS:
A case series study of 400 patients with 2 dermatological diseases (acne and psoriasis); 200
patients for each disease were evaluated. Information related to socio-demographic data and
disease severity were recorded and quality of life was assessed by means of the Dermatology Life
Quality Index.
RESULTS:
The DLQI of patients with acne and psoriasis were comparable; 7.71+/-4.64 and 8.52+/-4.48
respectively. In patients with acne the DLQI was significantly affected by higher level of education
P=0.002, also in unmarried patients P=0.0001. Increased disease severity also affected DLQI
(P=0.003). In patients with psoriasis the only factor which was associated with a higher DLQI was
female gender.
CONCLUSION:
Acne and psoriasis affect significantly the DLQI of patients. DLQI is a good indicator of the
impact of the disease on the life of the patient.

BACKGROUND:
Assessment of LV systolic function is sometimes difficult because of obesity, chest wall deformities
or in critically ill patients. We try to evaluate alternative methods for rapid assessment of LV systolic
function.
OBJECTIVE:
In this study we try to evaluate mitral annular plane systolic excursion (MAPSE) ( Since LV
longitudinal shortening reflected by MAPSE is a sensitive marker of LV systolic function.) & E-point
septal separation (EPSS) for rapid assessment of LV systolic function & as alternative way to assess
ejection fraction (EF).
METHODS:
This is an observational case-control study enrolling 143 patients, 73 patients with LV dysfunction &
70 persons with normal LV function served as a control group.
LV EF (Left ventricle ejection fraction), MAPSE & EPSS all are measured for patients & the control
groups. P-value ≤0.05 is considered as a statistically significant.
RESULTS:
A 73 patients with LV dysfunction & 70 patients with normal LV function (taken as a control) were
enrolled in this study. There are significant LV dilatation, a decrease in LVEF, decrease in MAPSE
& increase in EPSS in patients group in comparison with control groups, & all are statistically
significant (P-value=0.0001).MAPSE less than 7 mm & EPSS more than 7 mm had a sensitivity of
34.24 % & 97.26% respectively & a specificity of 100% & 85.71% respectively.
CONCLUSION:
Both MAPSE & EPSS parameters are simple, easy to obtained & require no time especially in
patients with poor acoustic window.
An average MAPSE of less than 7 mm & EPSS of more than 7 mm can be used as a surrogate of LV
systolic dysfunction with acceptable sensitivity & specificity.

BACKGROUND:
Guillain-Barre syndrome (GBS) is an acute idiopathic progressive ascending weakness and
considered the most common cause of acute flaccid paralysis in healthy infants and children. It is
now known to be a heterogeneous syndrome with several variant forms. In addition to the
demyelinating form, which is the most common type, axonal forms of GBS are now well
recognized.
OBJECTIVE:
To estimate frequency, demographics, clinical characteristics and complications of GBS
subtypes from nerve conductive study (NCS) and electromyography (EMG) in patients were
admitted to Children Welfare Teaching Hospital.
PATIENTS& METHODS:
Fifty three children with GBS admitted to Children Welfare Teaching Hospital Medical CityBaghdad from January 2009 till August 2010 was enrolled in this study. Clinical data were
obtained; electrophysiological studies (NCS, EMG) were performed to determine GBS subtypes.
RESULT:
Out of 53 children studied, eleven patients (20.6%) were diagnosed as axonal subtype and 42
(79.4%) were of demyelinating subtype.
Axonal subtype was more frequent in rural than urban (8/11 patients 72.7% and 3/11 patients
27.3% respectively), where as demyelinating subtype was more frequent in urban residency
compared to rural area (33/42 patients 78.6% and 9/42 patients 21.4% respectively) with a P
value=0.0025.
Although gastroenteritis was higher in axonal subtype (3/11 patients 27.3%) compared to only
(5/42 patients, 11.9%) in demyelinating subtype, it did not reach the statistical significant.
History of upper respiratory tract infection was reported more in demyelinating compared to
axonal subtype (25/42 patients 59.6% and 3/11 patients 27.7% respectively).
Cranial nerve involvement was found in 8 patients (72.7%) of the axonal subtype while it was
found in 24 patients (57.1%) of demyelinating subtype.
Respiratory failure was reported as complication in 4 patients (36.4%) of axonal subtype,
compared to 7 patients (16.7%) of demyelinating subtype. Ventilator support was recorded in 3
patients (27.3%) of axonal, compared to only 1 patient (2.4%) in demyelinating subtype (p
value=0.024).
CONCLUSION:
The demyelinating subtype was the predominant type of GBS followed by the axonal.
Gastroenteritis was the predominant recorded antecedent event in axonal subtype and more
frequent in rural residency. Cranial nerves involvement was reported more frequently in axonal
subtype and has been a significant factor for future assisted ventilation.

BACKGROUND:
Keratoconus is a non-inflammatory, usually bilateral disorder, that leads toabnormal thinning and
steepening of the cornea duo to progressive corneal instability.
OBJECTIVE:
To estimate the progression of keratoconus after cross linking during 1 year duration.
PATIENTS AND METHODS:
This study is a prospective study carried out to estimate the progression of keratoconus after cross
linking. It was conducted in Dar Al Salam eye hospital, Lasik center, Baghdad city, fromMarch,
2011 to the December, 2016. All patients with keratoconus included in this study were referred
from private clinic.The surgery was done in Dar Al Salam hospital by one consultant
ophthalmologist. The researcher followed up the keratoconus eyes for 1 year.
RESULTS:
Two hundred sixty six eyes of one hundred seventy two patients were completed follow up after
Collagen cross-linking using UVA light and riboflavin. Mean age of patients was 18 ± 10 years
and female to male ratio was nearly 2:1. Postoperatively, VA was unchanged in 206 eyes,improved
in 50 eyes, and deteriorated in 10 eyes. No significant differences were observed in means of
autorefraction, simulated keratometry and central corneal thickness postoperatively for all eyes (p
> 0.05).
CONCLUSION:
Cross linking is a minimally invasive procedure. This method can halt or reduce keratoconus
progression.

BACKGROUND:
More than 14 antiepileptic drugs (AEDs) have been licensed for use in epilepsy over the last 20
years. Levetiracetam (LEV) & topiramate (TPM) are two of the most commonly prescribed new
AEDs. The comparison between different AEDs is a crucial issue for decision making in
epileptology.
OBJECTIVE:
To compare the efficacy & safety of LEV vs. TPM as monotherapy or add-on therapy in focal
onset or generalised epilepsy.
METHODS:
The study carried on 75 epileptic patients (45 on LEV vs 30 on TPM). Data were taken regarding
age, gender, type, dosage & duration of treatment, type & frequency of seizures six months before
& after therapy, & drug-related adverse reactions (ARs). For data analysis each therapy group is
divided into mono or add-on therapy. Further subdivision into generalised or focal seizure was
done. Efficacy was assessed as a percentage of reduction of monthly seizure frequency after LEV
or TPM initiation compared to baseline.
RESULTS:
In the total samples; although LEV was better than TPM in overall seizure control, the difference
was not significant (p-value = 0.1). Seizure freedom was 57.8% with LEV vs. 43.8% with TPM.
Reduction ≥50% was achieved in 100% LEV vs. 90% TPM patients. Both showed high efficacy in
generalised & focal seizures in both add on & monotherapy groups. In the subgroup analysis of
monotherapy; LEV showed a higher rate of seizure freedom (83.3%) vs. 55.6% with TPM for
treatment of generalised seizure. While for focal seizure, LEV showed 100% responder rate vs.
50% for TPM. Despite the above observations none of the two AEDs showed significant
superiority over the other. Both were equally effective in paediatric & adult patients in high & low
doses. Drug ARs were less frequent with LEV than TPM although both of them had reasonable
safety profile.
CONCLUSION:
The efficacies of LEV & TPM were almost equal in treating focal or generalised seizures as mono
or add-on therapy. Both were equally effective in adults & paediatric patients, in high & low doses.
The safety profile of LEV was more favourable than TPM.

BACKGROUND:
More than 14 antiepileptic drugs (AEDs) have been licensed for use in epilepsy over the last 20
years. Levetiracetam (LEV) & topiramate (TPM) are two of the most commonly prescribed new
AEDs. The comparison between different AEDs is a crucial issue for decision making in
epileptology.
OBJECTIVE:
To compare the efficacy & safety of LEV vs. TPM as monotherapy or add-on therapy in focal
onset or generalised epilepsy.
METHODS:
The study carried on 75 epileptic patients (45 on LEV vs 30 on TPM). Data were taken regarding
age, gender, type, dosage & duration of treatment, type & frequency of seizures six months
before & after therapy, & drug-related adverse reactions (ARs). For data analysis each therapy
group is divided into mono or add-on therapy. Further subdivision into generalised or focal
seizure was done. Efficacy was assessed as a percentage of reduction of monthly seizure
frequency after LEV or TPM initiation compared to baseline.
RESULTS:
In the total samples; although LEV was better than TPM in overall seizure control, the difference
was not significant (p-value = 0.1). Seizure freedom was 57.8% with LEV vs. 43.8% with TPM.
Reduction ≥50% was achieved in 100% LEV vs. 90% TPM patients. Both showed high efficacy
in generalised & focal seizures in both add on & monotherapy groups. In the subgroup analysis
of monotherapy; LEV showed a higher rate of seizure freedom (83.3%) vs. 55.6% with TPM for
treatment of generalised seizure. While for focal seizure, LEV showed 100% responder rate vs.
50% for TPM. Despite the above observations none of the two AEDs showed significant
superiority over the other. Both were equally effective in paediatric & adult patients in high &
low doses. Drug ARs were less frequent with LEV than TPM although both of them had
reasonable safety profile.
CONCLUSION:
The efficacies of LEV & TPM were almost equal in treating focal or generalised seizures as
mono or add-on therapy. Both were equally effective in adults & paediatric patients, in high &
low doses. The safety profile of LEV was more favourable than TPM.

BACKGROUND:
Neonatal jaundice affects more than 60% of neonates. Phototherapy is the main treatment, and
its effectiveness is directly related to the duration of exposure, exposed surface area of the infant,
and intensity of light used for phototherapy.
OBJECTIVE:
To determine the role of extensive phototherapy in the treatment of neonatal jaundice and to
compare efficacy of extensive phototherapy with traditional phototherapy.
PATIENTS AND METHODS:
Over a period of one month occupying throughout April 2017, 100 cases of neonatal jaundice
whom either term or preterm, near term (≥ 35 weeks of gestational age), visited Al-Elwiya
Pediatrics Teaching Hospital were collected from day zero age, precisely from 1st hour till 240
hours of age. Half of them were put on traditional phototherapy and other half were on extensive
phototherapy depending on clinical grounds and their total serum bilirubin levels according to
American Academy of Pediatrics guidelines, where a cutline total serum bilirubin (TSB) level of
20-25 mg/ dl was used to identify a phototherapy type.
RESULTS:
Percentage of improvement in neonates whose treatment included extensive (intensive)
phototherapy was 72% compared to 40% for traditional phototherapy, with full term neonates`
relative risk (1.9) was higher than preterm (near term babies) (1.7), also males` relative risk
(1.84) was higher than females` (1.78), but no significant difference was seen regarding both
(gestational age and sex). Breast fed, bottle fed, and mixed fed newborns were improved better
in extensive than traditional phototherapy (87.50% vs 41.20%, 55% vs 36.36%, 78.57% vs
45.45%, respectively). Extensive phototherapy was more frequently associated with lethargy as a
side effect (12% vs 10%).
CONCLUSION:
Extensive phototherapy was more effective in treating neonatal hyperbilirubinemia (significant p
value= 0.0012), but with a slightly higher percentage of lethargy as a side effect (12% vs 10%).

BACKGROUND:
Today; mid urethral slings are the first option for surgical treatment of stress urinary incontinence (SUI)
due to high success rates and minimally invasive characteristics of the procedure. Concomitant prolapse
surgery does not appear to have an effect on treatment outcomes according to previous studies
predominantly evaluating tension-free vaginal tape (TVT) procedures.
OBJECTIVE:
To evaluate the efficacy of cystocele repair performed simultaneously with trans obturator tape (TOT)
on the outcome of operation in patients with stress urinary incontinence (SUI) and pelvis organ prolapse
(POP).
PATIENTS AND METHODS:
The data of patients who had SUI and cystocele were evaluated prospectively and Patients who
underwent only TOT were classified as group 1 and the patients who underwent TOT simultaneously
with cystocele repair (grades 1&2) were classified as group 2. The age, number of normal deliveries,
number of pad used per day, cystocele grade, and duration of operation, pre- op International
Consultation on Incontinence Questionnaire-Short Form (ICIQ-SF) and postoperative complications
were evaluated.
RESULTS:
It was observed that there was no significant difference between groups 1 and group 2 in terms of
preoperative International Consultation on Incontinence Questionnaire-Short Form scores (16.08±0.32
and 16.71±0.31, respectively). It was observed that the postoperative ICIQ-SF scores decreased
markedly in both groups (2.31±0.69 and 4.42±1.21, respectively, p=0.003).
CONCLUSION:
Cystocele repair performed simultaneously with TOT in patients with mild to moderate (grade
1&grade2) cystocele did not provide additional improvement on TOT alone in regard to treatment of
SUI.

BACKGROUND:
Neonatal jaundice affects more than 60% of neonates. Phototherapy is the main treatment, and
its effectiveness is directly related to the duration of exposure, exposed surface area of the infant,
and intensity of light used for phototherapy.
OBJECTIVE:
To determine the role of extensive phototherapy in the treatment of neonatal jaundice and to
compare efficacy of extensive phototherapy with traditional phototherapy.
PATIENTS AND METHODS:
Over a period of one month occupying throughout April 2017, 100 cases of neonatal jaundice
whom either term or preterm, near term (≥ 35 weeks of gestational age), visited Al-Elwiya
Pediatrics Teaching Hospital were collected from day zero age, precisely from 1st hour till 240
hours of age. Half of them were put on traditional phototherapy and other half were on extensive
phototherapy depending on clinical grounds and their total serum bilirubin levels according to
American Academy of Pediatrics guidelines, where a cutline total serum bilirubin (TSB) level of
20-25 mg/ dl was used to identify a phototherapy type.
RESULTS:
Percentage of improvement in neonates whose treatment included extensive (intensive)
phototherapy was 72% compared to 40% for traditional phototherapy, with full term neonates`
relative risk (1.9) was higher than preterm (near term babies) (1.7), also males` relative risk
(1.84) was higher than females` (1.78), but no significant difference was seen regarding both
(gestational age and sex). Breast fed, bottle fed, and mixed fed newborns were improved better
in extensive than traditional phototherapy (87.50% vs 41.20%, 55% vs 36.36%, 78.57% vs
45.45%, respectively). Extensive phototherapy was more frequently associated with lethargy as a
side effect (12% vs 10%).
CONCLUSION:
Extensive phototherapy was more effective in treating neonatal hyperbilirubinemia (significant p
value= 0.0012), but with a slightly higher percentage of lethargy as a side effect (12% vs 10%).

BACKGROUND:
Elastography is a promising diagnostic tool that is increasingly used by radiologists to increase the
sensitivity and specificity of conventional ultrasound in a wide range of disease processes. One of its
major uses was to differentiate between benign and malignant lesions.
OBJECTIVE:
Is to investigate the value of elastography in assessing lymph nodes in the patients with breast
carcinoma.
PATIENTS AND METHODS:
This single center prospective cross sectional study involved forty-nine (49) women with breast cancer
and the total of sixty (60) lymph nodes (LNs) that were suspicions to be metastatic. The study was
carried out at Al-Imamain Al- Kadhimain Medical city/the breast clinic, from January 2016 through
October 2016. Ultrasound examination included conventional B-mode, power Doppler and
elastography at same session. The results were compared with tissue diagnosis of biopsy specimens and
fine needle aspiration cytology.
RESULT:
Our final result included 60 LNs, 33 reactive and 27 metastatic. The Mean of B-mode score of lymph
nodes involved by metastasis was higher than that of reactive lymph nodes, 3.26 ±0.98 versus 1.00
±1.12, and the difference was highly significant (P<0.001). While the mean for strain elasticity score of
lymph nodes involved by metastasis was higher than that of reactive lymph nodes, 3.89 ±0.70 versus
1.85 ±0.76, and the difference was highly significant (P<0.001). The Mean strain ratio of lymph nodes
involved by metastasis was higher than that of reactive lymph nodes, 5.04 ±1.96 versus 1.7 ±0.87, and
the difference was highly significant (P<0.001). Overall sensitivity and specificity of B mode US was
81.5% and 90.9% respectively, sonographic elastography sensitivity and specificity 77.8% and 100.0%
respectively, while the sensitivity of combined B mode and elastographic ultrasonography increase to
96.3%.
CONCLUSION:
The present study showed that combined ultrasound B-mode and elastography added significantly to
the sensitivity of ultrasound differentiation among benign lymph nodes and those which are involved by
malignant metastasis.

BACK GROUND:
Recent literature show a high prevalence of stigma in Iraq toward mental illness, discrimination
towards people suffering from mental illness is still common in Iraqi society and this can negatively
affects the attitudes of university students to ward patients with mental illness and till now the
publications of stigma among youth is scarce.
OBJECTIVE:
To estimate the prevalence of stigma against mental illness among university students.
SUBJECTS & METHODS:
A total of 405 university students from different governorates in Iraq. They were randomly selected
from colleges of Engineering, Arts, Education and Science. Stigma was measured by community
attitude toward mental illness questionnaire (CAMI) scale. CAMI consists of four subscale:
authoritarianism (oppressive attitude), benevolence (sympathetic attitude), social restrictiveness
(belief that mentally ill patients are threat to society) and community mental ideology (CMH1)
(community oriented care for mentally ill patients.
RESULTS:
The age of participants in the study sample was 21.3 ± 2.5 year giving male: female ratio of 0.58:1.
Students from Baghdad were 370 (91.1%), and 154 (38.0%) were living in houses of > 2 crowding
index.
Stigma was clearly noticed in 307 (75.8%) students. Three hundred ten (76.5%) were Authoritarians,
23 (5.7%) were benevolent, social restrictiveness was noticed in 298 (73.5%) and negative CAMI
was seen in 320 (79.0%). Out of males, in the study (77.9%) and out of females 191 (74.6%), are
showed stigma toward mentally ill patients, no significant role in developing stigma between sex and
educational stages (p=0.4 for both). Both those with crowding index > 2 and ≤ 2 have no significant
effect on stigma (p=0.2).
CONCLUSION:
High prevalence of stigma was noticed among university students.

BACKGROUND:
Spontaneous intracerebral hemorrhage is the deadliest and most disabling type of stroke.
Spontaneous ICH is defined as intraparenchymal bleeding in the absence of trauma or
surgery. Seasonal effect on incidence of intracerebral hemorrhage had Longley been studied with
unrewarding, and conflicting results.
OBJECTIVE:
To determine whether different seasons of the year had a relationship with the rate of primary
intracerebral hemorrhage,and some of the factors that may contribute for this relationship
PATIENTS AND METHODS:
A total of 315 patients diagnosed as a case of primary intracerebral hemorrhage attending ALImamain Medical City were taken between December 2009 and December 2011. Females were
112(35.6%) and males were 203(64.4%) aged between 18 and 93 years old with mean age group of
59.298±13.7616. The diagnosis was based on history, clinical examination and non-contrast
Computed Tomography scan of brain.
RESULTS:
Of the 315 patients, the highest rate of cases during December being 13.7% and the lowest during
February and October being 4.1% and 4.8% respectively.
Intracerebral hemorrhage rate among age group less than 55 years old being 42(34.71%) of 121
patients during summer. There was a significant relationship between winter season and
intracerebral hemorrhage incidence among diabetic patients being 29(34.52%) of total 84 diabetic
patients. 74(93.67%) of 79 patients presented during winter season had a large sized hemorrhage.
CONCLUSION:
The highest rate of intracerebral hemorrhage during December There was a seasonal variation in
patient’s age, incidence among diabetic patients and size of hemorrhage.

BACKGROUND:
Asthma is becoming increasingly prevalent among children in Iraq. Poor parent knowledge and
attitudes often contribute to inappropriate management practices.
OBJECTIVE:
The study aimed to document the knowledge, attitudes, and practices (KAP) of parents of children
with asthma and analyze how knowledge and attitudes relate to practices. The second objective was
to study the effect of educational interventions with parents of asthmatic children on the future use of
asthma controller medications and control status.
SUBJECTS AND METHODS:
A cross-sectional survey of knowledge, attitudes, and practices and educational intervention was
conducted on 130 parents of children with asthma attending an asthma clinic in Baghdad. KAP scores
were divided according to (Bloom’s cut off point 60-80%), and control scores were measured
according to Global Initiative for Asthma (GINA) guidelines.
RESULTS:
There were 36 (27.7%) male participants and 94 (72.3%) females. The knowledge scores were high
level in 83.1%, moderate level in 13.8% and low level in 3.1%.The attitudes scores were moderate
level in 43.1% and low level in 56.9%, and the practices scores were moderate level in 9.2% and low
level in 90.8%. One fifth of participants adhered to corticosteroid inhalers. There was no significant
association between knowledge score and practice, and there was a significant association between
attitudes score and practice. Use of controllers increased and asthma control scores increased
significantly after the educational intervention
CONCLUSION:
Negative attitudes towards steroids use especially inhalational preparations played an important role and resulted in the unsuitable practice of asthma control. Educational intervention may increase the use of asthma controllers and asthma control scores.

BACKGROUND:
Cervical cancer is the 3rd most common cancer in women globally. There is variation in incidence &
mortality between developing & developed countries is attributed to the national screening programs in
the developed countries to detect cervical changes in addition to human papilloma virus vaccination.
Human papillomavirus (HPV) is well known as a direct cause of cervical cancer.
OBJECTIVE:
This study designed to detect the percentage of cervical changes in Al-Anbar governorate.
Study design: A cross-sectional study for detection of abnormal cervical smears.
Study setting: Private clinic of gynecology & obstetric governorate & private laboratory of
histopathology & cytology in al-Anbar.
PATIENTS AND METHODS:
A prospective study was carried out from January 2012 - July 2014, 450 patients were included in this
study diagnosed at private laboratory in Al-Anbar govrnorate. Bethesda system was used to assess
these Pap smears. Patients were analyzed for clinical data with special focusing on the age and the chief
complaint.
Pap smears were prepared from patients presenting with complaints like abnormal vaginal discharge,
post-coital bleeding, irregular vaginal bleeding and dyspareunia.
RESULTS :
Among total of 450 patients , commonest age group at time of presentation was between 40-49 years
(172 pateints). Most of the patients were presented with vaginal discharge include one hundred eighty
eight patients (188) (41.8%). Others were presented with vaginal discharge include one hundred
eighty eight patients (188) (41.8%) , others presented with vaginal bleeding, post coital bleeding &
dyspareunia . The results of cervical smears were classified into non specific inflammation ( 150 cases)
( 33.3 %) , and abnormal pap smear results ( 300 cases). The results of abnormal pap smear include
ASC-US (40 cases) (8.9 %) , LSIL (99 cases) (22 %) , HSIL (45 cases) (10%) , squamous cell
carcinoma (25 cases) (5.5%) , AGC (21 cases), adenocarcinoma ( 0 case) & koliocytosis (70 cases)
(15.6 % ).
CONCLUSION:
Regular cervical Pap smear is highly advisable to recognize premalignant cervical changes in sexually
active female. HPV play a major role in development of cervical cancer. Cervical cytology is a simple,
safe and effective test to detect premalignant and malignant lesions of cervix at an early stage, so help
the clinicians in management of the patients.

BACKGROUND:
Anal fissure is an elliptical ulcer in the anal canal extending from the dentate line to the anal verge;
chronic anal fissure is a common problem across the world treated largely by surgical methods. The
treatment for chronic anal fissure (CAF) has undergone a transformation in recent years from surgical
to medical as the common goal is reducing the internal anal sphincter spasm.
OBJECTIVE:
To assess the efficacy of topical treatment with 2% diltiazem gel (DTZ) in patient with chronic anal
fissure versus combination cream.
MATERIAL AND METHODS:
Consecutive 400 adult male patients with symptomatic chronic anal fissure attending the surgery clinic
were enrolled in the study form February 2014- July 2016, 200 patients were treated with topical
application of 2% DTZ cream, other 200 patients were treated with combination cream. Patients were
followed up for 6 month at regular intervals for symptomatic relief and healing of fissure.
RESULT &CONCLUSION:
In our study diltiazem 2% gel was more effective than combination cream in the treatment of chronic
anal fissure.

BACKGROUND:
Malformations of the anorectum include a series of congenital lesions, ranging from a slight
malposition of the anus to complex anomalies of the hindgut and urogenital organs.An anorectal
malformation (AMR) occurs in one out of every 4000 to 5000 newborns and is slightly more
common in males. There is no specific cause of AMR has been described.
The most frequent defect in males is imperforate anus with a recto urethral fistula while in
females is a recto vestibular fistula. Imperforate anus without a fistula is unusual defect,
occurring in about 5% of the entire group of malformations, and is associated with Down
syndrome.
OBJECTIVE:
This prospective study was undertaken to evaluate the safety and feasibility of primary
anorectoplasty without a protective colostomy using the posterior sagittal anorectoplasty
(PSARP) technique in patients having vestibular fistulae, its complications, results, and outcome.
METHODS:
From January 2012 to November 2014, 20 patients with imperforate anus and vestibular fistulae
subjected to single-stage surgical correction at Children Welfare Teaching Hospital in Medical
City in Baghdad were followed prospectively for six months; their ages were range from 2 days -
2 months. Routine blood investigations such as hemoglobin, blood sugar, renal function tests,
serum electrolytes, blood group and Rh in addition to blood preparation was done. X-ray for the
chest and pelvic spine with abdominal ultrasound and echocardiography also done to rule out
any associated congenital anomalies. Patients who had undergone a staged repair were excluded
from the study. All patients were assessed for complications including stenosis, infection,
prolapse, excoriation, dehiscence and constipation.
RESULTS:
Anal stenosis (10%), mucosal prolapse (10%), superficial wound infection (10%), wound
dehiscence (5%), constipation (5%) and excoriation (5%). Mortality was nil. Apart from one
patient who needed re-do operation with protective colostomy, all patients with complications
were successfully managed by local wound care, antibiotics, laxatives, enema, anal dilatation,
and dietary changes.
CONCLUSION:
Single stage anoplasty without protective colostomy can be done safely and effectively as 3
stages operation in patients with imperforate anus and recto vestibular fistula in selected patients
with less burdens on the baby and family.