Mustansiriya Medical Journal

Background: Primary PCI is an emergent percutaneous catheter intervention in the setting of STEMI,without previous fibrinolytic treatment .It is the prefered strategy in patients with STEMI.
Aim: To evaluate the immediate and intermediate procedural and clinical outcome in a local experience.
Methods: This is a descriptive cross sectional study carried out in a tertiary cardiac center for 301 patirnts with acute myocardial infarction. Fifty patients(16.6%) were followed up prospectively for one month up to one year in the outpatient clinic.
Results: primary PCI was done in 294 patients (97.6%) and rescue PCI was done in 7 patients (2.4%). Ischemic time is ranging from one hour to twenty four hours (mean 5.02±3.27) . Procedural success rate was 100%. Mortality rate was 5.3% mostly because of cardiogenic shock.
Conclusion: Primary PCI should be the standered of care for patients with STEMI.

Background: Hydatid Cyst disease is caused by Echinococcus Granulosis which is a parasite that inhabits the intestine of dogs and canines as definitive hosts. Humans are infected accidentally after ingestion of the parasitic eggs. The commonly affected areas are the liver, lung, brain and other viscera. A variety of treatment modalities were employed starting from medical therapy for small cysts, to the classical surgical procedures. Nowadays Hepatic Hydatid Cyst can be effectively managed by laparoscopic surgery.
Aim: For evaluate the feasibility and safety of laparoscopy in the management, of Hepatic Hydatid Cysts regarding complications, recurrence rate, duration of surgery and hospital stay.
Patients and Methods: A study of 54 patients with hydatid cysts of liver, who underwent laparoscopic surgery at Al-Yarmouk teaching hospital, and two private hospitals in Baghdad.
Results: From Oct. 2009 - Oct. 2016 a study of 54 patients of hepatic hydatid cysts, who underwent laparoscopic procedure at Al-Yarmouk teaching hospital, and two private hospitals in Baghdad – Iraq. All patients were treated preoperatively with albendazole. A successful laparoscopic surgery was performed for 47 patients (87.03%), by de-roofing of the cyst wall and evacuation of the germinal membrane, daughter cysts and hydatid fluid by a 10mm sucker after packing of the peritoneal cavity with 20 per cent hypertonic saline-soaked packs and instilling 20 per cent hypertonic saline into the cyst cavity as a Scolicidal agent before it is opened. The cavity was then irrigated with normal saline and a drain placed inside it, while conversion to an open surgical procedure was done to 7 patients (12.96%).Due to various reasons, as deep intraparenchymal cysts 1 (1.85%) patient, posteriorly located cyst 3 (5.55%) patients, more than three cysts (multiple cysts) 1 (1.85%) patient, cysts with thick and calcified walls 1 (1.85%) patient, and cysts characterized by a heterogeneous complex mass 1 (1.85%) patient. Postoperative complications occurred in7 (13%) patients. About 46(85.2%) of patients were discharged from hospital within 3 days, and about 8(14.8%) of patients discharged from hospital within 4-7days., one patient, who converted to open surgery recurrence of the disease occurred after 3 years, exploration was done without complications. No mortality in this study.
Conclusion: Treatment of Hepatic Hydatid cyst by Laparoscopy is effective, feasible, safe, early recovery with low morbidity and no mortality.

Background: Meningitis in children is one of the life threatening condition in pediatric age group, which needs proper and early diagnosis in the emergency department. Meningitis morbidity and mortality depend on causative agent, time of diagnosis, proper and sufficient duration of therapy in the hospital. For diagnosis, many parameters can be used from history, physical examination and laboratory investigation, which needs sophisticated laboratory to perform.
Objective: To analyze CSF findings in children admitted to hospital as meningitis (bacterial and non-bacterial). Also, assess frequency and percentage of the bacterial species isolated from positive CSF culture and determine the resistance patterns of the different bacterial pathogens.
Method: A retrospective study carried out in Sulaimania, Iraq/pediatric teaching hospital from January to December 2014. lumber puncture done in 96 cases aged between 29 days to 15 years that have been diagnosed as meningitis CSF parameters; WBC total count, Sugar and protein level were examined, also culture done for all cases with CSF leukocytosis .
Results: According to CSF findings and clinical diagnosis, 51% (49cases) considered bacterial while 49% (47 cases) considered non bacterial meningitis. Deaths recorded only among Bacterial meningitis patients with a percentage of 6.1%. Results of CSF culture determined a 24 % (22 cases) as positive for bacterial growth. Streptococcal pneumonia, was on the top of the isolated bacteria with a high resistance against penicillin and Azithromycin.
Conclusion: Bacterial meningitis are still occupying large percentage of cases admitted to hospital, and if un-diagnosed promptly will have a high mortality. High index of suspicion for bacterial meningitis is recommended.

Background : Prosthetic mesh became one of the most widely used, and effective technique in the repair of different types of hernias. However its use in acute obstructed and strangulated hernia is still controversial.
Aim of the study: Assess the rate of postoperative complications in emergency mesh hernia-repair, and whether it is related to the presence of gangrenous bowel , and the need for bowel resection, or not. Or it is related to the site (type) of the complicated hernia (inguinal, incisional, or para-umbilical).
Patients and methods: A prospective cohort study was performed at Al-yarmouk teaching hospital for the period from the 1st of march 2011 to the 31st of march 2013. Forty three patients were admitted to the general surgery department with acute obstructed or strangulated hernia. Prosthetic mesh (prolene ) was used for repair of the hernia in all patients whether there is bowel resection or not. Collected data are classified, tabulated and cases were prospectively assessed for postoperative outcome .
Result : The mean age for patients was ( 52.8±16.7). Regarding the gender , 24 patients (55.8%) were male, and 19 patients (44.1%) were female, there were 23 patients (53.4%) with incisional hernia ,11 patients ( 25.5% ) with Para umbilical hernia , and 9 patients (20.9%) with inguinal hernia. The wound related complications (Superficial surgical site infection, Abscess, Recurrence, and mesh removal ) in relation with the type of hernia ;the result was statistically insignificant with a p-value (0.142 , 0.218 , 0.627, 0.218) respectively . Bowel resection was statistically an insignificant risk factor with p-value (0.280) .
Conclusion: Using of prolene mesh in obstructed or strangulated hernia regardless of the type(site) of hernia is safe, and bowel resection cannot be considered as a contraindication.

Background: Fetal distress in itself is a non-specific term include indicators such as an abnormal intrapartum fetal heart rate pattern, meconium stained amniotic fluid, low apgar scores or placental abnormality , it\'s not necessarily that an abnormality in one will reflected as an abnormality in the other or their may be none of these findings.
Aim of study: To describe the relation between intrapartum fetal heart abnormalities and operative findings and neonatal outcomes in an emergency cesarean section .
Patients and methods: A\" cross sectional study\" performed in Al-Yarmouk Teaching Hospital through the period from the 1st of July 2014 to the 1st of July 2016 on a convenient sample of 638women. Women participated in the study included: women in the labor room who delivered singleton, viable fetus, cephalic presentation, term size pregnancy with gestational age ≥37-40 weeks by emergency caesarian section for abnormal fetal heart rate As a part of the work protocol, the surgeons were instructed to document any findings that may be possible causes for the non-reassuring fetal heart rate as cord abnormality ( occult cord prolapse , true knots or entalengement) , placental abruption and rupture uterus , the placentae of those who have no intraoperative findings were send for histopathology.
Results: Mean maternal age was 27.6±8.1 years and mean fetal weight was 3.2±0.6 Kg . 35.2 % of neonates with intra-operative problems needed admission to the neonatal care unit in comparison to 20.3% of those not facing such problems. This difference was significant (p= 0.021)
There is significant association between maternal age and intraoperative abnormalities with P-value of 0.009%. No intraoperative findings were seen in 34% and 65.5% no placental finding were found on histopathology.
Conclusions: Fetal distress may occur for several underlining causes. However, neither of them may reflect fetal asphyxia or acidosis and an abnormal cardiotocography may carries a false diagnosis of fetal distress.

BACKGROUND: Intracranial hematomas is an important cause of death in closed head injury, autopsy findings is the final way to determine the types ,extent& associated findings of these hematomas.
OBJECTIVE: To compare the incidence of brain pathology as a cause of death in patients with isolated head injury and those with multiple organ injuries.
PATIENT & METHODS: One hundred consecutive bodies who were victims of fatal closed head injury(Group A) in the forensic medicine institute from jan.2004 to jan 2007 were included in this study, in addition a control study (Group B) of 100 consecutive victims of closed head & body injury with overt and non overt head injury signs.
RESULTS: Group A (patients with pure head injury signs)
Fifty five out of one hundred (55%) were having ICH , In which SDH (pure or combined) constitutes 35% of all cases.
In addition 45% were having a brain edema &/or herniation.
Group B (patients with multiple organ injury signs)
The majority 49% were having brain ischemia.
CONCLUSION:
1-ICH are important causes of death in fatal closed head injury in which SDH are a majority in these hematomas.
2-As a non hemorrhagic cause brain edema &/or herniation were a major factor.
3-Multiply body injury showed mainly brain ischemia.

Background: Tracheostomy is a surgical technique that could be performed for either as an emergency or an elective indicated considerations, and it might associated with a number of complications, however the frequencies and severity of these complications will depend upon the intermingle of various contributing factors.
Objective: The aim of the study was to evaluate and analyze the frequency of various elements of early complications associated with open surgical tracheostomy component in our set up.
Patients and methods: A series of 112 consecutive open surgical tracheostomy procedures conducted at Al-Yarmouk Teaching Hospital from February 2016 to February 2017. The data collection were included the following parameters; emergency or elective tracheostomy procedures, and according to their particular indications, as well as were performed under general or local anaesthesia, all the fore mentioned data were evaluated and analyzed in correlation with the frequency and the severity of various elements of early complications.
Results: There were (63.4%) males and (36.6%) females, with mean age of 46.851 years, about (56.25%) were emergency tracheostomies, and (43.75%) were elective type, in (54.46%) of them the indication was to relief upper air way obstruction. The overall frequency of an early complications in emergency tracheostomy was (30.35%), and was (8.92%) in elective modality. The commonest early complications was bleeding (11.6 %), followed by tubal obstruction (8.03%).
Conclusion: The frequency of the overall early complications of open surgical tracheostomy was detected at higher rate in emergency than in elective procedures, also the most common element of the early tracheostomy complication encountered was bleeding and being primarily revealed in an emergency indicated tracheostomy, followed tubal obstruction with more existing frequency in elective tracheostomy cases

Background: Preeclampsia is a multisystem disease and a threat to the well-being of both the mother and her newborn; it contributes significantly to the causes of maternal and perinatal morbidity and mortality. An increase in maternal plasma of erythropoietin in women with preeclampsia may be of placental origion and a reflection of an underlying placental hypoxic condition.
Aims: To compare serum erythropoietin concentrations among patients with and without preeclampsia and to investigate the association between serum erythropoietin levels and preeclampsia.
Methods: This case-control study involved one hundred pregnant women in their third trimester of singleton pregnancy with gestational age (28-40wk). Fifty patients were with preeclampsia (study group) and fifty patients were with normal healthy pregnancies (control group). For both groups maternal blood samples were collected for Erythropoietin concentration measured by ELISA method. Statistical analysis was performed to compare maternal serum erythropoietin levels in preeclamptic women and normal heathy pregnant women, and to evaluate the association between serum erythropoietin and preeclampsia.
Results: Mean erythropoietin level for the preeclamptic group was (41.66±26.76) ranging from 10.716-159.121(mIU/ml) with a median of 36.101 mIU/ml, while for the control group, the mean value was (28.71±14.38) ranging from 6.482-65.228 (mIU/ml) with a median of 26.741 mIU/ml. Erythropoietin levels were significantly (P=0.003) higher among preeclamptic patients compared with controls.
Conclusion: Women with preeclampsia have significantly higher levels of serum erythropoietin compared to normal healthy pregnancy.

Background: In developing countries, the skin diseases are one of the most common causes of morbidity among children.
Aim: The aim was to determine the pattern of skin diseases among children attending the kindergartens in Baghdad and to determine the changes in this pattern five years after.
Methods: A descriptive, comparative study between two surveys five years apart was conducted.
Two surveys were done; one during 2011 and the second in 2016 including kindergarten children in eight randomly chosen kindergartens in Baghdad. The total number of children was 216.Number of children enrolled in each survey was 108. Children were assessed by history and examination performed by dermatologist.
Results: In the first survey; the noninfectious diseases outnumber the infectious diseases; with pityriasis alba being the most common noninfectious disease and impetigo contagiosum being the most common infectious disease.
In the second survey; the infectious diseases outnumber the noninfectious diseases; with scabies being the most common infectious disease and atopic dermatitis being the most common noninfectious disease.
Conclusion: There is a shift in the dermatological disease pattern among kindergarten children from non infectious towards infectious diseases, with a noticed increase in the frequency of scabies and molluscum contagiosum.

Background: Leptin/adiponectin ratio has a potential additional value as a marker of central role of excess adipose tissue in insulin resistance, thus it contributes in the modulation of diabetes mellitus risk. Adipose tissue is involved in the regulation of energy balance and insulin action in type 2 diabetes mellitus patients.
Aim of this study: Study of the role of leptin/adiponectin ratio and its association with insulin resistance in type 2 diabetic patients treated with different oral antidiabetic agents.
Materials and Methods: Ninety patients with type 2 diabetes mellitus (45 males and 45 females) age between (35-60 years) and body mass index (<25) were enrolled in this study in addition to 40 healthy subjects matched with the patients for age, gender and body mass index. This study was conducted between March to December 2016 in the National Diabetes Center for Treatment and Research and Al-Yarmook teaching hospital/ Baghdad/ Iraq. We divided the patients into three groups according to medication option: Group I-include 30 type 2 diabetic patients treated with metformin alone, Group II-include 30 type 2 diabetic patients treated with glibenclamide alone, Group III-include 30 type 2 diabetic patients treated with metformin and glibenclamide. Blood samples were analyzed for fasting serum glucose, glycosylated heamoglobin, fasting serum insulin, total cholesterol, triglyceride, high density lipoprotein cholesterol, serum leptin, serum adiponectin, homeostasis model assessment of insulin resistance and leptin/adiponectin ratio.
Result: Fasting serum glucose, glycosylated heamoglobin, fasting serum insulin, insulin resistance, total cholesterol, triglyceride and serum leptin levels showed significant increase in diabetic patients when compared with control group (p<0.05). High density lipoprotein cholesterol and serum adiponectin levels showed significant decrease in diabetic patients (p<0.05), while leptin/adiponectin ratio was significantly higher for diabetics as compared with controls (p<0.01). Leptin concentration was significantly low as well as adiponectin concentration was significantly higher in type 2 diabetic patients treated with metformin alone (group I) when compared to those treated with glibenclamide alone (group II) or those treated with metformin plus glibenclamide (group III), while non-significant difference was noticed between (group II) and (group III). Homeostasis model assessment of insulin resistance in group I and III (patients treated with metformin as monotherapy or combination) showed a significant positive correlation with leptin and negative correlation with adiponectin (p<0.01), but non-significant correlation was recorded in group II (patients treated with glibenclamide alone). Correlation of homeostasis model assessment of insulin resistance with leptin/adiponectin ratio found to be significant in metformin treated groups (p<0.05) while non-significant with glibenclamide group.
Conclusion: Leptin/adiponectin ratio in type 2 diabetes mellitus can serve as an index of insulin resistance independent of body mass index. Leptin/adiponectin ratio can measure the usefulness of antidiabetic therapy based on insulin level and insulin sensitivity.

Background: Hepatitis B virus is a powerful serious form of hepatic inflammation due to hepatitis B virus (HBV) infection ,and one of the most common chronic infectious diseases worldwide.
Aim of study: to highlight the knowledge regarding hepatitis B infection (HBV) among a sample of Health and Medical Specialtystudents.
Methodology: A cross – sectional study including 107 students was conducted at Nursing College and Technical College of Health and Medicine / Baghdad during November and December 2015 who answered self – structured questionnaire covering socio-demographic characteristics and different aspects of disease knowledge of the students about Hepatitis B infection.
Results: Academic lectures were the main source of information of students (50.1%). The student\'s highest correct responses (46%, 42%) for vertical and sexual transmission, 69% for blood receivers as people at risk, 44% for physicians and dentists and drug addicts as people at risk. Children are exposed in developing countries 47, 6 % and mainly vaccination 72% as preventivemeasure.
Conclusion: In general students\'knowledge were poor -fair for mode of transmission and people at risk while it was good for disease epidemiology and very good for prevention and treatment .

Background: Pilonidal sinus is an acquired disease due to the collection of fallen hair in the sacrococcygeal area; there may be one or more openings which communicate with one or more tracts lined by granulation tissue. There are many surgical operations to treat the condition, but no single operation carries a 100% cure rate without the risk of recurrence. Financial considerations are important in the management of patients with pilonidal sinus, because it affects young adult patients, so admission to the hospital and the work off time has significant considerations in choosing the type of operative management.
Objective: To study the significance of operative treatment of acute uncomplicated sacrococcygeal sinus under the effect of local anesthesia.
Patients and Methods: A randomized cross sectional analytic study performed at the Al-Imamain Al-Kadhimain Medical City, for patients with acute pilonidal sinus with a single opening, over the period from April 2007 to April 2015. The operation was done in the theater with the patient in the prone position, local anesthetic infiltration around the opening of the sinus, and along its tract; incision along the tract of the sinus and laying it open, removing the hair, debris, and the granulation tissue by gently curating it. Excision of the lateral wall of the sinus, and the skin edges are trimmed, secure hemostasis, and dress the wound. Follow up of patients was daily for one week, then every week till complete healing occurred (usually 2-4 weeks), looking for any complications; then follow up of the patients every month for three months, and every three months for one and a half year, for any recurrence.
Results: A total of 53 patients; 52 males (98.11%), and one female (1.88%), their age ranged from 17-39 years, mean age was 25.16±76 years. The patients presented with pain 43 (81.13%), infection was 8 (15.09%), and abscess 2 (3.77%) patients. The average healing time was about 2-4 weeks. The patients returned to their work one week after the operation. There were no complications other than one patient 1 (1.88%) who had recurrence after 9 months, and the procedure was repeated to him successfully.
Conclusion: Treatment of sacrococcygeal pilonidal sinus under the effect of local anesthesia is a safe and simple procedure; there is no need for admission to the hospital, the patient can return to his work after one postoperative week, and the procedure can be repeated in case of recurrence.

Cancer metastatic is dependent on capability of tumor cells to enter "blood and lymphatic system" and there after form tumors in "lymph nodes and distant organs".
Matrix metalloproteinase-9(MMP-9) is considered to as important for degradation of the basement membrane and extracellular matrix through cancer invasion and other tissue-remodelling events. This study evaluate the value of Matrix metalloproteinase-9, by Immunohistochemical technique in a series of50 colorectal carcinoma tissues. There was a significant difference betweenMMP-9protein and tumor differentiation, as well as tumor stage.
There was highly significant difference in mean percentage of (MMP-9) proteins expression in tissue of colorectal carcinoma (CRC) and colorectal normal tissue (CRN).
Conclusion: This study shows that (MMP-9)expression in colorectal cancer is related with better prognosis.