Mustansiriya Medical Journal

Background: The international hip dysplasia institute (IHDI) classification is a new method for quantifying the severity of the developmental
dysplasia of the hip (DDH). Objectives: This study aimed to compare the reliability of this classification between different medical personnel
such as pediatricians, general practitioners, and family doctors in addition to orthopedic surgeons and radiologists. Methods: Hundred pelvic
radiographic films (with 200 hips) were randomly selected from the files of children already diagnosed and treated as DDH cases. These
films were analyzed by 12 independent observers of four different specialties: three orthopedic surgeons (Ortho Group), three radiologists
(Radio Group), three pediatricians (Pediat Group), and three general practitioners (GP Group). Results: The average measures (Cronbach’s
alpha) for the intraclass correlation coefficient (ICC) for absolute agreement between all observers was 0.874 (with 95% confidence intervals
between 0.780 and 0.925). This was considered as having a good level of reliability and agreement between all observers. The ICC for
agreement between the observers of radio group showed the highest score (0.904) while that between those of GP Group had the lowest
one (0.826). However, during the comparison between the mean score of each group with that of the other groups by the one‑way ANOVA
method, there was no statistically significant difference between all groups (P values were 0.563, 0.415, 0.399, and 0.291 respectively).
Conclusion: The IHDI classification method for cases of DDH has a good level of reliability among different medical personnel regardless
of their specialties.

Background: Florid diabetic retinopathy (FDR) is a severe form of proliferative diabetic retinopathy associated with high risk of
blindness. Aim: The aim of this study is to evaluate the efficacy and safety of prompt intravitreal injection of bevacizumab followed by
complete pan‑retinal photocoagulation (PRP) for treating eyes with FDR. Setting and Design: Prospective, interventional case series.
Patients and Methods: Patients with FDR were treated initially with intravitreal injections of bevacizumab 1.25 mg. One week after the
injection, patients were sent for wide field fluorescein angiography (WFA), and PRP was performed in two sessions, 2 weeks apart. Patients
were examined every 2–4 weeks to determine the status of new vessels (NVs). Additional laser burns were applied in cases with recurrence
of NVs. Statistical Analysis: Numbers and percentages were calculated and reported. Results: Eleven patients (18 eyes) with FDR were
included. All included patients had poorly controlled diabetes mellitus with mean glycated hemoglobin of 10.6%. One week after the
injection, all eyes showed clinical regression of NVs. WFA showed extensive areas of peripheral retinal capillary nonperfusion. Eight weeks
after the injection, three eyes (16.7%) showed recurrent increase in NVs, and additional laser therapy was performed for these eyes with
special attention to ablating the areas of peripheral capillary non‑perfusion. After 16 weeks from the primary treatment, 15 eyes (83.3%) had
complete neovascular regression on clinical and angiographic assessment. Pars planavitrectomy was required for three eyes (16.7%) with
tractional retinal detachment (2 eyes) or macular epi‑retinal membranes (one eye). Conclusions: According to this study, most cases with
FDR stabilized after prompt bevacizumab injection followed by complete PRP with special attention for ablating the peripheral capillary
nonperfusion areas, guided by WFA images.

Background: Bone cutter is a widely used procedure to cut the prepuce during circumcision. Aim of the study: The aim of the study was to
assess the safety of circumcision of male using bone cutter with thermal cautery, including the operative time and healing time and the effect
of dressing on rate of infection and bleeding. Materials and Methods: Over 20 years period from 1996 till 2015, six thousands of males
were circumcised under local anesthesia (in form local infiltration of 1% plain lidocaine 5 min before circumcision and xylocaine spray after
the procedure) using a bone cutter with thermal cautery, the first assistant is to fix the upper limbs, while the main assistant is to fix the knees
in a fully extended position by the left hand, while the right hand used to elevate the two mosquitoes, then by using thermal cautery to cut
the foreskin above the jaw of bone cutter and by using S‑ring in certain situation to fix the bone cutter tightly. Results: Six thousands males
were included in this study. The mean operative time was 1-2 minutes, healing time was 5-7 days, 387 cases (6.45%) developed early & late
complications, 180 (3%) bleeding, 195 (3.25%) developed infection, 3 (0.05%) with mild glans injury need dressing only for 24-48 hours
only 9 (0.15%) need re-circumcision later on in the same procedure. Conclusions: Bone cutter with thermal cautery circumcision is feasible
with a relatively lower complications rate, shorter operative time, and short healing time.

Background: Preeclampsia (PE) is considered one of the major causes of both maternal and fetal mortality and morbidity. Advances have
been made on understanding the pathophysiology of this pregnancy‑specific disorder. Sestrin2 (SESN2) is a metabolic regulator protein,
whose expression is induced in response to exposure to different adverse effects such as hypoxia, DNA damage, or oxidative stress, thus
acting as cytoprotective. Objective: The objective of the study was to investigate the levels of maternal serum SESN2 in preeclamptic and
uncomplicated pregnancies and their association with the disease severity. Patients and Methods: This was a case–control study conducted at
the Department of Obstetrics and Gynecology at Al‑Yarmouk Teaching Hospital in Iraq – Baghdad city from the first of March till the end of
November 2019. The study included a total of 92 pregnant women, 27 with a healthy pregnancy, 33 with nonsevere PE, and another 32 having
severe PE. From all participants, blood samples were collected for the evaluation of serum SESN2 levels using enzyme‑linked immunosorbent
assay. Results: The mean readings of SESN2 for normal pregnancies were 5.22 ± 1.71 ng/ml which was significantly lower than that for the
nonsevere PE group (8.41 ± 1.42 ng/ml), while SESN2 levels were the highest among those with severe PE (16.92 ± 5.15 ng/ml). A negative
correlation was found between each of GA at delivery, birth interval, and birth weight and the SESN2 level (P = 0.001); while mean arterial
pressure positively correlated with SESN2 levels (P = 0.001), the cutoff value for the diagnosis of severe PE was 9.95 ng/ml (sensitivity of
93.8% and specificity of 98.8%). Conclusion: Maternal serum SESN2 levels are significantly higher in pregnancies complicated by severe
PE than nonsevere PE and control groups. It could be a useful biomarker that can help in diagnosing severe PE.

Background: Hypertension is an important risk factor for many cardiovascular diseases worldwide. Assessment of left ventricular (LV) systolic
function has a major diagnostic and prognostic importance in patients with hypertension. The use оf mitral annular plane systolic excursion in thе
assessmеnt of LV systolic dysfunction is helpful especially in cases of poor imaging quality, “since good imaging quality is needed for the modern
echocardiographic techniques. Objectives: Detection of early subclinical LV longitudinal systolic dysfunction in hypertensive patients without LV
hypertrophy (LVH) with preserved ejectiоn fraction by mitral annular plane systolic excursion. Patients and Methods: A comparative case‑control
study which took place at Al‑Yаrmouk Tеaching Hospitаl in Baghdad/Iraq from October 2018 to October 2019. The study population consisted
of 60 patients without LVH and 60 healthy subjects considered as controls. Echocardiographic parameters for left ventricular systolic assessments
were done for all subjects. Results: Mean peak annular systolic velocity was significantly lower in hypertensive patients without LVH compared
to controls (P = 0.034). There was no significant difference between hypertensive patients without LVH and controls regarding mitral annular
plane systolic excursion (P = 0.4). There was positive linear correlation between mitral annular plane systolic excursion and peak annular systolic
velocity for hypertensive patients without LVH (r = 0.535, P = 0.015). Conclusion: Although there was a significant linear correlation between
mitral annular plane systolic excursion and peak systolic velocity and both are considered as a surrogate for LV longitudinal systolic function, mitral
annular plane systolic excursion cannot be used for assessment of LV longitudinal systolic function in patients with hypertension without LVH.

Respiratory diseases caused by a number of infectious agents including Streptococcal pneumonia, streptococcal pyogenes, Klebsiella pneumonia
H. influenzae, Legionella pneumophilia, Mycoplasma pneumonia, Coxiella Bunetii, chlamydia pisittaci. These microbes enter into the lungs and
cause primary cases of pneumonia. The whole respiratory epithelium down to the internal bronchioles is ciliated. The cilia and the thin film of mucus
covering them have the critical function of trapping foreign particles, including bacteria, and propelling them toward the pharynx. They contribute
to the prevention of respiratory infection as they do the macrophages utilizing their secretory, phagocytic, and bactericidal activity. Despite the
wonderful defense, the bacterium escapes and settles in the lungs to produce diseases. Pneumonia is the term used to describe inflammation of
the lung. Pneumococcal pneumonia is characterized by homologous consolidation of one or more lobes or segments. Pneumococcal pneumonia
occurs at all ages but most frequently in early and middle adult life. Pneumonia is characterized with the rise in body temperature 39-40oC,
remain associated with painful cough initially dry, but later patient develops production of tenacious sputum, which is often rusty and occasionally
bloodstained. Staphylococcal pneumonia is caused due to Streptococcus aureus, which may occur either as a primary respiratory infection or as
a blood‑borne infection from a staphylococcal lesion elsewhere in the body. Klebsiella pneumonia is caused due to K. pneumoniae, a rare disease
with high mortality. There is usually massive consolidation and excavation of one or more lobes, with the upper lobes being most often involved
and with large amounts of purulent sputum, sometimes characteristic red currant jelly sputum. Legionella pneumonia is caused by Gram‑negative
bacillus L. pneumophila, which is usually transmitted in water droplets from infected cisterns used to provide water for showers, particularly in
warm climates. It is often a serious and occasionally a fatal illness. C. psittaci causes psittacosis (ornithosis), a systemic illness contracted from
infected birds. Pneumonia associated with it may be extensive, with severe toxemia. M. pneumoniae is a pleomorphic bacterium; symptoms of
mycoplasma pneumonia are mild compared to other cases of pneumonia (walking pneumonia). On the other hand, liver function test derangements
and dyselectrolytemia are more common. It is susceptible to tetracyclines though a few strains are sensitive only to erythromycin.