About Journal

  The Iraqi Postgraduate Medical Journal is a medical journal issued in English; it is concerned in all medical specializations.It started from year 2000. It is a peer-reviewed based publication and it is approved for scientific promotion purposes. It is considered an important source for many researchers. It is published quarterly and available in paper and electronic forms. Our journal is indexed in: - Directory of Medical Journals for the Middle East Region, In 2005, it was selected to be one of the sources of input of the  IMEMR, Index Medicus - Scientific site of Iraqi scientific...
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Chronic Liver Disease and the COVID Vaccine

Iraqi Postgraduate Medical Journal, 2022, Volume 21, Issue 1, Pages 1-2
DOI: 10.52573/ipmj.2021.174064

The systemic acute respiratory syndrome Coronavirus 2 (SARS-COV2) has rapidly and mercilessly spread around the globe causing the Coronavirus 2019 (COVID-19) pandemic.
Patients with chronic disease have been found to have the greatest morbidity and mortality rates, and those with chronic liver disease (CLD) with or without cirrhosis were no exception.

The Role of Gamma Knife Radiosurgery in Brain Metastatic Tumors

Ahmed A. Salam Al- Atraqchi; Ahmed J. Mohammed

Iraqi Postgraduate Medical Journal, 2022, Volume 21, Issue 1, Pages 3-14
DOI: 10.52573/ipmj.2021.174065

BACKGROUND: 
Brain metastasis represents a significant source of morbidity and mortality in patients with systemic cancer, In adults, cerebral metastasis are by far the most common intracranial tumors, and their incidence is rising because of increased cancer survival.
GKRS has arguably been the most important advancement in the management of metastatic brain tumors since the 1980s.
PATIENTS AND METHODS:
This is a prospective study of 50 patients of brain metastasis treated with (GKRS) between January 2017 and January 2019. A group of 14 males and 36 females with mean age was 59.1 years, 34 patient were <65 years old and 16 patients were >65 years old.
Patients status assessed according Karnofsky Performance Score (KPS), 4 % were >70 KPS and 96% were <70 KPS. The lung cancer was the primary lesion in 56% of patients, breast was 32%, and Skin Melanoma 8% and unknown origin 4%.
80% of the patients had previous treatment: surgery and chemotherapy (22%), chemotherapy (20%), surgery (16%), surgery, chemotherapy and DXT (10%), surgery, chemotherapy and WBRT (8%) WBRT (2%) and DXT (2%), while absent in 20%.
Brain MRI with contrast follow up was done in 6 months, and after 12 months
RESULTS:
After 12 months of follow up the mean of tumor volume after (GKRS) decrease from 6.2cm3 to 3.4cm3 , The mean KPS improve from (61) to (75) , Local tumor recurrence was (16%) and edma was seen in (20%) ,The Age of patients > 65, KPS < 70, patients with previous treatment surgery, chemotherapy and WBRT had poor prognosis ,The mortality was seen in (20%) half of them related to neurological death and the other to primary tumor.
CONCLUSION:
The Gamma knife radiosurgery is effective and safe treatment modality of secondary brain metastasis and is effective in increasing survival rate and Karnofsky performance scale in addition to reduction of                the tumor size of patients with brain metastasis.
 

Is It Reasonable to Screen for Undiagnosed Diabetes and Prediabetes in Asymptomatic Individuals? A Sample from Baghdad

Raed Salih Mohammed; Omar Farooq Nafea

Iraqi Postgraduate Medical Journal, 2022, Volume 21, Issue 1, Pages 15-21
DOI: 10.52573/ipmj.2021.174066

BACKGROUND:
Diabetes Mellitus is a complex chronic illness that has increased significantly around the world and is expected to affect 628 million in 2045. Undiagnosed type 2 diabetes may affect 24% - 62% of              the people with diabetes; while the prevalence of prediabetes is estimated to be 470 million cases              by 2030.
AIM OF STUDY:
To find the percentage of undiagnosed diabetes and prediabetes in a slice of people aged ≥ 45years, and relate it with age, gender, central obesity, hypertension, and family history of diabetes.
METHODS:
A cross sectional study that included 712 healthy individuals living in Baghdad who accepted to take part in this study and fulfilling the inclusion and exclusion criteria.
RESULTS:
From total 712 healthy participants, 373 (52.4%) screened negative for diabetes, 178 (25.0%) screened positive for diabetes and 161 (22.6%) had impaired fasting glucose. There was significant relation with central obesity, family history for diabetes and hypertension.
CONCLUSION:
It was concluded thatscreening for type 2 diabetes and prediabetes is reasonable, both conditions are common in people living in Baghdad and should be considered especially in people aged ≥45 years and those who are obese, have hypertension, and have a positive family history for diabetes.
 

Comparison between Caudal Block and Saddle Block in Anorectal Surgery

Ruaa Kamal; Raghad Hannon Al-Sudani; Marwa Alaa Kamal; Alaa Kamal Jabbar

Iraqi Postgraduate Medical Journal, 2022, Volume 21, Issue 1, Pages 22-29
DOI: 10.52573/ipmj.2021.174067

BACKGROUND:
Anorectal surgery includes pilonidal sinus, hemorrhoidectomy, anal fissure, and anal fistula operations. Various surgical and anesthetic techniques have been used to increase the level of patients perioperative analgesia and decrease the length of stay in the hospital.                       
AIM OF STUDY:
To compare the effectiveness of saddle block and caudal block during anorectal surgery on patients' perioperative hemodynamic values, onset of  sensory and motor block, mobility and frequency of analgesia given post op.
PATIENTS AND METHODS:
80 patients underwent anorectal surgery were randomly allocated into 2 equallygroups, caudal block was applied to the 1st group 40pt. and saddle block was applied to the 2nd group 40 patients .Onset of Sensory and motor block was recorded. Heart rate, systolic arterial pressure, diastolic arterial pressure and oxygen saturation were measured every 3 minutes until the end of the operation. In postoperative period the frequency of rescue analgesic drugs given and duration of staying in hospital were recorded.
RESULTS:
In both groups, there were no changes in hemodynamic profile. No motor block was detected in group B but noted in group A. Onset of sensory nerve block in group B was more rapid than in group A and duration of post operative  analgesia was shorter than that in group A. Early discharge from hospital was associated with group B in comparison with group A.
CONCLUSION:
Saddle block provides rapid-onset of sensory block, zero motor block, early ambulation and early hospital discharge in comparison to caudal block which was slower in onset with mild to moderate motor block and associated with increase time of staying in hospital.
 

Complementary Feeding Types, Timing and Practices by Mothers in Al-Kut City

Samaa Jaber Abdulkareem; Waleed Arif AL-Ani

Iraqi Postgraduate Medical Journal, 2022, Volume 21, Issue 1, Pages 30-37
DOI: 10.52573/ipmj.2021.174068

BACKGROUND:
Complementary feeding is a process starting when breast/formula milk alone is no longer sufficient to meet the nutritional requirements of infants, and therefore other foods and liquids are needed, along with breast/formula milk.
AIM OF THE STUDY:
To determine the type and time of initial complementary feeding practiced by mothers in Kut City and its relation with some associated factors.
METHODS:
A descriptive primary health center-based study conducted on 500 mothers attending 29 primary health care centers in Al-Kut City for the period of 4 months extended between 1st of April to 31st of July 2017. Data were collected using a structured questionnaire by direct interview.
RESULTS:
The majority of children received food made from carbohydrates (Rice & Rice water, Porridge, Potato’s, Broths, and Biscuits) and Cerelac in percentage of 33.8 and 33.6 respectively.                      The majority of the complementary feeding was started at 6th month (49.6%).
CONCLUSION:
The majority of infants who attend primary health centers in Al-Kut city received cereal-based food and Cerelac as their first complementary food.
 

Benefits of using Programmable Lumboperitoneal Shunt in the Management of Idiopathic Intracranial Hypertension

Omar Mohsin Mohammed Ghazal; Ali Kamil Al-Shalchy

Iraqi Postgraduate Medical Journal, 2022, Volume 21, Issue 1, Pages 38-45
DOI: 10.52573/ipmj.2021.174069

BACKGROUND:
Idiopathic intracranial hypertension (IIH) is a neurological disorder that requires the use of lumboperitoneal (LP) shunt which is the procedure of choice for most surgeons.
AIM OF THE STUDY:
To assess the benefits of using a programmable LP shunt in the treatment of IIH, and how to reach the optimal final performance level with minimal shunt-related complications.
PATIENTS AND METHODS:
A prospective single-center study of 30 patients diagnosed with IIH, treated with adjustable LP shunt in the neurosurgical department at the teaching Martyr Ghazi Al-Hariri Hospital for Specialized Surgery for a period extending from August 30th, 2017 till November 21st, 2018.
RESULTS:
Among the included patients in the study (30 patients), the female:male ratio was 9:1 with an age range of 17-50 years. Most of the cases (40%) were presented with BMI more than 35. The opening pressure was within the range of 280-585 mmH2O. For the final performance level (P/L), 67% ended up with P/L 1.5 and 27% ended up with P/L 2.0. The outcome recorded as headache improvement 97% and visual improvement 85%. The complications were CSF collection 10%, infection 3%, and the need for shunt revision 7%.
CONCLUSION:
Using the adjustable Medtronic Strata NSC valve has the possibility of avoiding shunt-related complications with better outcomes.
 

Value of Dynamic Contrast Enhanced Magnetic Resonant Imaging in Detection of Local Recurrence Breast Cancer

Mohammed Abd Kadhim; Ula Majeed Abd-Alhassan

Iraqi Postgraduate Medical Journal, 2022, Volume 21, Issue 1, Pages 46-54
DOI: 10.52573/ipmj.2021.174070

BACKGROUND:
Breast cancer has become a major threat to female health in Iraq, with a cancer-related mortality rate of (23%). Despite advances in early diagnosis, treatment, and biomarker identification of breast cancer, it carries a high risk of recurrence, about 20-30% and substantially worse overall survival.
AIM:
To evaluate the role of dynamic contrast enhanced magnetic resonance imaging in differentiation between benign postoperative changes and recurrent malignant tumors in postoperative patient with breast cancer.
PATIENTS AND METHODS:
Cross-sectional prospective study was performed at MRI unit of Al-Imamein Al-Kadhimein Medical city in Baghdad/ Iraq within the period from January 2019 to January 2020. The study included 29 female patients with 42 detected lesions suspected as local recurrent.All women were recruited for dynamic contrast enhanced (DCE-MRI).
RESULTS:
The mean age of 29 patients were 50.58±10.01 years (range 21-66 years). of the 42 detected lesions 22 proved histopathologically as local recurrence (17 were invasive ductal carcinoma, 2 were ductal carcinoma insitu and 3 were invasive lobular carcinoma), the remaining 20 were benign postoperative lesions (8 were fibrosis, 5 were granulation tissue, 5 were fat necrosis, 2 were seroma and 1 was diffuse skin thickening and edema). DCE-MRI study show to have a sensitivity of 95.5%, a specificity of 90%, Positive Predictive Value of 91.3% Negative Predictive Value of 94.7% and an accuracy of 92.86% in differentiation between benign postoperative changes and recurrent malignant tumors.
CONCLUSION:
DCE-MRI is a valuable tool in evaluation of postoperative breast as it has high sensitivity and specificity in differentiation between benign postoperative changes and recurrent malignant tumor.
 

The Diagnostic Accuracy of MRCP and Transabdominal Ultrasound in Patients with Obstructive Jaundice in Correlation with ERCP

Hiba Mohammed Abdulwahid; Ammar Mosa Al-Mosawe; Jinan Abdul Kareem Jabbar; Qusay Tayseer Nayyef

Iraqi Postgraduate Medical Journal, 2022, Volume 21, Issue 1, Pages 55-62
DOI: 10.52573/ipmj.2021.174071

BACKGROUND:
The validation of the non-invasive radiological tools to replace invasive procedures like Endoscopic retrograde cholangiopancreatography (ERCP)for diagnosis of biliary obstructive disease become essential in modern medical practice. Magnetic resonance cholangiopancreatography (MRCP) is best alternative for ERCP regarding diagnostic aspects.
AIM OF STUDY:
To assess the diagnostic accuracy of MRCP and transabdominal US in identifying the cause of biliary dilatation in correlation with Endoscopic retrograde cholangiopancreatography as the gold standard.
METHODS:
A prospective cross sectional analytic study that involved 64 patients with obstructive jaundice. Abdominal US and MRCP were performed and the cause of obstruction were recorded and correlated with a subsequent ERCP results which were considered as the gold standard. Accuracy, sensitivity, specificity, positive and negative predictive values and P value were calculated for each test.
RESULTS:
Choledocholithiasis was the commonest cause of biliary obstruction (45%). The detection rate for MRCP was 96.6% and for ultrasound was 41.4% regarding CBD stones. The diagnostic performance of MRCP for malignant pathologies was (91.7%) sensitivity,100% specificity, 91.7% accuracy with significant level for detection (P value <0.001).While trans-abdominal ultrasound had lower diagnostic parameters for malignancy detection with 75% sensitivity, 66.7% specifity, 41.6% accuracy and P value (0.228).
CONCLUSION:
MRCP is a non-invasive technique that can detect level and cause of biliary obstruction with high diagnostic performance especially in choledocolithiasis and malignancies. MRCP can replace the invasive ERCP as a diagnostic tool in most cases. Also if no cause was identified in MRCP, ERCP can be avoided in most cases
 
 

Blood Donation; Motivators and Barriers among the Attendees of the National Centre for Blood Transfusion/ Baghdad 2019

Marwah Saad Abdullah; Wijdan Akram Hussein

Iraqi Postgraduate Medical Journal, 2022, Volume 21, Issue 1, Pages 63-69
DOI: 10.52573/ipmj.2021.174072

BACKGROUND:
Willingness to donate blood is affected by many factors such as availability of blood banks and their accessibility to the public, awareness regarding blood donation and knowledge about blood donation.
AIMS:
To evaluate the (Knowledge, attitude and practice) in a sample of subjects toward blood donation. To determine motivators and barriers that influence blood donation and to study the influence of some demographic character with the means of the KAP scores.
METHODS:
A descriptive cross sectional study was conducted in the National Centre for Blood Donation in Baghdad, data collection was carried out from 1st of March to 31st of May 2019, on a sample of four hundred participants.
RESULTS:
This study results demonstrated higher rate of male participants by 87%, , better knowledge among females (p= 0.001), females also got better attitude than males (p= 0.001).
CONCLUSION:
The most reported motives for blood donation was that they knew it's good for their health and because they liked to help others. The most reported barriers were that they weren't approached to donate and fear of the medical errors.
 

Preoperative Predictors of Difficult Intubation

Rasha. S. Alaubaidi; Maitham. M. Hussein

Iraqi Postgraduate Medical Journal, 2022, Volume 21, Issue 1, Pages 70-75
DOI: 10.52573/ipmj.2021.174073

BACKGROUND
Because a difficult intubation may occur unexpectedly, airway examination is the most critical component of anesthetic practice.  Prior to surgery, all of the patients' airway parameters were examined. Parameters included age, body mass index, neck circumference, head movement, mouth opening space, mandibular length, sternomental and thyromental distance, dental deformities, as well as a history of medical, surgical, and difficult intubation were all taken into consideration with thyroid related factors (tracheal deviation and retrosternal goiter).In respect to the preoperative parameters, all patients were categorized intraoperative, using the Cormack and Lehane laryngoscopic View. Clinical data from each test was collected, and analyzed to establish its relevance, positive predictive value, and negative predictive value.
AIM OF THIS STUDY:
The effectiveness of airway characteristics in predicting difficult intubation was compared in                           a prospective research to enhance airway management especially in those with difficult intubation to prevent post operative morbidity and mortality airways complication.
METHODS:                                                                       
From January 1 to June 30, 2021, a cross-sectional study was conducted on 72 patients their age range between 25-70 years old both genders .They were admitted to the Baghdad Medical City Teaching Hospital for a variety of elective procedures.  The patients were collected and examined preoperatively involving the age, gender, weight and length with special evaluation of upper airway assessment including neck movement is assessed by extending the head at the atlanto-occipital joint and performing the cervical flexion-rotation test manually.
RESULT:
The findings revealed a 13.9 percent incidence of problematic intubation among the 72 patients studied.  Higher prevalence of difficult intubation  noticed significantly among patients with past medical history  (44.4%)  , patients  with abnormal dentation (36.4%) also Prevalence of difficult intubation was increasing with aging to reach (30% )in patients aged ≥ 50 years. Difficult neck movement before surgery was significantly associated with difficult intubation (P= 0.001). In this study, means of mouth opening and sternomental distance were significantly (P < 0.05) lower in patients with difficult intubation than those with easy intubation. No statistically significant correlation (P ≥ 0.05) % between Cormack-Lehane grading system and any of the other characteristic.
CONCLUSION
In this study we discovered that patients with a positive past medical history like history of diabetes mellitus and those with abnormal dentation are highly significant preoperative Intubation difficulty predictors. The risk of difficult intubation also increases in patients over the age of 50, difficult neck movement, and in patients with limited mouth opening, as well as short sternomental distance.
 
 

The Role of Histochemical and Immunohistochemical Methods for The Detection of Helicobacter Pylori in Chronic Gastritis

Hala Thanoon Amuri; Wahda M Al-Nuaimy

Iraqi Postgraduate Medical Journal, 2022, Volume 21, Issue 1, Pages 76-81
DOI: 10.52573/ipmj.2021.174074

BACKGROUND:
Helicobacter pylori represents one of the most common pathogen worldwide. Infection with it can cause medical problem and establishe as etiologic factor in the development of gastritis, So                            the accurate detection is important for proper patient management.
OBJECTIVE:  
This study was conducted to assess the detection of H pylori by Hematoxylin & Eosin, special stain (Modified Giemsa stain) and immune stain in gastritis biopsies and to assess the sensitivity and specificity of each method use in detection.
MATERIAL AND METHODS:
A retrospective and prospective (case series) study, from October 2019 to October 2020, 100 gastric biopsies with gastritis referred to histopathology department, in AL-Khansaa Teaching Hospital and some private labs in Mosul city, were examined.
All biopsy specimens examined histologically to assess H. pyloriinfection, by Hematoxylin & Eosin , modified Giemsa and immunohistochemical stains.
RESULTS:
Patients age range 17 to 78 years with a mean+­­- SD of 44.5+6.11   years. H. pylori positive with H&E /MGS in 79% of cases, while with IHC in 88% of cases. The sensitivity and specificity of the H&E /MGS comparing with the IHC stain were 90% and 100% respectively.
CONCLUSION:
We have concluded from this research that H& E is a reliable way to detect H. Pylori infection. As well as we recommend the usage of IHC in special cases.
 
 

Carotid Artery Intimal Medial Thickness in Acute Ischemic Stroke Subtypes and Intracerebral Hemorrhage

Abbas Fadheel Nasser; Zaki Noah Hasan

Iraqi Postgraduate Medical Journal, 2022, Volume 21, Issue 1, Pages 82-88
DOI: 10.52573/ipmj.2021.174075

BACKGROUND:
Stroke is the second cause of adult death globally. The Intimal Medial Thickness of the Carotid Artery is regarded as a measure of atherosclerosis. Since the pathogenesis and treatment differ among stroke subtypes; therefore, evaluating the intimal medial thickness may help in distinguishing intracerebral hemorrhage from other ischemic stroke subtypes.
OBJECTIVE:
To assess the carotid artery intimal medial thickness in ischemic stroke Subdivisions and intracerebral hemorrhage.
METHOD:
A cross-sectional case-control study of 200 subjects, 100 patients with different Stroke subtypes and 100 control that are age and gender matched. All subjects were examined by B-mode ultra-sonography to measure the intimal medial thickness of both common carotid and internal carotid arteries on either side. Time of study is from January 2018 to January 2019.
RESULTS:
200 patients, 110 male, 90 female, with mean age of 61.59 ±9.1. The mean IMT for LA, SA, ICH, CE and control groups were 0.91±0.12, 0.77±0.04, 0.74±0.04, 0.70±0.09 and 0.62±0.07 mm respectively (p value ˂0.001). There was significant increase in Mean IMT with increasing age (p value ˂0.001).
CONCLUSION:
There is possible diagnostic ability of using IMT to differentiate Stroke subtypes from each other’s.
 
 

Acute Upper Gastrointestinal Bleeding Risk Stratification Using Complete Rockall Score

Abbas Faraj Khalaf; Sabiha AL Bayati

Iraqi Postgraduate Medical Journal, 2022, Volume 21, Issue 1, Pages 89-95
DOI: 10.52573/ipmj.1970.174076

BACKGROUND:
Complete Rockall risk score uses clinical criteria and endoscopy to identify patients at risk of adverse outcomes after acute upper gastrointestinal haemorrhage.
AIM:
To Identify patients at risk of adverse outcome following acute upper gastrointestinal bleeding.
METHODS:
An observational descriptive hospital-based study conducted on about 65 patients with acute upper gastrointestinal bleeding.  Data from history, physical examination and oesophagogastroduodenoscopy were collected and entered into a Complete Rockall score.
RESULTS:
65 cases were identified (43 men and 22 women; mean age 50.1 years). Patients considered to be at low risk of adverse outcomes were 25(38%), while patients considered to be at high risk of adverse outcome were 40(62%).
CONCLUSIONS: 
The majority of the patients who were admitted to hospital with upper gastrointestinal bleeding are of high risk group and of male gender. 
 
 

Comparison of the Effect of Combined Infusion of Ephdrine and Phenylephrine, Ephdrine, or Phenylephrine in Prevention of Post Spinal Hypotension in Cesarean Section

Ali Hadi Muslih Al-maʼini; Bushra Noori Jamaʼan

Iraqi Postgraduate Medical Journal, 2022, Volume 21, Issue 1, Pages 96-101
DOI: 10.52573/ipmj.1970.174077

BACKGROUND:
Hypotension is the most common complication after spinal anesthesia for patients undergoing cesarean section. Prevention and treatment of post-spinal hypotension   has been frequently investigated.
AIM OF STUDY:
Our study aimed to compare the effect of prophylactic infusion of combined ephedrine and phenylephrine, ephedrine, or phenylephrine alone in prevention of maternal hypotension after cesarean section.
PATIENTS AND METHODS:
90 pregnant women that underwent elective cesarean delivery under spinal anesthesia were included and divided into: group A   received an infusion of combined ephedrine and phenylephrine; group B received ephedrine infusion, and group C received phenylephrine infusion. Maternal parameters were recorded.
RESULTS:
There was an insignificant difference in demographic data among the groups. The maternal MAP shows no statistically significant difference, but the combined group shows less hypotensive episodes and less maternal side effects.
CONCLUSION:
Prophylactic infusion of ephedrine and phenylephrine combination can effectively decrease spinal anaesthesia related hypotension without any significant side effect.
 
 

Role of Multiphasic Computed Tomography in Prediction Histopathology of Renal Parenchymal Lesions

Mohammed Noori Al-Musawi; Mohammed Abdulameer Mahdi; Maha Abbas AL-Khafaji

Iraqi Postgraduate Medical Journal, 2022, Volume 21, Issue 1, Pages 102-108
DOI: 10.52573/ipmj.1970.174078

BACKGROUND:
Renal masses have different histologic types and subtypes, aggressiveness and metastatic potential, depending on there changes in angiogenesis
OBJECTIVE:
Is to evaluate the role of multiphasic contrast enhanced CT scan in prediction histopathology of renal masses.
PATIENTS AND METHODS:
In this prospective study, 50 patients with renal mass were diagnosed by abdominal ultrasound underwent multiphasic contrast enhanced computed tomography prior to surgical treatment,CT parameters at each phase of contrast study and histopathology results were correlated.
RESULTS:
In this study( 26 female and 24 male with mean age of 55.1 ± 10.1) were evaluated, clear renal cell carcinoma was documented in 35 patients(70%), papillary renal cell carcinoma in 5 patients(10%), Wilm´s tumors in 3 patients(6%), chromophobe renal cell carcinoma in2patients(4%), angiomyolipoma in 2 patients(4%),while collecting duct renal cell carcinoma , lymphoma, and tubulocystic renal cell carcinoma were found in only one patient for each one. The correlation of mean mass density with the histopathological types revealed no statistically significant difference in noncontrast phase. Significant difference (P<0.001) was noted in the mean enhancement of mass between the types of RCC during corticomedullary phase, however it is insignificantly different than angiomyolipoma  AML (P>0.05).  clear cell RCC show maximum enhancement (152H.U at corticomedullary phase ) with rapid wash out while papillary subtype show delayed progressive enhancement with delayed wash out with relatively low level of peak enhancement (69H.U at nephrogenic phase ) AML and chromophobe RCC with other subtypes show moderately rising enhancement with presence of plateau   and evidence of delayed washout. From the remaining renal masses that were hypovascular with slow pattern of enhancement during dynamic examination one in old patient proved to be lymphoma and other in pediatric age proved histologically as Wilms tumor.
CONCLUSION:
Muliphasic contrast enhanced CT is reliable modality to differentiate clear cell cancer from other subtype by maximum enhancement and rapid wash out at corticomedullary phase while papillary subtype show delay progressive enhancement with delayed wash out
 
 

Augmentation of Depressed Nasal Dorsum by Diced Cartilage Graft Wrapped with Fascia Lata

Rosol Tarique Shihab; Ahmed Kh. Al Tememi

Iraqi Postgraduate Medical Journal, 2022, Volume 21, Issue 1, Pages 109-119
DOI: 10.52573/ipmj.2021.174079

BACKGROUND:
Dorsal reconstruction and augmentation for a saddle nose or generalized under projecting nose (familial ) require some type of grafting that increase the volume, raise the radix , raise the entire dorsum ,camouflage the osseocartilaginous junction or any irregularity along the dorsum, diced cartilage graft wrapped with fascia lata used to achieve that .
AIM OF THE STUDY :
The purpose of the study was to assess the aesthetic and functional outcome of dorsal augmentation by diced cartilage graft wrapped with fascia lata.
PATIENTS AND METHODS:
Between July 2018 and May 2019. 7 patients included ,4  females and 3 males ,their age ranged between 20 to 37 years ,5 were primary and 2 secondary case rhinoplasty,2 operated by closed approach , 3 open approach and 2 of the them the graft placed by intercartilaginous  incision. Subjective evaluation was done by clinical and photographic assessment during postoperative follow up period 3-12 months.
RESULTS:
All the patients were satisfied with the postoperative results. with improvement of aesthetic shape and respiratory function .
CONCLUSION:
Diced cartilage graft wrapped with fascia lata is an effective technique for nasal dorsal augmentation.
 

The Value of Diffusion-Weighted Magnetic Resonance Image in the Evaluation of Temporal Bone Cholesteatoma

Sura Jwad; Mohammed AL Hilly

Iraqi Postgraduate Medical Journal, 2022, Volume 21, Issue 1, Pages 120-126
DOI: 10.52573/ipmj.2021.174080

BACK GROUND :
Cholesteatoma is non-neoplastic destructive lesion .MRI including diffusion weighted imaging (DWI) is helpful, since high content of keratin is associated with restricted diffusion.
AIM OF STUDY:
To determine the value of DWMRI and apparent diffusion coefficient (ADC) value in diagnosis of temporal bone cholesteatoma .
PATIENTS AND METHOD :
A prospective study conducted 33 patients with clinical suspicious of cholestatoma  using 1.5tesla  MRI scanner ,DWI with bvalue 1000 sec/ mm2.ADC was reconstructed and mean value measured  in mm2/sec for each lesion .Enhancing image obtained  after intravenous contrast administration  with early and delay images in suspected recurrent cases .
RESULT:
DWI  accurately detect 22 of 25 cholesteatoma lesions (sensitivity = 88% and specificity = 100%).Positive predictive value and negative predictive value were 100%  and76.9% respectively with accuracy rate 91.4%.  ADC value revealed  (0.469 x10-3  to 0.823 x10-3 mm2/sec) for restricted lesions  with  mean value ( 0.653 x10-3 ± 0.09092 SD mm2 /sec)which is significantly difference from non restricted lesions(P value  less than 0.001) .T1W  post contrast  images also give high accuracy  in diagnosis  of cholesteatoma 23 from 25 cases (sensitivity =92.59 %, specificity = 100).
CONCLUSION:
MRDWI give high accuracy in detection of cholestatoma in patient with chronic ear discharge.
 

A Case Report of Papulo-pustular Rosacea-Like Reaction after the Second Dose of Pfizer Vaccine

Hayder Al-Hamamy; Zainab K Jawad

Iraqi Postgraduate Medical Journal, 2022, Volume 21, Issue 1, Pages 127-130
DOI: 10.52573/ipmj.2021.174081

Coronavirus disease-2019 (COVID-19) has affected countries around the world. The introduction of COVID-19 vaccines has proved the most effective weapon in the fight against the disease.
The massive vaccination campaign against COVID-19 pandemic started in 2020 lead to significant decrease in the number of symptomatic infected patients and a decline in the mortality related to COVID-19 infection. However, with the vaccination of billions of people, data on vaccine-induced adverse reactions are also emerging.
Here we report a 50 year old woman who manifested a papule-pustular rash within 24hours of receiving the second dose of pfizerBioNTech COVID19 vaccine. We report this case to raise awareness regarding various cutaneous manifestations associated with COVID-19 vaccination.

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YASIR Mohammed Hasan HAMANDI

Iraqi Postgraduate Medical Journal, In Press
DOI: 10.52573/ipmj.2021.131393.1009

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Penetrating Injuries of the Neck

Musaed L. H. Albadri; Uday A. Albeiruty; Ahmed Abass Mossa

Iraqi Postgraduate Medical Journal, 2009, Volume 8, Issue 3, Pages 196-203

BACKGROUND:
Penetrating injuries of the neck are potentially dangerous, causing high rates of morbidity and mortality due to their association with sever bleeding and serious damage to the vital structures in the cervical region.
OBJECTIVE:
To know the incidence and distribution of these injuries on the anatomical zones of the neck and the damage of the vital structures in the cervical region and their early surgical management.
METHODS:
A prospective study on 52 patients of both civilian and military personnel with penetrating neck injuries attended the casualty department at Alyarmouk hospital over a period of 7 months from June-December 2006.
RESULTS:
Fifty patients (96.15%) were males. Twenty four patients (46.15%) were in their third decade. Twenty six patients (50%) were injured by shrapnel of explosives, 23 patients (44.21%) by bullets & 3 patients (5.77%) by unknown objects. Thirty six patients (69.23%) were injured at zone 2, 11 patients (21.15%) at zone 3 & 5 patients (9.62%) at zone 1. Twenty nine patients (55.77%) had laryngeal & tracheal injuries. Thirteen patients (25%) had pharyngeal & esophageal injuries. Four patients (7.7%) had recurrent laryngeal nerve injury. Nine patients (17.3%) had vascular injuries 6 arterial & 3 venous. One patient had vertebral & spinal cord injury. Forty one patients (78.86%) had tracheostomy operations, & 13, (25%) had neck exploration.Six patients (11.54%) treated conservatively. Nine patients (17.3%) have died.
CONCLUSION:
Male patients at their middle age were the predominant victims either by shrapnel or by bullets. Zone 2 was most commonly affected followed by zone 3 & zone 1. Laryngo – tracheal, pharyngo – esophageal & vascular structures were mostly involved. Tracheostomy & neck exploration were the main urgent operations performed for them. The high mortality reflected the serious nature of these injuries.

Peripapillary Retinal Nerve Fiber Layer Thickness by Optical Coherence Tomography in Patients with Unilateral Amblyopia

Noor Adnan Laylani; Salah Alasady

Iraqi Postgraduate Medical Journal, 2021, Volume 20, Issue 1, Pages 91-98
DOI: 10.52573/ipmj.2021.167831

BACKGROUND:
Amblyopia is a common cause of unilateral visual defect, affecting patients with history of strabismus, refractive errors, and those who had visual deprivation in the critical period of visual development.  Amblyopia may have an effect on various levels of the visual pathway. Cells atrophy in the lateral geniculate nucleus that receives information from the affected eye, and a shift in the dominance pattern in the visual cortex have been reported. Retinal involvement in amblyopia is controversial.
SUBJECTS AND METHODS:
This is a cross sectional study carried out in Al-Shaheed Ghazi al-Hareery Teaching Hospital in Medical City at Baghdad, Iraq .Forty-two patients with unilateral amblyopia were selected, 23 males and 19 females with age range of 12-40(mean age of 25.33 years) all of these patients had one amblyopic eye and the other eye normal.  OCT scan was done for both eyes of each patient and the RNFLT measured after complete ophthalmological examination ( VA, refraction, slit lamp, and funduscopic examination
RESULTS:
It has been noticed that the mean of NFLT in normal eyes was higher than that of amblyopic eyes (108.88 versus 105.05) but this difference was statistically not significant (P=0.074).
CONCLUSION:
OCT is a sensitive way to estimate RNFLT, we concluded that there is no statistically significant difference in NFLT between the amblyopic, compared to the normal eyes. Also NFLT seems not affected by: type of amblyopia, age of patients and also the severity of amblyopia as all these factors didn’t reach statistical significant.
 

Surgical Correction of Caudal Septal Dislocation in Septoplasty and Septorhinoplasty

Emanuel Sargon Emanuel; Hiwa Asaad Abdulkareem

Iraqi Postgraduate Medical Journal, 2021, Volume 20, Issue 1, Pages 17-26
DOI: 10.52573/ipmj.2021.167821

BACKGROUND:
Several techniques and maneuvers for surgical correction of caudal septal dislocation have been
mentioned in the literature nevertheless the subject has still bearing different opinions and preferences
on which approach to be applied.
AIM OF STUDY:
to assess different surgical approaches and techniques that are used in the management of caudal septal
dislocation.
PATIENTS AND METHOD:
A prospective, observational study was conducted on 50 patients from 10 January 2018 to August 2018
with age range from (18-39 years) who underwent nasal surgery (septoplasty, septorhinoplasty). The
study conducted in Center of Otolaryngology- Head and Neck surgery/ Sulaymaniyah Teaching
Hospital and Azmar private hospital. Preoperative assessment data were gathered & compared with
postoperative assessment data after 3-6 months follow up. The data was analyzed statistically using
SPSS version 25.
RESULTS:
patients included in the study were 64% males and 36% females, 22% went through septoplasty while
78% went through septorhinoplasty. For the techniques that used in surgical correction of the caudal
dislocation (wedge resection, batten graft and L-strut graft) the results were significant postoperatively
while for scoring technique the results were insignificant postoperatively .
CONCLUSION:
There are different techniques used in surgical correction of caudal septal dislocation with good results
and according to each patient. The use of L-strut graft technique whenever it needed especially in
severe deviation .

Efficacy of Etanercept Treatment in Iraqi Patients with Moderate to Severe Psoriasis

Iraqi Postgraduate Medical Journal, 2020, Volume 19, Issue 1, Pages 9-15

ABSTRACT:
BACKGROUND:
Etanercept is a tumor necrosis factor (TNF) α inhibitor that has been approved for the treatment
psoriasis.
OBJECTIVE:
Assessing the efficacy of etanercept therapy in Iraqi patients with moderate to severe psoriasis.
PATIENTS AND METHODS:
This study was a therapeutic interventional study at Medical City; center of dermatology and
venereology (Baghdad, Iraq) from January 2017 till June 2018, with 53 patients, 31 (58.49%) males
and 22 (41.51%) females, with 51 patients having moderate to severe plaque psoriasis and 2 patients
with pustular psoriasis. All patients were given 50 mg subcutaneous injection of etanercept twice
weekly for 3 months, followed by single injection of etanercept weekly for the next 9 months.
Psoriasis area and severity index calculations were done every 3 months until 1year of treatment.
RESULTS:
The baseline PASI score changed from a mean ± standard deviation of 24.28 ± 14.56 to 1.62 ± 3.11
At the end of 12 months of treatment with a significant difference (P=0.001). Regarding the
reduction in the patients' PASI score: At 3 months of treatment, (71.4%) achieved PASI 50, (48.2%)
had PASI 75, and (5.35%) had PASI 90, at the 12th month of treatment (75.4%) reached PASI 90,
(86.79%) reached PASI 75, &(94.33%) had PASI 50. Side effects were mild and tolerable.
CONCLUSION:
Etanercept is an effective therapy in treating moderate to severe psoriasis with tolerable side effects.

Primary Repair of Unilateral Cleft Lip Nasal Deformity

Zakaria Y.Arajy; Ahmed A.M.Nawres

Iraqi Postgraduate Medical Journal, 2009, Volume 8, Issue 3, Pages 212-219

ABSTRACT:
BACKGROUND:
There is a growing attitude towards correcting the nasal deformity in conjunction with primary repair of cleft lip. Many studies had concluded that this repair will not affect the nasal cartilages growth; it usually reorients the deformed nasal cartilages into a near normal position, and will allow a better growth pattern.
OBJECTIVE:
This study was conducted to document the pattern of primary unilateral cleft lip nasal repair and to evaluate the medium term outcome.
METHODS:
A total of 33 babies with unilateral cleft lip deformities underwent simultaneous nasal correction with their lip closure, between March of 2004 and April of 2008.Through short nostril rim incision, alar suspension to the dorsal skin at the nasion and interdomal sutures were performed primarily. Alar transfixion stitches were used to maintain the new position of the suspended cartilages.
RESULTS:
The average follow up periods were 3 years (ranging from 1 – 5 years).The results were assessed by 4 parameters: Nostril asymmetry, nasal dome projection, alar buckling deformity, and flaring deformity of the alar base. Eleven patients had good results, 16 patients had acceptable results, and 6 patients had poor results.
CONCLUSION:
Alar suspension is a relatively simple effective procedure for the primary correction of cleft lip nasal deformity. Short nostril rim incision can be relied on to access the alar dome and facilitate insertion of suspension sutures. Weather it interferes with nasal growth or not, it is necessary to have a long period of follow up to answer this question.

Indications of IV Fluids in Medical City

Bassam Hameed Al-Jarrah; Zeena Muthafer Al-Nema

Iraqi Postgraduate Medical Journal, 2009, Volume 8, Issue 4, Pages 380-383

ABSTRACT:
BACKGROUND:
Intravenous (IV) fluids are the most commonly used drugs in the inpatient wards and the emergency units. They are not usually dealt with as a medication, and are frequently prescribed even by junior doctors and even the nursing staff. Serious side effects and complication may arise from this practice.
OBJECTIVES:
To evaluate the indications of IV fluid prescription in the Medical City.
METHODS:
A cross-sectional study of the use of IV fluids in surgical wards and emergency units in the Medical city in Baghdad during a period of ten weeks. Two hundreds and ninety three patients were collected. Studying the indication for prescription, monitoring of the patients, combinations and role of pharmacists.
RESULTS:
Most common IV fluid used was glucose water (28.3%). The most common indication in the emergency unit was vomiting and diarrhea (19.1%). While in the inpatient wards, routine postoperative hydration was the commonest indication for IV fluid (13.6%). Unnecessary or wrong uses were recorded in number of cases (36.8). Deficient monitoring of patients on IV fluids was noticed in most cases (95%). No apparent role for the clinical pharmacist in this respect was reported.
CONCLUSION:
There was a quiet high ratio of unnecessary or wrong use of IV fluids and also a high ratio of low or deficient monitoring of patients that necessitate more attention by the specialists and more supervision to the practice of IV fluid prescription.

The Validity of Beck Depression Inventory –Short Version in Depressed Patients Diagnosed According to ICD10

Abdul-Rasoul Al-Yasiri; Yasir S. AbdKarkosh

Iraqi Postgraduate Medical Journal, 2013, Volume 12, Issue 4, Pages 603-613

ABSTRACT:
BACKGROUND :
Beck Depression Inventory (often abbreviated asBDI) is an instrument to measure the severity and depth ofdepression symptoms. BDI was developed in a novel way for its time by collating patients' verbatim descriptions of their symptoms and using these to construct a scale which could reflect the intensity or severity of a givensymptom.
OBJECTIVE:
To measure the validity of Beck depression Inventory short version using ICD 10 criteria for major depression as a gold standard
METHOD AND PATIENTS :
The study was carried out in IbnRushd and Baghdad Teaching Hospitals. The sample was selected purposely among patients diagnosed to have major depressive disorder according to the ICD- 10 criteria for major depressive disorder. For each patient a clinical interview was done using the ICD 10 criteria for major depressive episode after being given beck depression inventory – short version in a paper
RESULTS :
The overall result indicates ‘fair to good’ agreement between both Beck and ICD-10 suggesting that Beck Depression Inventory is valid in assessing the degree of severity of depression
CONCLUSION:
Beck Depression Inventory short version (13 item ) is adequate in assessing the severity of depression in patients with ICD-10 diagnosis of depression

Topical Nitroglycerin in Treatment of Plantar Fasciitis

Qais A. Adi; Sami Salman; JewadIbraheem Resheed

Iraqi Postgraduate Medical Journal, 2013, Volume 12, Issue 0, Pages 751-759

ABSTRACT:
BACKGROUND:
Planter fasciitis is the most common cause of inferior heel pain in adults; it is a degenerative process of the planter fascia at its origin on the calcaneus. Many treatment modalities are used including NSAIDs, orthotics, local steroid injection, extracorporeal shock wave therapy and others. Recent studies have shown that topical nitroglycerin has a healing and analgesic effect in other tendinopathies like: tennis elbow, suraspinatus tendinitis and Achilles tendinitis.
OBJECTIVE:
We want to establish the role of topical nitroglycerin in treatment of plantar fasciitis.
PATIENTS AND METHODS:
A double blind placebo controlled study included 54 patients, after taking medical history they were subjected to physical examination. Nitroderm TTSR 5 patches were used in the treatment group, similar placebo patches were used in the placebo group. The severity of the symptoms was quantified initially for each patient using the visual analogue scale (VAS). By using SPSS (statistical package for social sciences) software for windows, data of all patients were entered and analyzed with appropriate statistical tests according to the types and distribution of variables (Chi square test and Students’t test).
RESULTS:
Response to topical treatment was (76.7%) in the GTN group most of them with moderate and good response compared to (41.7%) in placebo group most of them with mild response.
CONCLUSION:
It was clear that NGT patches were superior to placebo patches in improving the symptoms of patients, so that topical NGT can enhance healing of planter fasciitis. This may be a useful alternative to the current modalities of treatment used for this common

Anaesthesia for Anal Dilatation using Propofol Versus Sevoflurane in Peadiatric Patients

Sanaa Fareed Qassim

Iraqi Postgraduate Medical Journal, 2017, Volume 16, Issue 1, Pages 102-106

ABSTRUCT:
BACKGROUND:
Anal dilatation is streaching of the anal incision gently with special dilators as a part of follow up after posterior sagittal anorectoplasty (PSARP) and pull through operations in peadiatric patients . Sevoflurane has many of the features of an ideal volatile anaesthetic agent with rapid induction which make it particularly useful in children . Propofol is the most desirable intravenous agent in outpatient anaesthesia because of rapid induction and recovery.
OBJECTIVE:
Is to compare propofol with sevoflurane as a single anaesthetic agent for anal dilatation in peadiatric patients that produce more rapid turn over of cases.
Patients and methods: 50 peadiatric patients who had anal dilatation with Hegar dilators allocated into 2 groups according to the anaesthetic agent used sevoflurane (S) or propofol(P) . The variables measured are the induction time(T1) and the time needed to achieve good relaxation(T2).
RESULTS:
T1 was shorter in group P(mean 60 sec)than group S(mean 86 sec)p value0,000(highly significant),T2also shorter in group P(mean 99.5 sec)than group S(mean 121.3 sec)p value0.012(significant) so both variables measured were shorter in case of using propofol with statistical significancy.
CONCLUSION:
Propofol produces more rapid turn over of short cases than sevoflurane and with no risk of malignant hyperthermia.
.

The Value of Diffusion Weighted Magnetic Resonance Imaging in Differentiating Atypical Vertebral Haemangiomas from Metastatic Lesions

Mohammed Abd Kadhim; Thaair A. Kameel Alkhuzaie; Kirmanj Ismaiel Baker

Iraqi Postgraduate Medical Journal, 2016, Volume 15, Issue 3, Pages 272-278

ABSTRACT:
BACKGROUND:
Atypical vertebral hemangioma and metastatic spinal lesions share many MRI signal intensity and
appearance in common ,thats why differentiation between them is crucial. For two decades,
diffusion-weighted imaging (DWI) has been applied to the evaluation of intracranial diseases, but
DWI technical advancement make it possible to apply for assessment of extra cranial sites,
including vertebral column.
OBJECTIVE:
The goal of our study is to assess the value of diffusion weighted MRI imaging in differentiating
vertebral atypical hemangiomas from metastatic lesions.
PATIENTS AND METHODS:
A prospective cross-sectional study was employed at AL-Imammain AL-Khadymain Medical city
in Baghdad health directorate, (43)patients with total (65) vertebral lesions grouped into three
groups Group(A) 10 patients (23.2%)with total (15) lesions of vertebral typical hemangiomas,
Group(B) 13 patients (30.3%) with total ( 13) lesions of vertebral atypical hemangiomas and
Group (C) 20 patients(46.5%) with total ( 37) lesions of spinal vertebral metastases .
MRI was done for all patients (including T1, T2, T1 fat suppression with IV contrast
administration (when needed) and DWI). Complementary non contrast CT was also done.
RESULTS:
Total study sample were (43) patients with total (65) lesions, with (29/43) females and (14/43)
males with male to female ratio of (1:2), their age range from (28-75 years) and their mean age
was (54.2+ 10.1 years). Atypical hemangioma and malignant lesions were generally low signal in
T1 and high or intermediate signal in T2 WI. Restricted diffusion and low ADC values were seen
in atypical hemangioma compared with metastasis with mean ADC value were (1.426+0.231.6x10
-3mm2/s and 0.6182+ 0.137x10-3mm2/s respectively).
Complementary CT confirmed the lytic or sclerotic nature of malignant lesions while in
haemangiomas, it showed their characteristic striated (polka dot) appearance.
CONCLUSION:
Diffusion weighted Magnetic Resonance Imaging is a valuable tool in differentiation of atypical
hemangioma and metastasis of spine with high sensitivity and specificity with the aid of ADC
values calculated from the maps obtained by DWI.
KEYWORDS: diffusion weighted magnetic resonance imaging, atypical haemangiomas,
metastasis.

Publisher: The Iraqi Board for Medical Specializations

Email:  iraqipostgradmedjrnl@gmail.com

Editor-in-chief: Prof. Yasir M.H. Hamandi

Managing Editor: prof. Yasir M.H. Hamandi

Print ISSN: 1608-8360

Online ISSN: 2706-9893

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