Al-Kindy College Medical Journal

Locking of the knee is a one of the commonest orthopedic outpatient presentation. This patient usually need magnetic resonance imaging (MRI) when there is suspected lesion in the soft tissue clinically. Meniscal tears is the first differential diagnosis when accompany with painful knee. (1, 2)
Giant cell tumor (GCT) is benign a localized nodular tenosynovitis often occur in the tendon sheath , Mostly involve the hand tendons in middle age group between 30 and 50 years old , female affect more than male.(3,4) The WHO defines two well-known kinds of giant cell tumor: (1) pigmented villonodular synovitis ( generalized type), which mainly involve the joints of the lower limb and (2) giant cell tumor of the tendon sheath ( localized type) , which usually involve the figures and small joints rarely the large one. (5, 6)
This case presented as unusual appearance of GCT arising from the suprapatellar synovial pouch.
Informed consent obtains from the patient.

Background: Injuries to blood vessels are among the most dramatic challenges facing trauma surgeons because repair is often urgent, the surgeon has to decide between management options (open or endovascular), and gaining control and reconstructing a major arterial injury can be technically demanding .
Objective:,To analyze the cause of injury, surgical approach, outcome and complications of axillary artery injuries.
Methods A descriptive cross-sectional study on fifty patients at Ibn-Alnafees hospital in Baghdad from January 2005 to December 2010
Results Males were more commonly affected than female with ratio of 6.1:1. Most injuries were caused by bullet and shell (84%), followed by stab wounds (10%) and blunt trauma (6%). Patients were divided into three groups according to the involved part of the axillary artery: the first part, the second part and the third part. The second part represents most of the cases (48%), the third part account for (30%), while the least is the first part (22%). Resection and end to end anastomosis was done in 80% of the cases, lateral repair in 8%, graft interposition in 8 % and ligation in 4%.
Conclusion: The outcome of the injury in this study was in general good. The morbidity of the patients due to nerve injury and wound infection still problem. Mortality due to associated injury and delayed presentation was 4% which is acceptable as compared with other studies.

Background: Irritable bowel syndrome (IBS) is one of the most common GI disorders in people under 50 years of age.
Objective: To Formulate an overview about demographics of IBS and patterns of presentation, to determine IBS patients severity ranking, and to recognize the main regimens with their patient satisfaction.
Methods: This is a cross sectional clinical study that is conducted in Outpatient Consultant Internal Medicine Clinic in Al-Kindy Teaching Hospital from 11/12/2017 to 24/12/2017. The patients suffering from IBS are diagnosed by a consultant according to the symptom-based Rome criteria for functional GI disorders, by implementing a questionnaire collecting thorough information. 77 cases of IBS patients were collected (24 male and 53 female).
Results: This study revealed that majority of patients were female (68.8%). Most of the patients were married, employees and housewives, aged between (20-30 yrs). Most patients use anxiolytics, muscle relaxants and proton pump inhibitor. There is a high IBS prevalence among low educational level (high school graduates and non-school graduates).
Most patients in our study had constipation.
Aggravating factors Psychological factors (stress) are intrinsically associated with IBS and symptoms in a large percentage of patients.
Antispasmodics usage in our study show high effectiveness for IBS patients especially those with crampy abdominal pain and diarrhea.
Conclusions: Diagnosing and managing IBS can be a big challenge since many drugs used to reduce symptoms and severity, but also, they could be unnecessary medication that could aggravate bowel symptoms and have adverse effects on the long term.

Background: Animal bite is one of the public health problems all over the world, especially in poor countries. Animal bites have an impact on human health due to rabies disease, which is a viral transmitted disease from animal to human with a high mortality rate.
Objective: To determine the epidemiological characteristics of animal bite cases by person, time, and place.
Method: Descriptive cross sectional study was done by reviewing cases caused by animal bites., Data including the demographic characteristics of age, gender, occupation, site of bite, and attending health institutions searching treatment were all included.
Results: There were 11600 animal bite cases. Most of bites caused by stray dogs 11577(99.8%), and the males were more affected than females. The mostly affected site of bite was lower limbs. Babylon and Naniva provinces registered the highest rate of animal bite victims.
Conclusion: The study is determining the epidemiological characteristics of animal bite cases by person, time, place and giving an accurate view about the epidemiological importance of the problem in Iraq.

Background: Coronary artery disease remains the main cause of death despite several preventive programs. Epicardial adipose tissue is a visceral fat depot of the heart located along the large coronary arteries and on the surface of ventricles and apex. Intima media thickness is commonly recognized as the initial stage in the development of atherosclerosis. The development of ultrasound machines, advances in echocardiographic devices and high resolution transducers facilitate comprehensive analysis of epicardial fat thickness (EFT) and carotid –intima media thickness (C-IMT).
Aim: To investigate the relationship of echocardiographic epicardial fat thickness (EFT) and carotid –intima media thickness (C-IMT) with the severity of coronary artery disease.
Methods: A cross sectional multicenter diagnostic accuracy study carried out at Ibn Al-Nafis Cardiovascular Hospital, Ibn Al- Bitar Cardiology Center and Ghazi Al-Hariri Hospital –Iraqi Center for Cardiology during the period between October 2016 and May 2017 assessing. History regarding demographic data and risk factors was taken. Two dimensional transthoracic echocardiographic measurements were done. EFT was measured from parasternal long axis view perpendicular to the right ventricular free wall. C-IMT was measured according to that recommended by the American society of echocardiography (ASE).
Results: The current study demonstrated that the EFT has a direct and significant correlation with the number of involved vessels (P value ˂ 0.001, r= 0.770). The validity of EFT to discriminate between multiple vessels disease and no vessel involvement is excellent (AUC= 0.984, cut point > 8mm, sensitivity=92.9%, specificity= 93.3%). There is inverse and significant correlation between ejection fraction (EF) and three vessels disease (P value ˂ 0.001, r= -0.507). Also there is a direct and significant correlation between C-IMT and severity of CAD. ROC analysis for validity of C-IMT to discriminate between multiple vessels disease and no vessel involvement is excellent (AUC= 0.961, cut point > 1.04mm, sensitivity=92.9%. specificity=86.7%). C-IMT is fair to discriminate between single vessel disease and no vessel involvement (AUC=0.738, cut point ˃ 0.84mm, sensitivity 100%), so if correlated with age, C-IMT above 0.84 can be used as a cut off point for the prediction of CAD. Finally, EFT and C-IMT are more likely to reflect severity of CAD than their ratio.
Conclusions: C-IMT and EFT are simple and reproducible parameters that can be used as a screening tool for the presence and severity of CAD especially before symptoms appearance in high risk patients

Background : The number of primary hip arthroplasty is growing with every passing year. At present this surgical operation has no equal in the rate of yielding good results. Despite the fact that in many cases in the long term after surgery radiolucent lines around the cup are observed, the clinical outcomes remain satisfactory.
Aim of the study :To study the clinical and radiological manifestations of the aseptic loosening of the endoprosthesis
Methods: This is a prospective study based on an analysis of diagnostic findings of 51 patients with aseptic loosening of hip joint components, aged 30 to 84 years. We depend for diagnosis of a septic losing by both clinical evaluation and X-ray assessment Results:The majority of clinical and radiological evidence of aseptic loosening appear after three years (47%).All our patients had a pain syndrome of varying intensity, with (43.2%) used a walking-stick. Shortening limb from 1 to 7 cm was found in 43 patients 85.2%.
The aseptic losing are common in cementless hip prosthesis especially in femoral stem part of prosthesus 53.9% versus 25.6% in cemented type,
Revision surgery for primary hip prosthesis occur mainly for femoral stem involve 49% while other 25.5% involve both acetabular cup and femoral stem, while the rest of patient(25.5%) involve revision of acetabular cup only. Discussion :At present this surgical operation has no equal in the rate of yielding good results. The lifetime of the majority of artificial joints does not exceed 15 years mainly due to aseptic loosening of one or both endoprosthetic components There are many causes of aseptic instability: substandard surgical technique, unwarranted extension of the indications for arthroplasty, inappropriate choice of the prosthesis dimension type, incorrect installation of components, reaction to the massive foreign body and the development of synovial-like membrane on the metal-bone interface .
As a rule, early instability within 1 year was associated with defects in the operative techniques, from 1 to 3 years mostly due to the wrong selection of the type of primary endoprosthesis while more than 3 years period, the instability was caused by two reasons: excessive load on the operated extremity or traumas and the rapid wear of plastic with large areas of osteolysis due to the high loads or inaccurate positioning of the prosthetic cup.
Conclusions: X-ray examination is the fundamental for diagnosing of aseptic loosening of hip endoprosthesis , and improved surgical techniques, the proper selection of the type of prosthesis are the keys for reduction of risk of aseptic loosening

Background; Neonatal period is a very vulnerable period of life due to many problems, In spite of advances in perinatal and neonatal care still, the mortality rate of neonate high especially in developing country The World Health Organization estimates that globally four million neonatal deaths per year, Developing countries account for around 99% of the neonatal mortality in the world, In Iraq. Neonatal mortality rate about 19 per 1000 live births which represent 56% of child death below 5 years age in 2012. .
Objectives The aims of the study were to determine the institutional new-born case fatality rate and the cause of admission and death in the neonatal care unit.
Method; Across-section study was carried out of the Neonatal Care Unit of Central Teaching Hospital of Pediatric in Baghdad Al-krakh Health Directorate
Result; During 2015, 1977 neonates were admitted, Mortality rate was 9%, Four main causes of death were identified; Respiratory related condition, Bacterial sepsis, premature neonate (Disorder related to short gestational and low birth weight not relayed to elsewhere classification) and congenital malformation 37.5%, 33.3%, 7.1% and 7.1% respectively , The main causes of morbidity were Neonatal jaundice, Respiratory related condition, Bacterial sepsis 37.5%, 35.2%. 14.1% respectively Conclusions: The majority of neonatal morbidity and mortality can be prevented by appropriate interventions

The aim of this study is to evaluate the association between IBD and oral symptom and mucosal lesions in patients with Crohn’s disease and ulcerative colitis

Methods: This is a cross-sectional study that has been done in (Kurdistan center for Gastroenterology and hepatology) of Teaching Hospital in Sulaymaniyah-Iraq, which included 101 patients previously diagnosed with Inflammatory Bowel Disease who were interviewed regarding manifestations of inflammatory bowel disease especially oral manifestations. Required data were collected through a specially designed questionnaire,

Results: The patients’ mean age was 45.74±12.58 years. Patients with ulcerative colitis and Crohn’s disease were not significantly different in terms of age, sex, smoking, and drinking alcohol (p>0.05), and it was seen that age groups 41-50 and 51-60, males, smokers, and drinkers were more affected by these two diseases. They were not significantly different in terms of chief complaint, drug history, oral hygiene, and disease duration (p>0.05). Most of the patients (78 out of 101) had fair or poor oral hygiene. The two groups of the patients were not significantly different in terms of oral manifestations and symptoms (p>0.05). The most common oral manifestations were found to be respectively angular cheilitis, aphthous ulcer, and diffuse lip swelling in both diseases. The most common symptoms were respectively dry mouth and halitosis.

Conclusion: This study revealed that dentists and oral and maxillofacial Medicine could involve in a diagnosis of IBD, by at least in the referral process, because patients in clinical setting may give a history of orofacial complaints giving a hint on possible systemic background of IBD

Objective : Sciatic nerve block (popliteal approach) and femoral N block is a new technique other than general anesthesia in below knee surgery because it provides adequate muscle relaxation, with good intraoperative and post-operative analgesia. Nefopam is non opioid, non-respiratory depressant and non-sedative was mixed with local anesthetics drug to study the effects. This study was done to compare the onset and duration of sensory and onset time and duration of action of motor block following administration of either bupivacaine alone with administration of bupivacaine and Nefopam in patients undergoing below knee lower limb surgeries under ultrasound guided regional anesthesia.
Methods: 100 patients with American society of anesthesiologists (ASA) 2 / 3/4 patients between 25 and 85 years who underwent elective and emergency lower limb surgeries randomly allocated into two group, each group has 50 patients by a sealed envelope technique to receive 20 ml of 0.5% Bupivacaine with 2 ml of normal saline in Group BS and 20 ml of 0.5% Bupivacaine with 2ml (20mg) of Nefopam in the second group (Group BN). The onset time, duration time of both sensory and motor blocking were seen and compared between the two groups.
Results : The onset time of both sensory and motor blockade was shorter in Group BN (bupivacaine with nefopam) when compared to Group BS (bupivacaine and normal saline) (p<0.0001). The duration of both sensory and motor blockade was longer in Group BN when compared to Group BS (p<0.0001). There were no significant hemodynamic changes (PR, BP,SPO2) in both groups. Also there is no any side effect or any complication.
Conclusion Nefopam when mixed with Bupivacaine in Sciatic nerve block and femoral nerve block in below knee surgeries shortens the onset time and prolongs the duration of action of both sensory and motor blockade without any systemic side effects and give excellent intra and postoperative analgesia.

Background: Osteoid osteomaa benign tumor is unusual before the age of 5 or after age 30 and is more prevalent in men. The main symptom is pain, which is typically severe and responsible for nocturnal awakenings. The conditons usually diagnosed through radiological imagine and confirmed by Histopathology.
Objectives: To assess the effectiveness and the complications that had been risen during the surgical procedure of osteoid osteoma using en bloc resection.
Methods: (10) Patients diagnosed with osteoid osteomawere treated with enbloc surgical reseaction were included in this study.the study took place at Al Yarmouk teaching hospital.the from April 2017-october 2018 and included 10 patients..(7) male, (3) females.The mean age of the sample was 18±4 years. descriptive and inferential statistical sanalysis was fulfill the study objectives..
Results: There was significant decrease in their median pain scores after 8 weeks of treatment (t test , P <0 .05).Total pain resolution and cessation of analgesics were achieved in 9 of 10 patients after 8 weeks post-operatively. P value was set at 0.05 or less.SPSS software version 20 was used for data entry and statistical calculations
Conclusions: En bloc resection of osteoidosteoma is very safe and effective procedure with a very low complications rates.

Background :Infectious disorders in general have high morbidity and mortality.. CNS infections include many disorders like bacterial meningitis, tuberculous and other subacute and chronic meningitis, viral meningitis, cerebral abscess, spinal cord infections, and others.
Objective: To assess our locality about prevalence of CNS infections , to have more awareness regarding CNS infections, and to try to find the proper way to reduce their prevalence and to treat them in appropriate way.
Method :We revised the records of all the cases of CNS infections excluding cases of spinal cord infections who were admitted in the wards of neuroscience hospital over the previous two years ( from July/2010 to June 2012 ),those were 132 cases.Seasonal incidenceand other clinical aspects and other parameters like age , sex, , fever are extracted and recorded
Results: The most common CNS infections in sequence from the most to the least were bacterial meningitis, viral encephalitis, tuberculous meningitis, viral meningitis, and cerebral abscess.
The most common age group which is affected by CNS infections was below 10 years.
Males are affected more than females taking in consideration all types of infection.
P values were statistically significant for age, fever, signs of meningeal irritation, focal neurological deficit, and seizures.
Conclusion : The total rate of admission of CNS infections in our series was lower than other study.
The most frequent type of CNS infections was bacterial meningitis which is the same as most of the studies.
Males are affected more than females in our study in all types of CNS infections, this was approximate to other studies except for tuberculous meningitis.
Bacterial meningitis and viral encephalitis were more common in preschool children in our study.
Fever rate in bacterial and tuberculous meningitis was different from other studies.
Seizure rate in bacterial meningitis and viral encephalitis was approximate to other results.
Rate of focal deficit in viral encephalitis and tuberculous meningitis was different from other studies.
Rate of CSF protein elevation in all CNS infections was approximate to other studies.
Rate of hypoglycorrhachia was different from other studies only in tuberculous meningitis.
CSF pleocytosis was approximate to other studies in all types of CNS infections.
The two most common types of CNS infections , bacterial meningitis and viral encephalitis, are more common in preschool age groups.

Background: Penetrating neck injuries are common problem in our country due to increasing violence, terrorist bombing and military operations.
These injuries are potentially life threating and need great attention and proper management.
Objective: The aim of this study is to focus on the importance of anatomical zonal classification of the neck in the management of penetrating injuries of the visceral compartment of the Neck.
Methods :70 patients with various injuries who were managed at causality unit and Otolaryngology department in Al-Kindy Teaching Hospital during aperiod from January 1st 2015 to October 31st 2015.
The study carried on those patient depending on proper clinical examination and their urgent management.
Results : Both civilian and military patients were admitted to the hospital, 34 patients (47.2%) in their 20s age group, while only 2 (2.8%) in 60s.
High percentage of penetrating neck injuries in zone , 48 patient (68.6%) and lowest in zone , 6 patients (8.5%).
40 patients (57.1%) presented with tracheal and laryngeal injuries and 12 patients (17.5%) were with pharyngeal injuries, 4 patients (5.7) were with recurrent laryngeal nerve injury and 13 patients (18.5%) presented with vascular injuries.
Radiological examination done for 53 patients (75%) and we found foreign bodies in 30 patients (56.6%), tracheal deviation in 4 patients (7.5%) and emphysema in 19 patients (35.8%).
Tracheostomy done in 51 patients (72.8%) neck, exploration in 20 patients (28.5%) and a 9 patients (12.8%) treated conservatively.
Conclusion: Zonal classification of penetrating neck injuries was helpful in the management. Our study explains demographics and location of the injuries. Young men involved in violence and bombing was at high risk.
Zone with involvement of trachea, larynx and pharynx were most common areas of injuries.
Recommendations
Anatomical zone classification should be used as a guideline in management of penetrating neck injuries. (Trauma lifesaving guideline).Tracheostory should be practiced by every doctor in casualty unit. Team of surgeons and anaesthiologist should be always ready for any intervention with patient present to the casualty unite with a penetrating neck injury. Emergency medicine medical practice must be presents in every casualty unit to deal with insults.
Aim of the study
1.To recognize penetrating injuries of the neck according to the anatomic neck zones.
2.Identify the outcome of their treatment

Background : The aim of this work is to study the clinical features and causative fungi of tinea pedis in diabetic and non-diabetic patients. Result : Tinea pedis was estimated to be the second most common skin disease in the United States, after acne. Up to 15% of the U.S., population may have tinea pedis. Across Europe and East Asia, prevalence rates reach 20 %. Methods: The Complete history taking regarding: age, sex, occupation, residency, history of diabetes and diabetic profile (fasting blood sugar and post prandial).and Clinical examination of the feet Aim of the study : The aim of this work was to study the clinical features and causative fungi of tinea pedis in diabetic and non-diabetic patients Conclusion : Tinea pedis is more frequent in tropical climates and may be associated with use of occlusive footwear. Males are more often affected than females. It is mostly affecting the web space between the fourth and fifth toes. Children do not often develop tinea pedis. Patients with atopic dermatitis or immuno suppressive disorders may be predisposed to developing tinea pedis

Background: Hair loss is a common distressing disease and challenging problem for many dermatologist. Telogen effluvium is the most common hair loss disease in which nutritional deficiencies may precipitate the disease through their effect on hair structure and growth.

Study Aim : Validating role of serum ferritin level and body mass index in Chronic Telogen Effluvium and analyzing association between these factors with socioeconomic, demographic, gynecological factors and weight loss effect. Establishing a nutritional preventive advice to improve treatment successfulness and decrease the disease occurrence.

Methods : A case series study on 327 chronic telogen effluvium patients (15-65 years old) main teaching dermatological outpatients' clinics in Baghdad. Data were collected by direct interview and questionnaire filling to analyze the associations between variables set in the data collection tool with serum ferritin level and body mass, which in turn may precipitate chronic telogen effluvium.

Results :Mean patients' age was 39±9 years, 93.6% of patients had serum ferritin below normal for hair cycle requirement (≤70μg/l). Serum ferritin significantly associated with age (p value= 0.002) and 41.1% of poor socioeconomic patients had serum ferritin ≤20μg/l.

Nearly half of the patients with ≥3 pregnancies, 43.9% of patients on weight-losing diet and 52.7% of those who actually lost weight had low ferritin levels with statistically significant associations. Being obese is a risk factor for having low serum ferritin (OR= 0.297).

Conclusion : Serum ferritin found to be ≤ 70μg/l in the majority of chronic telogen effluvium patients, which is significantly associated with patients' socioeconomic status, age, and weight status.